Neurocircuit Mechanisms of OCD Across the Lifespan

Summary

Obsessive-compulsive disorder (OCD), characterized by intrusive thoughts (obsessions) and related behavioral rituals (compulsions), is a common psychiatric illness that often emerges in childhood and causes life-long disability in over 50% of patients. Psychological theory suggests that OCD symptoms are driven by a person's difficulty disengaging their feelings from simple tasks (e.g. washing hands, locking a door) due to excessive anxiety about performance errors. Cognitive behavioral therapy (CBT), the gold standard treatment for OCD, repeatedly exposes patients to their OCD-stressor until this anxiety is reduced. While CBT is typically more effective in teenagers than adults, patients from both age groups are usually left with residual symptoms, highlighting the need for better treatments. In this study, CBT will be studied in both teen-aged and adult patients. Two groups, both with childhood onset OCD, will be randomized to either CBT for OCD or stress management training (SMT), an active therapy but with minimal effects on OCD symptoms. The investigators will also study age-matched, healthy controls as comparison subjects.

Before and after 12 weeks of CBT, all subjects will undergo functional Magnetic Resonance Imaging (fMRI) scans to see what regions of the brain become active when a concentration task is performed and how that activation is changed after CBT. The purpose of this study is to demonstrate the brain changes associated with CBT treatment and how differences in these changes in teenage compared to adult patients may drive differences in CBT response.

Conditions

• Obsessive-Compulsive Disorder

Interventions

BEHAVIORAL

Cognitive Behavioral Therapy - Adolescents

A therapy which gradually yet repeatedly exposes adolescent patients to their obsessive compulsive-relevant "error" cues during a task performance until their anxiety habituates.

BEHAVIORAL

Stress Management Therapy - Adolescents

An active control therapy with minimal effects on OCD symptoms.

BEHAVIORAL

Optional CBT - Adolescents

This is the cross-over element for those that completed the SMT treatment group and opt to have the OCD treatment.

BEHAVIORAL

Cognitive Behavioral Therapy - Adults

A therapy which gradually yet repeatedly exposes adult patients to their obsessive compulsive-relevant "error" cues during a task performance until their anxiety habituates.

BEHAVIORAL

Stress Management Therapy - Adults

An active control therapy with minimal effects on OCD symptoms.

BEHAVIORAL

Optional CBT - Adults

This is the cross-over element for those that completed the SMT treatment group and opt to have the OCD treatment.

OTHER

fMRI only - Healthy Control Adults

Two fMRI's only, scheduled at 12-weeks apart. This is for Healthy Control Adults and is used only as a means for observation, NOT as an intervention to be studied.

OTHER

fMRI only - Healthy Control Adolescents

Two fMRI's only, scheduled at 12-weeks apart. This is for Healthy Control Adolescents and is used only as a means for observation, NOT as an intervention to be studied.

Sponsors & Collaborators

• National Institute of Mental Health (NIMH)

  collaborator NIH

• University of Michigan

  lead OTHER

Principal Investigators

• Kate Fitzgerald, MD · University of Michigan, Dept of Psychiatry

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

13 Years

Max Age

45 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2015-03-09

Primary Completion

2020-04-13

Completion

2020-10-21

Countries

• United States

Study Locations