Zhang ZF, He Y, Su YQ, Liu JM. Decreased inter- and intra-network connectivity after group cognitive behavioral therapy in patients with unmedicated obsessive-compulsive disorder. World J Psychiatry 2025; 15(8): 107860 [DOI: 10.5498/wjp.v15.i8.107860]
Corresponding Author of This Article
Ji-Meng Liu, MD, Chief Physician, Department of Psychiatry, The Affiliated Kangning Hospital of Ningbo University, No. 1 Zhuangyu South Road, Zhuangshi Sub-District, Ningbo 315201, Zhejiang Province, China. 13216645323@163.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zong-Feng Zhang, Yan He, Yu-Qiu Su, Ji-Meng Liu, Department of Psychiatry, The Affiliated Kangning Hospital of Ningbo University, Ningbo 315201, Zhejiang Province, China
Zong-Feng Zhang, Yan He, Yu-Qiu Su, Ji-Meng Liu, Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
Author contributions: Zhang ZF and He Y contributed to data analysis and manuscript drafting; Liu JM was responsible for research design and overall supervision; and Su YQ conducted the research implementation and sample evaluations; All authors advised upon, edited, and reviewed the manuscript.
Supported by the Pharmaceutical Science and Technology Project of Zhejiang Province, No. 2023RC266; and the Natural Science Foundation of Ningbo, No. 202003N4266.
Institutional review board statement: The study was approved by the Ethics Committee of the Affiliated Kangning Hospital of Ningbo University (NBKNYY-2021-LC-5).
Informed consent statement: All participants were signed informed consent forms.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The datasets utilized and examined in this investigation are available from the corresponding author upon reasonable request at 13216645323@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Meng Liu, MD, Chief Physician, Department of Psychiatry, The Affiliated Kangning Hospital of Ningbo University, No. 1 Zhuangyu South Road, Zhuangshi Sub-District, Ningbo 315201, Zhejiang Province, China. 13216645323@163.com
Received: April 22, 2025 Revised: May 20, 2025 Accepted: June 13, 2025 Published online: August 19, 2025 Processing time: 108 Days and 1.4 Hours
Abstract
BACKGROUND
Group cognitive behavioral therapy (GCBT) is increasingly being used to treat obsessive-compulsive disorder (OCD) because of its high efficiency, economy, and interaction among group members. However, the changes in network functional connectivity (FC) in patients with OCD with GCBT remain unclear.
AIM
To investigate inter- and intra-network resting-state FC (rs-FC) abnormalities before and after GCBT in unmedicated patients with OCD and validate the efficacy of GCBT.
METHODS
Overall, 33 individuals with OCD and 26 healthy controls underwent resting-state functional magnetic resonance imaging. The patients were rescanned 12 weeks after GCBT. Four cognition-related networks-default mode network (DMN), dorsal attention network (DAN), salience network (SAN), and frontoparietal network (FPN)-were selected to examine FC abnormalities within and between OCD networks before and after GCBT. Neuropsychological assessments including memory, executive function, speech, attention, and visuospatial ability were reassessed following GCBT. Pearson’s correlations were used to analyze the relationship between aberrant FC in cognition-related networks and altered neuropsychological assessments in patients.
RESULTS
Rs-FC within the DMN and DAN decreased significantly. Additionally, rs-FC between the DMN-DAN, DMN-FPN, DMN-SAN, and DAN-SAN also decreased. Significant improvements were observed in cognitive functions, such as memory, executive function, attention, and visuospatial ability. Furthermore, reduced rs-FC within the DMN correlated with visuospatial ability and executive function; DAN positively correlated with Shape Trails Test (STT)-A test elapsed time; DMN-DAN negatively correlated with Rey-Osterrieth Complex Figure (Rey-O) mimicry time and the three elapsed times of the tower of Hanoi; DMN-SAN negatively correlated with Rey-O imitation time and positively correlated with STT-A test elapsed time; and DMN-FPN negatively correlated with Auditory Word Learning Test N1 and N4 scores.
CONCLUSION
Decreased rs-FC within the DMN and DAN, which correlated with executive function post-treatment, has potential as a neuroimaging marker to predict treatment response to GCBT in patients with OCD.
Core Tip: This study demonstrated that group cognitive behavioral therapy (GCBT) reduced resting-state functional connectivity (rs-FC) within and between the default mode (DMN) and dorsal attention networks (DAN) in patients with unmedicated obsessive-compulsive disorder (OCD). These connectivity changes correlated with improved executive function, memory, and visuospatial abilities, suggesting reduced DMN/DAN rs-FC as a potential neuroimaging marker for predicting GCBT efficacy in OCD treatment.
Citation: Zhang ZF, He Y, Su YQ, Liu JM. Decreased inter- and intra-network connectivity after group cognitive behavioral therapy in patients with unmedicated obsessive-compulsive disorder. World J Psychiatry 2025; 15(8): 107860
Obsessive-compulsive disorder (OCD) is a chronic and refractory disease characterized by intrusive thinking and repetitive behaviors, often accompanied by anxiety and depression, which severely affects social function and quality of life. Previous studies have demonstrated that cognitive-behavioral therapy (CBT) is as effective as pharmacotherapy in patients with OCD[1-3]. One meta-analysis suggested that group CBT (GCBT) may be effective in relieving OCD symptoms[4] in the long term[5]. Other studies have suggested that CBT elicits improvements in clinical symptoms by altering cognitive function[6,7]; however, the results have been inconsistent.
Recently, studies have documented abnormal functional connectivity (FC) in the prefrontostriatothalamo-cortical loop[8], with increasing evidence indicating altered network connectivity in OCD[9,10]. Based on convergent evidence from multiple studies, three networks-the default mode (DMN), frontoparietal (FPN), and salience (SAN)-are considered canonical[11,12]. The dorsal attention network (DAN) also exhibits increased FC with the FPN[10], explained by their interactive role in most cognitive functions. Abnormal functional organization of these networks and dynamic cross-network communication may underlie a wide range of psychiatric symptoms. The DMN comprises the bilateral medial prefrontal cortex (mPFC), superior frontal gyrus, inferior frontal gyrus, posterior cingulate, temporal lobe, and subparietal lobules. Furthermore, it is often defined as a task-negative activation network, as its primary functions include maintaining alertness, consolidating memories, monitoring surroundings, and self-reflection[13]. The DAN, which includes the dorsolateral prefrontal lobe, frontal eye fields, and precentral, supraoccipital, middle temporal, and supraparietal gyri, is associated with attentional function and provides top-down attentional orienting and sustained activity to ensure task completion[14]. The FPN is associated with goal-directed cognitive functions and includes the lateral prefrontal cortex, precuneus, anterior subparietal sulcus, medial-superior prefrontal cortex, and anterior insula[15]. Finally, the SAN comprises the anterior cingulate gyrus and anterior insula and is involved in executive functions, such as planning and decision-making[16].
CBT and GCBT are considered the first-line treatments for OCD. Few functional neuroimaging studies have examined the potential neurobiological mechanisms and predictors of CBT response in patients with OCD and have found associations with frontostriatal circuitry or independent component networks[10,17-20]. A previous study reported that CBT normalized the aberrant resting-state FC (rs-FC) between the right orbitofrontal cortex and the left dorsolateral prefrontal cortex[17]. Another study showed that rs-FC within the DMN and visual network predicted the severity of OCD symptoms after CBT[18]. Greater pretreatment activation has also been reported within the right temporal lobe and rostral anterior cingulate cortex during cognitive control tasks, as well as within the ventromedial and lateral prefrontal cortices, orbitofrontal cortex, and amygdala during reward processing in patients with OCD[19]. Meanwhile, global network clustering coefficients and nodal clustering of the precuneus as well as the left lingual, middle temporal, and fusiform gyri, have been reported after CBT[21]; however, relatively few studies have focused on the effects of GCBT on FC in patients with OCD. The present study reported significantly decreased rs-FC within the DMN and DAN, and between the DMN-DAN, DMN-FPN, DMN-SAN, and DAN-SAN after GCBT.
Patients with OCD have been reported to have memory, attention, and executive function dysfunctions[22], which can be improved with CBT[23-25]. Additional difficulties include persistent cognitive inhibition and motor responses, difficulty in shifting attention from one aspect of a stimulus to another, impaired executive planning and decision-making, difficulty in forming words in a limited amount of time, and reduced capacity to recall verbal information[26,27]. One study applied the Connectivity Test, Verbal/Nonverbal Fluency and Flexibility Test, Tower of London, Complex Images Test, and Conversion Test and found significant improvements after CBT, suggesting that CBT can improve thinking and cognitive flexibility and help patients implement more effective cognitive strategies[23]. Cognition-related network abnormalities that align with changes in cognitive functioning can provide clearer insights into the underlying mechanisms of CBT efficacy in patients with OCD.
In this study, we aimed to assess unmedicated patients with OCD who underwent 12 weeks of GCBT. Four seed networks (i.e., DMN, DAN, SAN, and FPN) were used to investigate inter- and intra-network FC abnormalities before and after GCBT, and neuropsychological assessments (i.e., attention, memory, executive functioning, speech, and verbal fluency) were conducted to validate the mechanisms underlying the efficacy of GCBT.
MATERIALS AND METHODS
Participants
Overall, 33 patients with OCD were recruited from an outpatient service, and 26 healthy controls were recruited through local advertisements from January 2022 to December 2023. All the participants were right-handed, aged 18-54 years, and had completed at least junior high school education or higher. Patients with OCD did not take psychotropic medications for at least 8 weeks. All patients were diagnosed by a trained psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria and screened using the Mini-International Neuropsychiatric Interview to exclude other psychiatric disorders. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess symptom severity, and the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to assess anxiety and depression symptoms, respectively (Table 1). Exclusion criteria were as follows: (1) Diagnosis of pulmonary, cardiac, hepatic, neurological, endocrine, or metabolic disorders; (2) Current or past DSM-5 Axis I psychiatric disorders, other than OCD; (3) Severe suicidal ideation; and (4) Contraindications for magnetic resonance imaging (MRI), such as an implanted metal device. All participants provided written informed consent. The study protocol was approved by the Ethics Committee of the Affiliated Kangning Hospital of Ningbo University (No. NBKNYY-2021-LC-5).
Table 1 Comparison of general demographic information between groups.
A series of neuropsychological assessments were conducted in the present study, including the Montreal Cognitive Assessment-Based Scale (MoCA-B), Auditory Verbal Learning Test (AVLT), Verbal Fluency Test, Digit Span Test, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), Complex Figure Test, Trail Making Test, Stroop Color Word Test, California Card Sorting Test (CST), and the Tower of Hanoi. The assessments lasted approximately 45 minutes and were administered at baseline and after 12 weeks of treatment. Detailed descriptions of the neuropsychological assessments are provided in the online Supplementary material.
Functional MRI acquisition and preprocessing
Patients with OCD underwent functional MRI (fMRI) both before and after the treatment. The total scanning time was approximately 30 minutes and included both 3D-T1 (structural images) and resting-state (rs) fMRI scanning. A simultaneous multilayer scanning technique (multiband accel factor) and echo-planar imaging sequence were used to scan parallel to the anteroposterior joint line plane simultaneously. The scanning parameters were as follows: Echo time of 30 millisecond, repetition time of 2000 millisecond, field of view of 220 mm2, flip angle of 90°, automatic matrix coil mode, 4 mm layer thickness, 30 layers, 180 passes, and scanning time of 8 minutes and 30 seconds. The general preprocessing procedure was as follows: First, the first 10 time points of each participant’s rs fMRI data were excluded to allow participants to get used to the fMRI scanning noise. Second, the slices were timed to correct for differences in the acquisition time. Third, realignment was conducted to exclude participants with head translations of > 2 mm or rotations of > 2°. Fourth, spatial normalization was applied to align all selected participants to the standard Montreal Neurological Institute template with a sampling resolution of 3 mm × 3 mm × 3 mm. Finally, detrending was performed to reduce the signal drift caused by the banding of the receiver coil during scanning. Finally, a band-pass filter of 0.01-0.08 Hz was applied to remove interference from physiological noise signals and data were smoothed using a Gaussian kernel of 6 mm full width at half-maximum.
Group cognitive behavioral therapy
The study was conducted by two registered psychotherapists who had undergone systematic professional training and formed a homogeneous closed group with live recordings. Each group consisted of 6-10 participants, and the treatment was conducted for 12 weeks, with each session being conducted once per week for 2 hours. Before treatment, the psychotherapist conducted one pre-treatment interview with each participant to exclude patients who were not suitable for GCBT (e.g., poor introspection and severe symptoms of depression and anxiety). The first three sessions were to introduce participants to each other; re-emphasize the treatment setup, treatment process, and concept of group therapy; re-introduce the concept of OCD and explain the concepts of “obsessive-compulsive thoughts” and “obsessive-compulsive behaviors” and the relationship between the two; discussion of the principles of graded exposure development; and assign homework. The next 4-10 sessions involved practice exposures within the group, while the final 11-12 sessions included feedback and summarization. The details of the treatment protocols are provided in the online Supplementary material.
Cognition-related brain networks
The DMN, DAN, FPN, and SAN were selected as the networks of interest, with 12 seeds regions selected based on a previous study[8] (Table 2).
Table 2 Seed points of the default mode, dorsal attention, frontoparietal, and salience networks.
Abbreviation
X (L/R)
Y (L/R)
Z (L/R)
DMN
Dorsal medial prefrontal cortex
dmPFC
-8
50
34
Ventral medial prefrontal cortex
vmPFC
-2
44
-12
Posterior cingulate cortex
PCC
-2
-48
28
Precuneus
Pcu
-2
-60
50
Superior frontal gyrus
SFG
-8/12
20/18
62/62
Inferior frontal gyrus
IFG
-42/50
26/30
-14/-6
DAN
Frontal eye fields
FEF
-24/24
2/-2
62/56
Superior occipital gyrus
SOG
-18/26
-66/-64
50/54
FPN
Anterior inferior parietal lobule
aIPL
-54/50
-48/-44
48/46
Dorsolateral prefrontal cortex
DLPFC
-38/44
32/42
30/26
SAN
Anterior insula
aINS
-30/32
20/20
-2/-4
Dorsal anterior cingulate cortex
dACC
6
30
40
Statistical analysis
Clinical and neuropsychological data: Two-sample t tests and χ2 tests were used to compare clinical data using SPSS (version 22.0; IBM, Armonk, NY, United States).
fMRI data: fMRI data were processed using the MATLAB 2012a (MathWorks, Natick, MA, Unite States) software platform using the Data Processing Assistant. We conducted two-sample t tests on the FC values within and between the four networks extracted before and after the GCBT, with differences considered statistically significant at P < 0.05. To determine whether any changes in FC were consistent with changes in any of the neuropsychological assessments, Pearson’s correlations were calculated (P < 0.05 was considered statistically significant). All statistical analyses were conducted using the SPSS software. Additional details of the analyses are provided in the online Supplementary material.
RESULTS
Demographic information
A total of 33 patients with OCD and 26 healthy controls were enrolled in this study. There were no significant demographic differences between the two groups in terms of sex, age, or years of education. However, significant decreases were observed in the Y-BOCS score, HAMD, and HAMA after GCBT in the OCD group (Tables 1 and 3).
Table 3 Comparison of demographic information before and after group cognitive-behavioral therapy treatment.
Comparison of neuropsychological assessments between groups
Significant differences were observed between patients with OCD and healthy controls in MoCA-B, Complex Graphic Recall Score (Rey-O), Organization Score, Short Delayed Recall, and Long Delayed Recall on the ALVT, number of correct responses on the SDMT, number of correct responses on the PASAT, Shape Trails Test (STT) B, Tower of Hanoi, and Verbal Fluency Tests (Table 4).
Table 4 Comparison of neuropsychological assessment results between groups.
Changes in neuropsychological assessments after GCBT treatment
The Rey-O imitation time and recall score, AVLT-N1, AVLT-N2, AVLT-N3, AVLT-N4, AVLT-N5, AVLT-N6, number of correct SDMT, STT-A elapsed time, CCST, number of steps, and elapsed time of the four discs of the Tower of Hanoi were significantly different in the OCD group compared to the control group (Table 5).
Table 5 Changes in neuropsychological assessments before and after treatment.
After GCBT, a significant decrease in rs-FC within the DMN and DAN, and a weakened FC between the DMN-DAN, DMN-FPN, DMN-SAN, and DAN-SAN was observed (Table 6, Figure 1).
Table 6 Comparison of default mode network, dorsal attention network, frontoparietal network, and salience network intra- and inter-network functional connectivity before and after group cognitive-behavioral therapy.
Analysis of altered FC of cognitive-related networks with neuropsychological assessments after GCBT
The results of the Pearson analyses suggested that reduced FC within the DMN was negatively correlated with Rey-O recall scores, number of correct responses on the SDMT, and CCST total scores after GCBT. This reduction was also positively correlated with the elapsed time of the STT-A test and the Tower of Hanoi. DAN rs-FC was positively correlated with the STT-A test elapsed time, whereas DMN-DAN rs-FC was negatively correlated with the Rey-O mimicry time and the three elapsed times of the Tower of Hanoi. The rs-FC of DMN-SAN was negatively correlated with Rey-O imitation time and positively correlated with STT-A test elapsed time, whereas the rs-FC of DMN-FPN was negatively correlated with AVLT-N1 and N4 scores (Table 7).
Table 7 Correlations between functional connectivity and neuropsychological assessments after group cognitive-behavioral therapy.
In the present study, we conducted a seed-based FC analysis assessing 12 specific seeds from four cognitive networks (i.e., DMN, SAN, FPN, and SAN) to investigate intrinsic connectivity alterations at baseline and after GCBT treatment in patients with OCD. We found decreased rs-FC within the DMN and DAN as well as between the DMN-DAN, DMN-FPN, DMN-SAN, and DAN-SAN after GCBT, suggesting that abnormalities in the FC of these large-scale brain networks are implicated in the pathogenesis of OCD. Additionally, GCBT improved cognitive function in patients with OCD. We also observed a correlation between altered FC and neuropsychological assessments after GCBT, suggesting functional changes attributable to GCBT in patients with OCD.
We found significantly decreased rs-FC within the DMN and DAN as well as between the DMN-DAN, DMN-FPN, DMN-SAN, and DAN-SAN in patients with OCD after GCBT. Previous studies have demonstrated that the DMN is overactivated in patients with OCD[28,29], which is consistent with our results showing reduced network connectivity after treatment. Del Casale et al[30] found enhanced FC among the DMN, FPN, and SAN; aberrant FC between the SAN and SAN-dCEN; and correlations between SAN-dCEN FC and trait anxiety levels in patients with OCD. Another study reported significantly reduced FC between the anterior mPFC and the anterior insular cortex (regions within the DMN and SAN) in patients with OCD compared to healthy controls. Notably, reduced DMN-SAN FC has been associated with an increased severity of OCD symptoms and decreased sustained attention[31]. Furthermore, patients with OCD exhibit altered FC between the FPN and DMN[32]. These studies focused on baseline internetwork connectivity without treatment; however, several other studies have reported alterations in the connectivity of brain networks after treatment. Following 4 weeks of high-intensity CBT, a significant increase in FC between the cerebellum and caudate nucleus as well as between the dorsolateral and ventral prefrontal cortex[33] was observed in patients with OCD. Increased FC is associated with symptomatic improvement in obsessions, suggesting that CBT mechanisms are connected to enhanced cross-network integration within the CCST. Another study suggested increased FC within the DAN and between the DAN and FPN after 12 weeks of escitalopram treatment[10]. While there is a lack of research on the brain network changes before and after GCBT, our findings help bridge this lack of understanding. Previous studies have also suggested that decreased FC within and between networks may be the underlying mechanism of the efficacy of GCBT[29,34].
In this study, we reported improvements in multiple domains of cognitive function, including visuospatial ability (Rey-O imitation time and recall score), memory (AVLT-N1, AVLT-N2, AVLT-N3, AVLT-N4, AVLT-N5, and AVLT-N6), attention (number of correct responses on the SDMT), and executive function (time elapsed in STT-A, CSC, total score, number of steps, and elapsed time in the four Hanoi Tower discs) after GCBT treatment. These findings are consistent with those of previous studies, suggesting that CBT can improve cognitive dysfunction in patients with OCD[23,25]. Time and group effects on non-verbal memory, switching trials, and self-supervised behaviors were observed in patients with OCD after CBT, and the group with greater symptom improvement performed better than the group with less symptom improvement in the immediate and delayed recall of complex images[23]. However, one study found no significant changes in the neurocognitive assessments before and after CBT in patients with OCD[35]. This discrepancy may be attributed to differences in sample characteristics of the studies (OCD vs comorbidities), strategy and setting of CBT, researchers, and different methods of statistical analysis. Combining most research findings, we recommend the use of GCBT to improve cognitive dysfunction in patients with OCD.
In addition, the correlation analysis between altered FC and neuropsychological assessments after GCBT in our study suggested that reduced FC within the DMN was significantly associated with visuospatial, attentional, and executive functions. Similarly, reduced FC within the DAN was associated with executive functions. Reductions in FCs between the DMN-DAN as well as DMN-SAN were significantly associated with visuospatial and executive functions, while reduced FC between the DMN-FPN was significantly associated with memory functions These findings are consistent with the findings of previous studies[30,36]. The dorsomedial PFC (dmPFC) and ventral medial PFC act as key hubs for internal and conceptual thoughts, especially in normalization of self-monitoring. Overactive dmPFC is associated with pathological self-focusing, and treatment may restore its balance with other nodes of the default network[37]. The observed reduction in FC within DMN may reflect enhanced cognitive control in patients with OCD following GCBT. This is consistent with previous findings by Guo et al[38], who reported reduced rs-FC within the core subsystem of DMN in patients with OCD. This reduction may represent a characteristic neurobiological feature of OCD and could potentially serve as a biomarker for obsession severity. Another previous study reported enhanced activation in the middle/precuneus cortex, thalamus, basal ganglia, and inferior frontal gyrus/frontal lobe cap in OCD, along with impairments in visuospatial ability, memory, attention, executive functioning, and speech. Improvements in executive function after treatment suggest that changes in the brain network connectivity during treatment contribute to improved neuropsychological performance[39]. Moreover, sustained attention is lower in patients with OCD than in healthy controls, and sustained attention deficits in OCD are negatively correlated with impaired function of the left superior frontal gyrus of the right mPFC within the DMN, and FC between the left mPFC and the right parietal lobe. This suggests that the interactions between the DMN and the FPN are closely related to attentional function[40]. The DMN, SAN, and CST loops in patients with OCD are associated with conversion task responses and executive function[41]. Further research replicated previous research on cognitive inflexibility in OCD and provided neural correlates associated with task-switching deficits in the condition, suggesting that impaired task-switching ability in OCD may be associated with an imbalance in brain activation between the dorsal and ventral frontal striatal circuits[42,43]. Taken together, these findings suggest that GCBT improves both the intra- and internetwork FC within cognitive networks and affects cognitive function in patients with OCD, which was verified by neuropsychological assessment. In addition, reductions in rs-FC within the DMN may represent a promising neuroimaging biomarker for predicting therapeutic response to GCBT in patients with OCD.
This paper has some limitations. First, the sample size of the present study was not large enough to examine the neuroimaging findings associated with the symptom dimensions. Second, this study did not use a blinded design. Third, follow-up data were not available for healthy controls, and future longitudinal studies with healthy controls are warranted. Fourth, the FC analyses were exploratory in nature, which limits the strength of the conclusions. Future replication with pre-registered hypotheses and rigorous statistical corrections is warranted. Finally, the study did not incorporate baseline FC analysis of cognitive-related networks between patients with OCD and healthy controls.
CONCLUSION
We reported significantly decreased rs-FC within the DMN and DAN, as well as reduced rs-FC between the DMN-DAN, DMN-FPN, DMN-SAN, and DAN-SAN. Additionally, we observed significant improvements in memory, executive function, attention, and visuospatial abilities. Our results further showed that reduced rs-FC of inter- and intra-cognitive networks was correlated with visuospatial ability, executive function, memory, and attention, suggesting that decreased rs-FC within the DMN and DAN, which is correlated with executive function post-treatment, can potentially serve as neuroimaging markers for predicting the therapeutic response to GCBT in patients with OCD.
ACKNOWLEDGEMENTS
The authors sincerely thank all the participants for their contributions to this study.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade C, Grade C
P-Reviewer: Fluyau D; Khalifeh H S-Editor: Li L L-Editor: A P-Editor: Zhao S
Braga DT, Abramovitch A, Fontenelle LF, Ferrão YA, Gomes JB, Vivan AS, Ecker KK, Bortoncello CF, Mittelman A, Miguel EC, Trentini CM, Cordioli AV. Neuropsychological predictors of treatment response to cognitive behavioral group therapy in obsessive-compulsive disorder.Depress Anxiety. 2016;33:848-861.
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Vaghi MM, Vértes PE, Kitzbichler MG, Apergis-Schoute AM, van der Flier FE, Fineberg NA, Sule A, Zaman R, Voon V, Kundu P, Bullmore ET, Robbins TW. Specific Frontostriatal Circuits for Impaired Cognitive Flexibility and Goal-Directed Planning in Obsessive-Compulsive Disorder: Evidence From Resting-State Functional Connectivity.Biol Psychiatry. 2017;81:708-717.
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