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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychol. | doi: 10.3389/fpsyg.2019.02294

Effective Deep Brain Stimulation for Obsessive-Compulsive Disorder Requires Clinical Expertise

  • 1Amsterdam UMC, AMC, Department of Psychiatry, Netherlands
  • 2Institute for Logic, Language and Computation, University of Amsterdam,, Netherlands
  • 3University of Twente, Department of Philosophy, Netherlands
  • 4Amsterdam Brain and Cognition, University of Amsterdam, Netherlands
  • 5Amstedam UMC, AMC, Department of Psychiatry, Netherlands
  • 6Netherlands Institute for Neurosciences, an Institute of the Royal Dutch Academy of Arts and Sciences, Netherlands

Background.
Deep Brain Stimulation (DBS) is an innovative treatment for severe Obsessive-Compulsive Disorder (OCD). Electrodes implanted in specific brain areas allow clinicians to directly modulate neural activity. DBS affects symptomatology in a completely different way than established forms of treatment for OCD, such as psychotherapy or medication.
Objective.
To understand the process of improvement with DBS in patients with severe OCD.
Methods.
By means of open-ended interviews and participant observation we explore how expert clinicians involved in the post-operative process of DBS optimization evaluate DBS effects.
Results.
Evaluating DBS effect is an interactive and context-sensitive process which gradually unfolds over time and requires integration of different sources of knowledge. Clinicians direct DBS optimization towards a critical point where they sense that patients are being moved with regard to behaviour, emotion, and active engagement, opening up possibilities for additional Cognitive Behavioural Therapy (CBT).
Discussion.
Based on the theoretical framework of Radical Embodied Cognitive Science, we assume that clinical expertise manifests itself in the pattern of interaction between patient and clinician. To the expert clinician, this pattern reflects the patient’s openness to possibilities for action (‘affordances’) offered by their environment. OCD patients’ improvement with DBS can be understood as a change in openness to their environment. The threshold for patients to engage in activities is decreased and a broader range of daily life and therapeutic activities becomes attractive. Movement is improvement.

Keywords: Obsessive - compulsive disorder, Deep Brain Stimulation, Clinical expertise, Evaluation, Decision - making, radical embodied cognitive science

Received: 30 Apr 2019; Accepted: 24 Sep 2019.

Copyright: © 2019 van Westen, Rietveld and Denys. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD. Maarten van Westen, Amsterdam UMC, AMC, Department of Psychiatry, Amsterdam, Netherlands, m.vanwesten@amc.nl