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Brain regions related to fear extinction in obsessive-compulsive disorder and its relation to exposure therapy outcome: a morphometric study

Published online by Cambridge University Press:  18 June 2013

M. A. Fullana ,
N. Cardoner ,
P. Alonso ,
M. Subirà ,
C. López-Solà ,
J. Pujol ,
C. Segalàs ,
E. Real ,
M. Bossa  and
E. Zacur
...Show all authors
M. A. Fullana*
Affiliation:
Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar and Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain King's College London, Institute of Psychiatry, London, UK
N. Cardoner
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain CIBERSAM, Carlos III Health Institute, Spain Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
P. Alonso
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain CIBERSAM, Carlos III Health Institute, Spain Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
M. Subirà
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
C. López-Solà
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain CIBERSAM, Carlos III Health Institute, Spain Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
J. Pujol
Affiliation:
CRC Mar, Hospital del Mar, Barcelona, Spain
C. Segalàs
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain CIBERSAM, Carlos III Health Institute, Spain
E. Real
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain CIBERSAM, Carlos III Health Institute, Spain
M. Bossa
Affiliation:
Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
E. Zacur
Affiliation:
Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
I. Martínez-Zalacaín
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
A. Bulbena
Affiliation:
Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar and Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
J. M. Menchón
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain CIBERSAM, Carlos III Health Institute, Spain Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
S. Olmos
Affiliation:
Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
C. Soriano-Mas
Affiliation:
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain CIBERSAM, Carlos III Health Institute, Spain
*
* Address for correspondence: M. A. Fullana, Ph.D., Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, Passeig Marítim, 25/29, 08003 Barcelona, Spain. (Email: Miguel.Fullana@kcl.ac.uk)
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Abstract

Background

The size of particular sub-regions within the ventromedial prefrontal cortex (vmPFC) has been associated with fear extinction in humans. Exposure therapy is a form of extinction learning widely used in the treatment of obsessive-compulsive disorder (OCD). Here we investigated the relationship between morphometric measurements of different sub-regions of the vmPFC and exposure therapy outcome in OCD.

Method

A total of 74 OCD patients and 86 healthy controls underwent magnetic resonance imaging (MRI). Cortical thickness and volumetric measurements were obtained for the rostral anterior cingulate cortex (rACC), the medial orbital frontal cortex and the subcallosal cortex. After MRI acquisition, patients were enrolled in an exposure therapy protocol, and we assessed the relationship between MRI-derived measurements and treatment outcome. Baseline between-group differences for such measurements were also assessed.

Results

Compared with healthy controls, OCD patients showed a thinner left rACC (p = 0.008). Also, left rACC thickness was inversely associated with exposure therapy outcome (r – 0.32, p = 0.008), and this region was significantly thinner in OCD patients who responded to exposure therapy than in those who did not (p = 0.006). Analyses based on regional volumetry did not yield any significant results.

Conclusions

OCD patients showed cortical thickness reductions in the left rACC, and these alterations were related to exposure therapy outcome. The precise characterization of neuroimaging predictors of treatment response derived from the study of the brain areas involved in fear extinction may optimize exposure therapy planning in OCD and other anxiety disorders.

Keywords

Brain morphometryexposure therapyfear extinctionneuroimagingobsessive-compulsive disorder
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 4 , March 2014 , pp. 845 - 856
Copyright
Copyright © Cambridge University Press 2013 

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