AUTHOR=Karch Susanne , Maywald Maximilian , Schwartz Caroline , Heil Clara , Neumüller Jakob , Keeser Daniel , Garcia Sarah , Tschentscher Nadja , Pogarell Oliver , Paolini Marco , Voderholzer Ulrich 

TITLE=Neuronal correlates of intensification and acceptance of symptoms during exposure therapy in patients with obsessive-compulsive disorder

JOURNAL=Frontiers in Psychology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1256046

DOI=10.3389/fpsyg.2024.1256046

ISSN=1664-1078

ABSTRACT=Introduction: Cognitive behaviour therapy with exposure and response prevention is efficient in treating patients with obsessive-compulsive disorder (OCD). Nevertheless, it would be helpful for many patients to complement the therapeutic treatment with acceptance strategies (ACS) to further increase the therapeutic benefit. The aim of the present study was to examine neurobiological responses to ACS and intensification strategys (INS) during symptom provocation alongside the psychotherapeutic process. Method: A total of 23 patients diagnosed with OCD (washing/contamination fear) was instructed to utilize either an ACS or an INS to cope with their emotional and cognitive reactions to personalized symptom-triggering and neutral pictures. Fourteen patients participated twice: at the beginning [T1] and at the end [T2] of an inpatient multimodal treatment including cognitive behaviour therapy with response prevention to assess functional variations. Results: For the contrast of T1vsT2, ACS showed increased brain activity in the left inferior frontal gyrus (IFG), left caudate body (CB), and posterior cingulate gyrus (PCC). They also showed decreased activity in the left anterior insula. INS showed decreased activation in right lingual gyrus and right CB. At T2, ACS showed increased activation compared to INS in the left cerebrum: IFG, CB, middle and superior temporal gyrus, and PCC. For the comparison of T1vsT2, the ACS revealed increased brain activity in the left IFG, left caudate body, and right inferior parietal lobe. It showed decreased activity in the left anterior insula. The INS revealed decreased activity in right lingual gyrus and right caudate body.The psychometric questionnaires suggested that patients were able to reduce obsession, compulsion, and depression symptoms. Furthermore, patients rated the ACS as more useful for themselves compared with the INS.The increased left IFG activity using ACS (T1vsT2) could be interpreted as a better inhibitory top-down process, while the increased PCC response might be due to a better reappraisal strategy after therapy. ACS seems to mobilise neuronal activations under therapy, especially in the left hemisphere. Both strategies showed reductions in emotional networks as a neuronal correlate of therapy success. Overall, ACS may be more efficient than INS, as rated by the patients and as in accordance with neurobiological findings.