Using electronically delivered therapy and brain imaging to understand OCD pathology: A pilot feasibility study

Callum Stephenson; Niloufar Malakouti; Joseph Y Nashed; Tim Salomons; Douglas J Cook; Roumen Milev; Nazanin Alavi

doi:10.3389/fpsyt.2023.1050530

Using electronically delivered therapy and brain imaging to understand OCD pathology: A pilot feasibility study

Front Psychiatry. 2023 Mar 9:14:1050530. doi: 10.3389/fpsyt.2023.1050530. eCollection 2023.

Authors

Callum Stephenson^{1

2}, Niloufar Malakouti², Joseph Y Nashed³, Tim Salomons⁴, Douglas J Cook⁵, Roumen Milev^{1

2

6}, Nazanin Alavi^{1

2}

Affiliations

¹ Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
² Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
³ Department of Medicine, School of Medicine, Queen's University, Kingston, ON, Canada.
⁴ Department of Psychology, Faculty of Arts and Sciences, Queen's University, Kingston, ON, Canada.
⁵ Neurosurgery Division, Department of Surgery, School of Medicine, Queen's University, Kingston, ON, Canada.
⁶ Department of Psychiatry, Providence Care Hospital, Kingston, ON, Canada.

Abstract

Background: Obsessive-compulsive disorder (OCD) is a debilitating mental health disorder with current psychotherapeutic treatments, while somewhat effective, yielding low accessibility and scalability. A lack of knowledge regarding the neural pathology of OCD may be hindering the development of innovative treatments. Previous research has observed baseline brain activation patterns in OCD patients, elucidating some understanding of the implications. However, by using neuroimaging to observe the effects of treatment on brain activation, a more complete picture of OCD can be drawn. Currently, the gold standard treatment is cognitive behavioral therapy (CBT). However, CBT is often inaccessible, time-consuming, and costly. Fortunately, it can be effectively delivered electronically (e-CBT).

Objectives: This pilot study implemented an e-CBT program for OCD and observed its effects on cortical activation levels during a symptom provocation task. It was hypothesized that abnormal activations could be attenuated following treatment.

Methods: OCD patients completed a 16-week e-CBT program administered through an online platform, mirroring in-person content. Treatment efficacy was evaluated using behavioral questionnaires and neuroimaging. Activation levels were assessed at the resting state and during the symptom provocation task.

Results: In this pilot, seven participants completed the program, with significant improvements (p < 0.05) observed between baseline and post-treatment for symptom severity and levels of functioning. No statistically significant (p = 0.07) improvement was observed in the quality of life. Participants had mostly positive qualitative feedback, citing accessibility benefits, comprehensive formatting, and relatable content. No significant changes in cortical activation were observed between baseline and post-treatment.

Conclusion: This project sheds light on the application of e-CBT as a tool to evaluate the effects of treatment on cortical activation, setting the stage for a larger-scale study. The program showed great promise in feasibility and effectiveness. While there were no significant findings regarding changes in cortical activation, the trends were in agreeance with previous literature, suggesting future work could provide insight into whether e-CBT offers comparable cortical effects to in-person psychotherapy. Applying a greater knowledge of the neural mechanisms of action in OCD can help develop novel treatment plans in the future.

Keywords: cognitive behavioral therapy; exposure response prevention; neural pathology; neuroimaging; obsessive–compulsive disorder; psychotherapy.