Experts Question the Benefits of Brain Imaging Research for OCD

Two experts—a leading neuroscientist studying OCD, and a psychiatrist specializing in OCD treatment—question whether expensive brain imaging research has added anything to the treatment of OCD.

Peter Simons
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New research, published in CNS Spectrums, suggests that despite an estimated $10 million spent on brain imaging research for obsessive-compulsive disorder (OCD), the preferred treatments for OCD have not changed in over 40 years. The authors of the study were Jon E. Grant, a psychiatrist who specializes in OCD treatment, and Samuel R. Chamberlain, a neuroscientist who specializes in studying brain changes associated with OCD.

Grant and Chamberlain write, “We think it timely for researchers to question whether case-control imaging research based purely on brain structure or blood oxygenation level dependent (BOLD) activation is likely to lead to direct patient benefit, especially if divorced from clinical trials.”

Photo Credit: Pixabay

The current first-line treatments for OCD include psychotherapy, in the form of exposure and response prevention (ERP), and medication, in the form of selective serotonin reuptake inhibitors (SSRIs). Grant and Chamberlain write that, in the research literature, ERP appears slightly more effective than medication; however, guidelines often recommend using both together, particularly for more severe cases of OCD.

The authors note that both these treatments were developed without neuroimaging studies. Instead, both were designed and tested through clinical intervention. According to Grant and Chamberlain, about 50% of people treated with ERP recover, and an estimated 65% experience some relief.

OCD research in the past 30 years has spent an estimated $10 million on brain imaging alone (this figure includes only the estimated MRI or PET scan cost, not the cost of the research itself). Researchers generally hope that this research will enable the development of treatments that may be more effective than the current ones. However, no such treatment has yet been found.

The authors identified the general consensus around the results from neuroimaging studies as having found smaller hippocampal volumes in some regions; smaller cortical thickness in other areas; hyperactivation of the striatal and insula regions; and hypoactivation of the prefrontal cortical regions. However, all of these findings were of small to very small effect sizes. This could mean that the brain differences are consistent but quite subtle.

However, it could also mean that there is tremendous overlap between people with and without OCD. That is, people with and without OCD have a wide range of brain volume and activation. However, people with OCD may be slightly more likely to fall on the lower range of this normal curve. This makes the clinical impact of such research negligible. Any individual with a smaller hippocampal volume than average may be either a person with an OCD diagnosis or without—there is no diagnostic potential there.

Although the researchers write that neuroimaging research still has the potential to enable the development of other treatments in the future, they note that there has been little direct clinical benefit of the research so far. They write:

“The total estimated expenditure on brain scan costs between 1984 and present day would have funded psychotherapy treatment for ∼4000 patients over the time frame examined.”

Grant and Chamberlain, therefore, suggest that the devotion of millions of dollars to brain imaging research is a misallocation of funds that could have been used for a direct clinical benefit to people struggling with obsessions and compulsions.

 

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Grant, J. E., & Chamberlain, S. R. (2018). Costs and benefits of neuroimaging research in obsessive-compulsive disorder: time to take stock. CNS Spectrums. doi: 10.1017/S1092852918000901 (Link)

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

15 COMMENTS

  1. Am labeld OCD for making complaints about psychiatrists and insisting my GP use all three of my names because I share the same name with another member of my family and there was a need to distingush between us. The GP repeatedly failed to do this so I repeatedly informed him of his failure. This got me an OCD label. Am sure they will see me posting on here as OCD as well. So where is the OCD, whose brain is it in and for what purpose is it being used ?

    Initially NO. This is a person I listen to with regards psychiatrists and the drugs. Her experience correlates to my own. I identify with her..give her some more views everybody:

    https://www.youtube.com/watch?v=pRL-6IOyO9o

    • You’re posting under a pseudonym. Even if they read it–mental illness makers avoid this place usually–how will they know it’s you? They can shove their own perfectly balanced brains where the sun don’t shine! You’re safe here. 🙂

    • You are clearly obsessed with the silly idea of being treated respectfully by the psychiatric profession. You’re also delusional because you imagined such a thing was possible. You’re only healthy when you believe all you are told and stop worrying about silly little things like being listened to and respected. After all, you’re just a brain, and how can something like respect or listening make a difference to a big mass of chemical reactions?

      (Just in case anyone is unclear – the above is intended to be utter sarcasm!)

      • Sarcasm or not…

        I am treated like a human being by mental health professionals. I’m listened to and I’m respected and when I ask for help I get help, within the limitations of what the services can offer, and my perspective is given credence. This has been the case for a long, long time. Okay, I very rarely ask for help and try as much as possible to go it alone. When I do need help, understandably, people that don’t know me too well, are a somewhat flustered by my refusal of drugs, for the most part, and then somewhat amiss about what to do. They would do more if they could. As things stand almost all services are designed and planned around drugs. It is unfair and unrepresentaive to dehumanise all professionals. And it’s no wonder many of them are turned off from thinking about new ways and new approaches when they are confronted by toxic attitudes.

        The middle way. How many wise men (and women) have called for the middle way? It is the ground upon which the promise of change and reconciliation occurs. Taking pot shots (even if they are sniggered away under the trojan horse of sarcasm) from either side is war-mongering, and reveals no sincere motivation for change.

        • You’re assuming shrinks want to leave their six or seven digit incomes and prestige. Most prefer not to. Plus they dislike acknowledging all the lives they have ruined. Cognitive dissonance.

          Most prefer to view us as stupid, subhuman, and helpless. They view us as domestic animals. This makes it easier to justify the way they treat us. A social process called dehumanizing. Funny how you don’t perceive psychiatric dehumanization. Or maybe it just doesn’t bug you like it does me.

          Not all slave owners were like Simon Legree, yet they patronized and manipulated their cheap sources of labor–telling them how stupid and helpless they would be on their own. Like chattel slavery and marriages where women had no property rights, psychiatry is an inherently abusive system.

          The only reason they log onto this site is to justify disabling, defaming, and killing people. I have forgiven them for ruining my life. Sort of. But I don’t like or trust any of them.

          Many here want revenge. I don’t. But I feel like shrinks are a lost cause. An abusive spouse begging his wife to come back alternating with threats and insults. Incapable of saying, “I was wrong.”

          And who wants to waste time listening to domestic animals anyhow? That’s how they view us. One or two shrinks have trolled this site just to get kicks out of mocking our suffering. Creeps!

          Till they can admit the damage they have created with their cruel pointless experiments on unwilling guinea pigs I would rather they stay as far away as possible!

        • rasselas.redux, I appreciate your comments and I’m glad to hear you have experienced mental health professionals who listened to you and respected you. I think it’s important we here at MIA fight the tendency to lump in all mental health professionals with the worst, biomedicaly-obsessed, dehumanising psychiatrists.

          • Brett, I am not anti-psychology like some here are. I try not to hate psychiatrists, but they truly frighten me. And psychiatry–the practice itself–ruined my life.

            Let me be clear; justice demands it. I have had two good shrinks who honestly cared about me as a person. One actually lowered my drugs till I felt like I was me again. He said I was no longer psychotic. Then we moved and I had to see Dr. Evil. I never saw her laugh except when she had reduced a patient to tears.

            The next good psych doctor saw me after her. He seemed concerned at my pain and marveled out loud at how I was the only person he had ever seen with “delusions of inferiority.”

            Kind but clueless. How could I not hate myself since I was a soulless, amoral monster unfit to associate with human beings? That’s what “severely mentally ill” means folks.

            Most shrinks I have seen are in between. More like used car salesmen of dubious honesty than the commandant from Schindler’s List.

            Speaking of Nazis, they were more complex than we realize. In Man’s Search for Meaning Viktor Frankel records how men running the camp sometimes practiced kindness despite their jobs. Most did not kick puppies for a hobby. And those who did had not started out that way. 🙁

  2. I never cease to be amazed at the vast sums of money that are spent on psychiatric research. And wonder if any of it has ever been useful. So much seems to be of the “bleedin’ obvious” variety (problems at work make you depressed etc.) or just of the “what’s the point of that?” variety (I remember seeing an article from the 1940s British Journal of Psychiatry about moustaches – or have I dreamt that up?) and then millions and millions spent on the rat brain stuff.

  3. Why does everyone keep forgetting neuroplasticity and epigenetics? The organization of brain circuitry is constantly changing as a result of our experiences. Psychological stresses also change the brain and when these stresses are addressed, the brain changes back again. So, even if there are some differences in brains (seen in neuroimaging), there’s no reason to get exited about it. Yes, these research studies are a total waste of time and money.

      • Yes – there is so much evidence that brains are constantly changing with experience, and psychiatrists prefer to ignore that. Strangely, the academic article that this article cites also does not mention neuroplasticity (or epigenetics).

        • I agree with you 100%. Epigenetics and neuroplasticity directly undermine the “broken brain” model and are therefore conveniently ignored by the mainstream of psychiatric research. This is not new information, either – neuroplasticity was uncovered back in the late 1990s, almost 20 years back. But you can’t use neuroplasticity to sell drugs, so it seems to get very short shrift.

          • Neuroplasticity might produce a demand for brain coaches or trainers–kind of like a physical trainer at the gym. I really think psychologists have excessive amounts of formal education for what they do.