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OCD psychotherapy causes brain changes

Thursday, February 14, 2008
By David Douglas

NEW YORK (Reuters Health) - X-ray scans show significant changes in brain activity after 4 weeks of daily counseling for obsessive-compulsive disorder (OCD), according to California-based researchers.

OCD is a type of anxiety disorder in which the patient has recurrent thoughts or obsessions regarding a particular fear, such as their body being dirty. This thought leads them to perform an action to rid them of the anxiety, such as constantly washing their hands.

"Our findings," lead investigator Dr. Sanjaya Saxena told Reuters Health, "highlight the remarkable and rapid benefits of intensive daily (cognitive behavioral therapy) for OCD, even for patients who had not responded well to standard treatment previously."

Cognitive behavioral therapy is a popular form of counseling in which an OCD patient is taught to recognize and address an erroneous thought rather than attempt to directly change the resulting feelings.

"There is no doubt," he added, "that intensive cognitive behavioral therapy should be the treatment of choice" for patients with OCD that has not responded to standard treatments.

In the journal Molecular Psychiatry, Saxena of the University of California, San Diego and colleagues note that intensive cognitive behavioral therapy can produce significant improvement in OCD in as little as 4 weeks and its effectiveness is well established.

To see whether changes in brain activity could be documented after such a brief period of therapy, the researchers conducted special PET scans of 10 patients before and after 4 weeks of cognitive behavioral therapy. Scans were also made several weeks apart in 12 normal, untreated comparison subjects.

Cognitive behavioral therapy consisted of 90-minute individual sessions, 5 days a week, plus 4 hours of homework daily.

Patients treated with cognitive behavioral therapy noted marked improvements in their symptoms and the therapy seemed to alter the way chemicals were processed in a number of key brain regions, the report indicates.

"Our results should encourage many more clinicians to provide intensive cognitive behavioral therapy, which is not widely available at present," Saxena commented.

"They should also spur health insurance companies and other third-party payers to cover intensive cognitive behavioral therapy -- most currently don't -- because it is highly effective in such a short time, and it clearly has neurobiological effects," he added.

SOURCE: Molecular Psychiatry, January 17, 2008 online.
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