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Updated: May 30, 2026
Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging
Published on: March 14, 2025
Developmental aspects of error and high-conflict-related brain activity in pediatric obsessive-compulsive disorder: a
Chaim Huyser1, Dick J Veltman, Lidewij H Wolters
1De Bascule, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands. c.huyser@debascule.com
Insights
Pediatric obsessive-compulsive disorder (OCD) involves heightened anterior cingulate cortex (ACC) activation during errors and insula activation during conflict, which is age-dependent and only partially improved by cognitive-behavioral therapy (CBT).
Area of Science:
- Neuroscience
- Developmental Psychology
- Child Psychiatry
Background:
- Heightened error and conflict monitoring are key in obsessive-compulsive disorder (OCD).
- Anterior cingulate cortex (ACC) function is implicated in these monitoring processes.
- Pediatric OCD offers insight into the developmental trajectory of ACC function and its link to psychopathology.
Purpose of the Study:
- To investigate functional magnetic resonance imaging (fMRI) differences in brain activity between pediatric OCD patients and healthy controls.
- To examine the impact of cognitive-behavioral therapy (CBT) on these neural mechanisms.
- To explore age-dependent effects on brain function related to error and conflict monitoring in pediatric OCD.
Main Methods:
- Functional magnetic resonance imaging (fMRI) was used to measure brain activity in 25 medication-free pediatric OCD patients and matched healthy controls.
- Participants completed an interference task (Flanker paradigm) before and after a course of cognitive-behavioral treatment (CBT).
- Repeated measures assessed changes in brain activation, specifically in the ACC and insula, during error and conflict trials.
Main Results:
- Pediatric OCD patients exhibited an age-dependent Group × Time × Age interaction in the ACC and insula during error trials, with increased activation in older subjects persisting post-treatment.
- A similar interaction was observed in the bilateral insula during high-conflict trials, driven by increased blood oxygen level dependent (BOLD) signal in older OCD patients before, but not after, treatment.
- A Group × Time interaction indicated increased BOLD signal over time in the dorsomedial prefrontal cortex, premotor region, and ACC in OCD subjects relative to controls.
Conclusions:
- Children and adolescents with OCD show heightened ACC activation during errors and bilateral insular cortex activation during high-conflict tasks compared to controls.
- These neural differences are age-dependent and only partially ameliorated by cognitive-behavioral therapy (CBT).
- ACC functioning may represent a vulnerability marker for pediatric OCD, while insular dysfunction appears to be state-dependent.
Background:
Heightened error and conflict monitoring are considered central mechanisms in obsessive-compulsive disorder (OCD) and are associated with anterior cingulate cortex (ACC) function. Pediatric obsessive-compulsive patients provide an opportunity to investigate the development of this area and its associations with psychopathology.
Methods:
Repeated measures were carried out using functional magnetic resonance imaging (fMRI) during the performance of an interference task, the arrow version of the Flanker paradigm, before and after cognitive-behavioral treatment of 25 medication-free pediatric obsessive-compulsive patients compared with age- and gender-matched healthy controls.
Results:
During error trials compared to correct trials, pediatric OCD patients and controls showed an interaction effect of Group × Time × Age in the ACC and insula. This effect was mainly driven by an increased activation in older OCD subjects, which was also present after treatment. During high-conflict trials compared with low-conflict trials, a Group × Time × Age interaction effect was found in bilateral insula. This effect was driven by an increase of BOLD (blood oxygen level dependent) signal in older OCD patients before but not after treatment. In addition, a Group × Time interaction effect in dorsomedial prefrontal cortex, premotor region and ACC was found. This effect was driven by an increase of BOLD signal in OCD subjects relative to controls over time.
Conclusions:
Compared to healthy controls, children and adolescents with OCD show increased activation of the ACC during error responses and in bilateral insular cortex during high-conflict tasks, which is age dependent and which is only partially affected by cognitive-behavioral therapy (CBT). Therefore, we suggest that ACC functioning is a vulnerability marker in pediatric OCD, whereas insular dysfunction may be state dependent.
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