Neuroanatomical aspects of cognitive-behavioural therapy response in obsessive-compulsive disorder

BACKGROUND Recent research has demonstrated that cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) can systematically modify cerebral metabolic activity in a manner which is significantly related to clinical outcome. METHOD A substantial body of research is reviewed which supports an involvement of neural circuitry connecting the orbitofrontal cortex, cingulate gyrus and basal ganglia in the expression of the symptoms of OCD. RESULTS Data are presented which expand upon previous work demonstrating effects of CBT on functional interactions between limbic cortex and the basal ganglia. CONCLUSIONS The relevance of these effects of CBT on brain function is discussed in the context of recent advances in our knowledge of cortical-basal ganglia physiology. The clinical importance of these data is best appreciated when they are seen to reflect the interactive nature of the relationships between cognitive choice, behavioural output and brain activity.

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