Disentangling Within- and Between-Person Effects During Response Inhibition in Obsessive-Compulsive Disorder

Pernille Hagland; Anders Lillevik Thorsen; Olga Therese Ousdal; Rolf Gjestad; Stella J de Wit; Bjarne Hansen; Kristen Hagen; Gerd Kvale; Odile A van den Heuvel

doi:10.3389/fpsyt.2021.519727

Disentangling Within- and Between-Person Effects During Response Inhibition in Obsessive-Compulsive Disorder

Front Psychiatry. 2021 Mar 25:12:519727. doi: 10.3389/fpsyt.2021.519727. eCollection 2021.

Authors

Pernille Hagland^{1

2}, Anders Lillevik Thorsen^{1

2}, Olga Therese Ousdal^{1

3

4}, Rolf Gjestad^{5

6}, Stella J de Wit^{7

8}, Bjarne Hansen^{1

4}, Kristen Hagen^{1

9}, Gerd Kvale^{1

2}, Odile A van den Heuvel^{1

7

8}

Affiliations

¹ Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
² Department of Clinical Psychology, University of Bergen, Bergen, Norway.
³ Department of Radiology, Haukeland University Hospital, Bergen, Norway.
⁴ Center for Crisis Psychology, University of Bergen, Bergen, Norway.
⁵ Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
⁶ Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
⁷ Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
⁸ Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands.
⁹ Psychiatric Department, Hospital of Molde, Molde, Norway.

Abstract

Background: Obsessive-compulsive disorder (OCD) has been related to worse performance, abnormal brain activity, and functional connectivity during response inhibition. Whether these findings are indications of stable traits that contribute to the development of the disorder, or whether they are a result of the state severity of obsessions and anxiety, remains unclear since previous research mainly has employed cross-sectional designs. The present study aimed to assess longitudinal between- and within-person relationships between symptoms, task performance, right inferior frontal gyrus brain activation, and connectivity between the right amygdala and the right pre-supplementary motor area in 29 OCD patients before and after concentrated exposure and response prevention treatment. Method: Patients received exposure and response prevention delivered during 4 consecutive days, following the Bergen 4-day Treatment format. Patients performed a Stop Signal Task during 3T functional Magnetic Resonance Imaging the day before treatment, as well as 1 week and 3 months after treatment completion. Multilevel models were used to analyze disaggregated within- and between-person effects over time. Independent variables were scores on the symptom severity scales for OCD, anxiety, depression, and state distress during scanning. Dependent variables were reaction time for go trials, stop signal response time, task-related brain activation and connectivity. Results: A positive between-person effect was found for obsessive-compulsive, anxiety, and depressive symptom severity on go trial reaction time, indicating that patients with higher symptom scores on average respond slower during accurate go trials. We also found no significant between- or within-person relations between symptom severity and task-related activation or fronto-limbic connectivity. Conclusions: The between-person findings may point toward a general association between slower processing speed and symptom severity in OCD. Longitudinal studies should disaggregate between- and within-person effects to better understand variation over time.

Keywords: Bergen 4-day treatment; functional magnetic resonance imaging; multilevel modeling; obsessive-compulsive disorder; response inhibition; stop signal task.