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Updated: Dec 31, 2025
Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging
Published on: March 14, 2025
Structural neural markers of response to cognitive behavioral therapy in pediatric obsessive-compulsive disorder
David Pagliaccio1,2, Jiook Cha1,2, Xiaofu He1,2
1Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
Insights
Brain structure, specifically thinner frontoparietal cortices, predicts cognitive behavioral therapy (CBT) response in pediatric obsessive-compulsive disorder (OCD). Reduced structural connectivity in cingulo-opercular regions was also observed in youth with OCD.
Area of Science:
- Neuroscience
- Pediatric Psychiatry
- Medical Imaging
Background:
- Cognitive behavioral therapy (CBT) is a primary treatment for pediatric obsessive-compulsive disorder (OCD).
- Predictors of CBT response in adult OCD patients are known, but robust markers for pediatric patients are lacking.
- This study aimed to identify brain structural markers that predict CBT treatment outcomes in children and adolescents with OCD.
Purpose of the Study:
- To identify neuroimaging-based predictors of treatment response to CBT in pediatric OCD.
- To investigate the relationship between brain structure (cortical thickness, subcortical volume, structural connectivity) and symptom improvement in youth with OCD undergoing CBT.
Main Methods:
- Structural and diffusion MRI scans were acquired from 28 unmedicated children/adolescents with OCD and 27 healthy controls (ages 7-18).
- Cortical thickness and subcortical volumes were estimated using FreeSurfer.
- Structural connectivity was assessed using MRtrix, and relationships between these measures and OCD symptom reduction (CY-BOCS scores) after CBT were analyzed.
Main Results:
- Thinner cortex in nine frontoparietal regions significantly predicted greater improvement in OCD symptoms.
- A significant cluster in the left supramarginal gyrus showed high specificity and sensitivity for predicting CBT response.
- Reduced structural connectivity (fewer streamlines) was found in cingulo-opercular regions in OCD patients compared to controls, and these connections predicted post-treatment symptom severity.
Conclusions:
- Brain structural features, including thinner frontoparietal cortices and altered cingulo-opercular connectivity, predict CBT response in pediatric OCD.
- These findings suggest that cortical and white matter characteristics of task control circuits can help identify pediatric OCD patients most likely to benefit from CBT.
- This research provides novel insights into the neural underpinnings of treatment response in youth with OCD.
Background:
Cognitive behavioral therapy (CBT) is an effective, first-line treatment for pediatric obsessive-compulsive disorder (OCD). While neural predictors of treatment outcomes have been identified in adults with OCD, robust predictors are lacking for pediatric patients. Herein, we sought to identify brain structural markers of CBT response in youth with OCD.
Methods:
Twenty-eight children/adolescents with OCD and 27 matched healthy participants (7- to 18-year-olds, M = 11.71 years, SD = 3.29) completed high-resolution structural and diffusion MRI (all unmedicated at time of scanning). Patients with OCD then completed 12-16 sessions of CBT. Subcortical volume and cortical thickness were estimated using FreeSurfer. Structural connectivity (streamline counts) was estimated using MRtrix.
Results:
Thinner cortex in nine frontoparietal regions significantly predicted improvement in Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores (all ts > 3.4, FDR-corrected ps < .05). These included middle and superior frontal, angular, lingual, precentral, superior temporal, and supramarginal gyri (SMG). Vertex-wise analyses confirmed a significant left SMG cluster, showing large effect size (Cohen's d = 1.42) with 72.22% specificity and 90.00% sensitivity in predicting CBT response. Ten structural connections between cingulo-opercular regions exhibited fewer streamline counts in OCD (all ts > 3.12, Cohen's ds > 0.92) compared with healthy participants. These connections predicted post-treatment CY-BOCS scores, beyond pretreatment severity and demographics, though not above and beyond cortical thickness.
Conclusions:
The current study identified group differences in structural connectivity (reduced among cingulo-opercular regions) and cortical thickness predictors of CBT response (thinner frontoparietal cortices) in unmedicated children/adolescents with OCD. These data suggest, for the first time, that cortical and white matter features of task control circuits may be useful in identifying which pediatric patients respond best to individual CBT.
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