Figure 3.

Post-treatment (1–12 months) follow-up (f/u) clinical scores in a sample of 19 adult OCD patients (filled circles) who received 4 weeks of intensive daily CBT.

Notes: (A and B) Scores assayed core OCD symptoms on the Yale–Brown Obsessive Compulsive Scale (Y-BOCS, A) and Obsessive-Compulsive Inventory (OCI, B). (C and D) Scores assayed depressive symptoms on the Montgomery–Åsberg Depression Rating Scale (MADRS, C) and anxious symptoms on the Hamilton Anxiety Rating Scale (HAMA, D). All scores are plotted as a function of the combined level (corrected for cerebrospinal fluid [CSF] content of the acquisition volume) of the energetic neurometabolites creatine (Cr) and phosphocreatine (PCr) in the midline (left + right) pregenual anterior cingulate cortex (pACC), a brain region linked to positive affect, among other functions. Levels were acquired with proton magnetic resonance spectroscopy (MRS) at most 1 week prior to CBT. Higher pretreatment levels of Cr+PCr were significantly correlated (Spearman) with lower OCD, depressive, and anxious symptoms across the sample. Thus, elevated energetic metabolism may dispose toward retention of response to CBT. This suggests that brain imaging may be helpful in predicting long-term outcomes in OCD.

Abbreviations: CBT, cognitive-behavioral therapy; CSF, cerebrospinal fluid; IU, Institutional Units; OCD, obsessive-compulsive disorder.