Researchers at the Yale School of Medicine studying obsessive-compulsive disorder are moving closer to personalizing treatments to individuals’ brains.
The researchers are the first to use functional Magnetic Resonance Imaging to predict whether neurofeedback — a technique in which patients are shown a real-time graph of their brain activity while they experiment with various treatment techniques — will work for certain patients. Using 13 patients, researchers found that individuals with a stronger connection between the orbitofrontal cortex, a region responsible for decision making that also becomes hyperactive when people become abnormally anxious about dirt and grime, and the rest of the brain respond better to neurofeedback.
“Some people will have a certain brain pattern and respond to certain types of treatment, while others will have a different brain pattern and respond to different types of treatment,” senior author and assistant professor of diagnostic radiology at the Yale School of Medicine Michelle Hampson said.
Researchers used fMRI technology to measure the brain activity of different regions of patients’ brains while they lied in a resting state with their eyes open and mind relaxed, free of specific thoughts. Afterwards, researchers compared the activity of various brain regions to see which were most connected with each other — similar activity patterns indicated higher connectivity. The OFCs of patients who showed the most improvement after neurofeedback had stronger connections with more regions of the brain than the OFCs of those who responded less successfully to neurofeedback.
Patients undergoing the treatment are first taught a variety of techniques like deep breathing and mindfulness, the latter of which consists of acknowledging and accepting OCD-aggravating stimuli like uncleanliness. Researchers then show patients images of filthy and unkempt objects such as mud or dirty toilet seats, along with a graph of a patient’s activity in the OFC. Techniques that lower OFC activity are then identified as those most effective for an individual patient. Patients are then given a quantitative measurement to confirm if a method works and do not have to rely on feelings or qualitative measures.
“[Neurofeedback] gives you something very concrete and you can know what works for sure,” said Christopher Pittenger ’94 GRD ’94, a study author and director of the Yale OCD Research Clinic. “You want to try random stuff, and if you hit on something that happens to work, you can practice it.”
Because scientists do not know exactly how connections in the brain are related to OCD, they cannot know ahead of time what will work for individual patients. What is more, over the course of months, the accumulation of trial and error treatments can become very expensive.
This latest study offers hope that doctors will one day be able to immediately point their patients to specific treatments.
“The main implication of this current study is that we always want to try to put someone in the best treatment for them,” said Dustin Scheinost, a postdoctoral fellow in diagnostic radiology and one of the study’s authors. “If we can guide someone from one treatment to the other it can reduce cost.”
However, the uses of fMRI technology to predict optimal treatment and neurofeedback as a treatment of OCD are still in their early stages, and scientists will have to carry out years of additional studies before they become widely used. A 2008 study conducted by Patric Hagmann from the University of Lausanne suggests that the prediction of resting state connectivity in the brain using fMRI — which the researchers relied on to predict which patients would most successfully respond to neurofeedback — is “constrained by the large-scale anatomical structure of the human cerebral cortex.”
Similarly, the Yale study also acknowledged that there is very little evidence to suggest that neurofeedback permanently improves OCD symptoms.
The next step for the Yale scientists on this project will be conducting clinical trials on a larger population of patients with OCD. Researchers were only able to run tests on three OCD patients because they are often hesitant to participate in studies that will trigger OCD symptoms.
The majority of participants in the study were not clinically diagnosed with OCD, but rather with strong contamination anxiety — a common symptom of OCD — which has effects on the brain similar to those of OCD.
According to the Anxiety and Depression Association of America, around 1 percent of Americans suffer from OCD.