Figure 1.
Expanded model of OCD pathophysiology.
A primary cognitive network (left) connects prefrontal and ventroanterior thalamic structures via dorsal striatal loops. A primary affective network (right) connects the posterior OFC and ventral parts of the ACC via ventral striatal loops and via limbic structures with the mediodorsal thalamus. The DLPFC interfaces with the parietal cortex and the cerebellum. (Modified according to [14], p. 264; [15], p. 541]).
Table 1.
Characterization of patients and healthy controls.
Figure 2.
Individualized symptom-provoking pictures.
Examples of individual compulsion-triggering pictures from a patients’ home environment. Such pictures are considered trivial for other individuals (for example control subjects). However, to the individual patient with his or her specific background of experience as well as individual conflictual issues, these pictures are emotionally highly charged and symptom provoking.
Table 2.
Descriptive results for the picture ratings after the first fMRI.
Figure 3.
Ratings for individualized symptom provoking pictures [a], IAPS disgust pictures [b], and IAPS neutral pictures [c]. Left: patients, right: healthy controls. Rating according to valence, arousal, and coping. The three adjacent columns represent the ratings of three successive fMRI scans. The fourth measurement taken for 2 patients and one control is not represented. 95% confidence intervals of the means were bootstrapped with R’s boot.ci function using 10.000 resamples and the “bca” type of confidence intervals.
Table 3.
Pre-post-comparisons of clinical measures, picture ratings, and brain activation.
Figure 4.
Global changes in brain activity.
Differences of brain activity in order transition intervals for patients (red), non order transitions for patients (yellow), and inter-scan-intervals for healthy controls (grey). (a): mean voxel number difference; (b): relative percentual changes. Abbreviations: OT: order transitions; NOT: non order transitions; ISI: inter-scan-intervals for healthy controls.
Figure 5.
Changes in brain activity in eight regions of interest.
Differences of brain activity in order transition intervals for patients (red), non order transitions for patients (yellow) and inter-scan-intervals for healthy controls (grey). Top: mean voxel number difference; below: relative percentage changes. Abbreviations: OT: order transitions; NOT: non order transitions; ISI: inter-scan-intervals for healthy controls. CC/SMA: anterior cingulate cortex/supplementary motor area; DLPFC r: dorsolateral prefrontal cortex right; DLPFC l: dorsolateral prefrontal cortex left; Insula r: insula right; Insula l: insula left; Parietal r: parietal cortex right; Parietal l: parietal cortex left; cuneus.
Table 4.
Differences in brain activation in relation to order transitions.
Figure 6.
Activation patterns for each patient during fMRI scans in sagittal views.
Talairach coordinate: x = 0. The order transitions within individual therapies are marked by arrows.