Exploring the effects of cognitive behavioral therapy on cognitive control circuit and behavioral task performance in

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Paula A Muñoz Rodríguez1, Adam Pines2, Xue Zhang2

  • 1Department of Neuroscience, Stanford University, Stanford, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.

Journal of Psychiatric Research
|May 2, 2025
PubMed

Insights

Cognitive behavioral therapy for hoarding disorder (HD) shows promise. This study found that improvements in HD symptoms correlated with brain activity changes in the right insula and anterior cingulate cortex after treatment.

Area of Science:

  • Neuroscience
  • Psychiatry
  • Cognitive Behavioral Therapy

Background:

  • Hoarding disorder (HD) involves persistent difficulty discarding possessions, causing significant distress and functional impairment.
  • Cognitive behavioral therapy (CBT) is a promising treatment for HD, but its underlying neural mechanisms are not well understood.
  • Previous research demonstrated the clinical effectiveness of the Buried in Treasures workshop (BIT) combined with home visits (BIT+) for HD.

Purpose of the Study:

  • To investigate the neural activity changes associated with cognitive control in adults with HD before and after a BIT+ intervention.
  • To explore the relationship between symptom reduction in HD and alterations in brain activity within cognitive control networks.
  • To compare neural activity in HD participants with healthy controls (HCs) during a response inhibition task.

Main Methods:

  • A task-based functional magnetic resonance imaging (fMRI) study was conducted on a subset of HD participants (n=19) before and after 18 weeks of BIT+ treatment.
  • Participants performed a response inhibition task to assess neural activity within cognitive control regions.
  • A comparison group of healthy controls (n=49) was included for reference.

Main Results:

  • HD participants initially made more omission errors but showed similar commission errors compared to HCs.
  • A correlation was observed between improved hoarding symptom severity and blood-oxygen-level-dependent (BOLD) signal changes in the right insula and anterior cingulate cortex during commission errors post-treatment.
  • These findings suggest that changes in these specific brain regions are linked to the therapeutic effectiveness of BIT+.

Conclusions:

  • This study provides novel insights into the neural underpinnings of hoarding disorder treatment.
  • Changes in the right insula and anterior cingulate cortex activity following BIT+ intervention may be crucial for symptom improvement in HD.
  • This research is the first to examine neural activity shifts during inhibitory control tasks in relation to BIT+ treatment for hoarding disorder.

Keywords:
Cognitive behavioral therapyCognitive controlGoNoGoHoarding disorderfMRI

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