Reshaping the OCD Brain: How Therapy Alters Neural Connectivity

Summary: A new study reveals that exposure and response prevention (EX/RP), a primary therapy for obsessive-compulsive disorder (OCD), effectively reshapes brain connectivity. This therapy enhances cognitive control by strengthening connections within key neural networks.

Using advanced MRI techniques, researchers observed significant changes in the frontoparietal, cingulo-opercular, and default mode networks among OCD patients who underwent EX/RP compared to those who received stress management training. These findings illuminate the neurological underpinnings of EX/RP’s effectiveness in treating OCD.

Key Facts:

  1. EX/RP therapy improves brain function in OCD patients by enhancing connectivity in three critical cognitive control networks.
  2. The study used sophisticated MRI analysis to demonstrate patient-specific brain changes post-EX/RP therapy, a novel insight into OCD treatment.
  3. Ongoing research includes using cognitive training video games to further enhance EX/RP therapy outcomes for OCD patients.

Source: Elsevier

A first-line therapy for obsessive-compulsive disorder (OCD) reshapes connectivity of the brain, according to a new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.

OCD is an anxiety disorder characterized by repetitive thoughts and behaviors that can be disruptive and even disabling. The first-line treatment for OCD, a form of cognitive-behavioral therapy called exposure and response prevention (EX/RP), is effective for many people with OCD, but how it works has remained unclear.

This shows a person washing their hands.
After treatment, OCD participants who received EX/RP displayed strengthened connectivity between the cognitive control networks that was not seen in participants who had stress management. Credit: Neuroscience News

This new study shows that EX/RP training reshapes brain activity for better cognitive control.

In people with OCD, functional brain activity is affected in three neural networks that participate in cognitive control. The networks are the frontoparietal network (FPN), the cingulo-opercular network (CON), and the default mode network (DMN).

For the new study, 111 adolescents and adults with OCD received either EX/RP, which is designed to build coping skills for a patient through gradual exposure, or stress management training as a control treatment. Then, participants underwent magnetic resonance imaging (MRI) while performing a cognitive task.

After treatment, OCD participants who received EX/RP displayed strengthened connectivity between the cognitive control networks that was not seen in participants who had stress management.

Senior author Kate Fitzgerald, MD, at Columbia University, said the study “is important because it shows how EX/RP improves brain function to treat OCD. Specifically, EX/RP improved connectivity of brain circuits underlying cognitive control, the ability to adjust the repetitive thoughts and behaviors.”

Leveraging the expertise of co-author Adriene Beltz, PhD, at the University of Michigan, the researchers used a sophisticated new analysis technique. Dr. Fitzgerald explained, “This allowed us to ‘see’ patient-specific brain changes with EX/RP that we were not able to uncover previously when using an older type of analysis that averages out brain differences between patients.”

In an upcoming study, Dr. Fitzgerald is using a cognitive training video game to exercise brain circuits for cognitive control before patients even begin EX/RP therapy. “We hope this pre-therapy training will exercise the brain to help children respond more fully to EX/RP so they can overcome OCD.”

Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, said of the work, “This study provides an important and clear example of how our increasing understanding of the functional organization of brain circuits can be harnessed to develop highly targeted therapies and to measure their impact both on the distressing symptoms of having OCD as well as the underlying brain circuits affected by the disorder.”

About this OCD and neuroscience research news

Author: Eileen Leahy
Source: Elsevier
Contact: Eileen Leahy – Elsevier
Image: The image is credited to Neuroscience News

Original Research: Open access.
Changes in Brain Network Connections after Exposure and Response Prevention Therapy for OCD in Adolescents and Adults” by Kate D. Fitzgerald et al. Biological Psychiatry Cognitive Neuroscience and Neuroimaging


Changes in Brain Network Connections after Exposure and Response Prevention Therapy for OCD in Adolescents and Adults


Functional alterations of tripartite neural networks during cognitive control (i.e., frontoparietal network [FPN], cingulo-opercular network [CON], and default mode network [DMN]) occur in patients with obsessive-compulsive disorder (OCD), and may contribute to illness expression.

However, the degree to which changes in these networks are elicited by gold standard treatment (e.g., exposure and response prevention; EX/RP) remains unknown. Understanding how EX/RP modulates network connectivity in adolescent versus adult patients with OCD may aid the identification of developmentally-sensitive treatment targets that enhance cognitive control.


A total of 169 adolescent (13-17 years) and adult (25-40 years; 57% female) patients with OCD (n=111) and healthy controls (HC; n=58) were randomized to either EX/RP or an active control therapy (stress management training; SMT). Participants performed a flanker task during functional magnetic resonance imaging (fMRI) pre- and post-treatment. To retain sensitivity to individual differences in connectivity, Group Iterative Multiple Model Estimation (GIMME) was used to assess functional connectivity (i.e. density) within and between brain networks.


Significant increases in FPN density and decreases in FPN-DMN density were observed from pre- to post-treatment in patients who received EX/RP. The opposite patterns of change occurred in those who received SMT. These treatment-related changes in network density did not differ across age group.


Results suggest EX/RP-specific changes in task-based connectivity in patients with OCD. Given baseline differences between HC and patients by age group, these treatment-related changes may indicate restoration of healthy FPN and DMN development across patients, providing targets for improving response to EX/RP.

Join our Newsletter
I agree to have my personal information transferred to AWeber for Neuroscience Newsletter ( more information )
Sign up to receive our recent neuroscience headlines and summaries sent to your email once a day, totally free.
We hate spam and only use your email to contact you about newsletters. You can cancel your subscription any time.