Discontinuous patterns of brain activation in the psychotherapy process of obsessive-compulsive disorder: converging results from repeated FMRI and daily self-reports

PLoS One. 2013 Aug 15;8(8):e71863. doi: 10.1371/journal.pone.0071863. eCollection 2013.

Abstract

This study investigates neuronal activation patterns during the psychotherapeutic process, assuming that change dynamics undergo critical instabilities and discontinuous transitions. An internet-based system was used to collect daily self-assessments during inpatient therapies. A dynamic complexity measure was applied to the resulting time series. Critical phases of the change process were indicated by the maxima of the varying complexity. Repeated functional magnetic resonance imaging (fMRI) measurements were conducted over the course of the therapy. The study was realized with 9 patients suffering from obsessive-compulsive disorder (subtype: washing/contamination fear) and 9 matched healthy controls. For symptom-provocative stimulation individualized pictures from patients' personal environments were used. The neuronal responses to these disease-specific pictures were compared to the responses during standardized disgust-provoking and neutral pictures. Considerably larger neuronal changes in therapy-relevant brain areas (cingulate cortex/supplementary motor cortex, bilateral dorsolateral prefrontal cortex, bilateral insula, bilateral parietal cortex, cuneus) were observed during critical phases (order transitions), as compared to non-critical phases, and also compared to healthy controls. The data indicate that non-stationary changes play a crucial role in the psychotherapeutic process supporting self-organization and complexity models of therapeutic change.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Case-Control Studies
  • Cerebral Cortex / physiopathology*
  • Cognitive Behavioral Therapy
  • Female
  • Functional Neuroimaging
  • Humans
  • Implosive Therapy
  • Magnetic Resonance Imaging
  • Male
  • Obsessive-Compulsive Disorder / physiopathology
  • Obsessive-Compulsive Disorder / therapy*
  • Psychotherapy
  • Self Report
  • Treatment Outcome
  • Young Adult

Grant support

This study was supported by the Austrian National Bank, Grant No. 11931; the German Society of Systemic and Family Therapy, and the German Systemic Society. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.