New Study Suggests Best Therapy for Kids and Teens with Obsessive-Compulsive Disorder

New research could lead to more personalized therapy for obsessive-compulsive disorder (OCD), something that eludes more than one-third of those who currently get OCD treatment.

The study, published in the journal American Journal of Psychiatry, was performed at the University of Michigan, which could predict the type of therapy best for those with OCD.

They tested their subjects in two types of therapy either in exposing them to the subject of their obsessive thoughts and compulsive behaviors, or the one that focuses on reducing the stressful event using a problem-solving approach.

The researchers plan to conduct more tests and studies if it could also be applicable for children with OCD.

Exposure Therapy vs. Stress-Management Therapy (SMT)

In the study, the researchers examined the brain scans of 87 teens and adults with moderate to severe OCD who were randomly assigned either the exposure therapy or the stress-management therapy (SMT) for 12 weeks.

They found that both therapies reduced symptoms of OCD, but exposure therapy was more effective and was able to reduce more symptoms over time than stress-management therapy.

But upon checking the brain scans taken before the participants began their therapy, while they performed a simple cognitive task and responded to a small monetary reward, and link them to personal treatment response, hey found a striking pattern.

It showed that those with more brain circuit activation for processing cognitive tasks and rewards are more likely to respond to CBT, while those who have lesser brain circuit activation at the start responded more to SMT.

That means that exposure therapy was better at relieving OCD symptoms. The brain scans suggest that certain areas in the brain were linked to a greater chance of responding to a CBT type of therapy like exposure therapy.

Brain Regions Involved in the Therapy

Experts believe that identifying certain brain regions are important in treating OCD. The emergence of the transcranial magnetic stimulation has targeted these brain regions to address the symptoms of OCD.

Specifically speaking, strong activity was detected in the brain circuit known as cinguloopercular network associated with a cognitive task, as well as the orbitostriato-thalamic network associated with reward were both linked to a better response to the exposure therapy. However, lower activity in these regions is linked to better respond to stress-reduction therapy.

Furthermore, the rostral anterior cingulate cortex (rACC) tend to respond more to CBT treatment. Previous studies have proven that people with OCD tend to have lesser activation in that area when performing cognitive control tasks.

Personalizing the Choice of Therapy

The study aims to suggest personalized therapy for OCD patients by doing brain scans, an impractical way, using everyday tests that will measure the characteristics that might predict better success.

Pediatric OCD specialist at Michigan Medicine, Dr. Kate Fitzgerald, recommended that those OCD patients with high cognitive control and reward responsiveness should be treated with CBT. At the same time, those who would benefit the most in relaxing and using problem-solving methods in improving their response to the stressor should undergo SMT.

The researchers noted that their study shows that different brains react to different treatments and that this knowledge can be used in moving toward having more personalized therapy for OCD patients.

There is a good chance of helping children and teens improve their brains' control functions since they are still maturing.