Brain Imaging and OCD: Understanding the Affected Brain Areas

Obsessive-Compulsive Disorder (OCD) is a mental health condition in which individuals experience intrusive thoughts (obsessions) and short term reward behaviours (compulsions) which aim to reduce the anxiety caused by these thoughts. Brain imaging studies have provided valuable insights into the affected brain areas that underpin OCD. Repeat research has highlighted specific brain areas that play a significant role in the disorder. The key brain regions related to OCD include:

1. Orbitofrontal Cortex (OFC): The OFC is involved in decision-making and the processing of rewards and punishments. Sufferers of OCD experience that this region is often overactive. This is seen as a contributing factor to the excessive anxiety and doubt that is often experienced by individuals. This overactivity leads to the repetitive thoughts (obsessions) that drive compulsive behaviors.
2. Striatum: The striatum is a part of the basal ganglia and is responsible for the formation of habits and motor control. In OCD, there is a dysfunction in the cortico-striato-thalamo-cortical loop, which leads to the persistence of compulsions. The striatum can reinforce compulsive behaviour when it is overactive.
3. Thalamus: The thalamus acts as a relay station for sensory information. It is believed that in OCD, abnormal thalamic function may contribute to the loop of repetitive thoughts and behaviours. Dysfunctional communication between the thalamus and the OFC leads to the persistence of obsessive thoughts.

These brain areas work together in a feedback loop that perpetuates the cycle of obsessions and compulsions in OCD.

CBT and ACT: Approaches to Managing OCD

Cognitive Behavioural Therapy (CBT) is widely regarded as one of the most effective treatments for OCD. Many styles of CBT aim to address the reinforcing cycle of obsession and compulsion. Since the pandemic, online CBT for OCD, such as those offered by therapists in London or through online platforms, has become increasingly popular, as it provides flexible access to treatment. Many individuals specialised in working with OCD may work further away.

CBT focuses on exposure and response prevention (ERP), a key technique in which individuals often gradually expose themselves towards feared situations or thoughts (exposure) whilst reducing, or stopping the performing of compulsive rituals (response prevention). This process helps to reduce the anxiety associated with their obsessions over time whilst consequently disrupting the compulsive behaviours that reinforce obsessive thoughts.

UCL Case Formulation ModelThe UCL Case Formulation Model of CBT offers a structured framework for understanding and treating OCD and was devised by the founder of ERP. This model places significant emphasis on understanding the individual's unique cognitive and other internal and external processes that contribute to the development and maintenance of OCD. By working with an OCD therapist online​, over the phone or in person, individuals can identify their respective factors that lead to compulsive behaviours. This allows for more tailored interventions.

The UCL model encourages clients to explore their own individual circumstances and contributing factors. Common elements can be the overestimation of the risk of harm or an excessive need for certainty, which can fuel obsessive thoughts.

Acceptance and Commitment Therapy (ACT)ACT, is a form of therapy that falls within the third wave of CBT, is often used in the treatment of OCD. ACT focuses on acceptance of intrusive thoughts rather than trying to eliminate them. It teaches individuals to view their obsessions as thoughts that do not necessarily require action. By further developing mindfulness skills, they also train impulse controls which fuels psychological flexibility and helps with OCD. ACT helps clients develop the ability to engage in values-based actions even in the presence of distressing thoughts.
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ACT can be particularly effective for those who struggle with the overwhelming anxiety that accompanies their obsessions, as it encourages acceptance of discomfort without resorting to compulsive behaviours. One can make use of it when pursuing therapy online, making it accessible for those looking for online options for treating their OCD through therapy. These often include phone therapy or video sessions.

How Different Forms of CBT Address Brain Areas Affected by OCDCBT works to address the brain regions associated with OCD by managing how individuals respond to intrusive thoughts and by reducing the overactivity in the regions responsible for compulsive behaviours.

• Orbitofrontal Cortex (OFC): CBT helps to recalibrate the overactive OFC by helping individuals tolerate anxiety and uncertainty whilst stopping compulsive actions from reinforcing obsessive thoughts.
• Striatum: The practice of ERP means that individuals can weaken the habit formation processes in the striatum by reducing the compulsive behaviours that this brain area promotes. ACT further reinforces this by encouraging individuals to engage in behaviours that are aligned with their values, even when impulses want to tell them otherwise. This breaks the automatic response loop.
• Thalamus: The communication between the thalamus and other brain regions is also addressed. By having a lessened need for compulsive responses, CBT and ACT help to interrupt the cycle that keeps obsessive thinking and compulsive behaviour going.

The Rise of Online Therapy for OCDAs many competent therapists that specialise in OCD are hard to find, pursuing therapy over the phone or online can provide a big benefit for many clients. Many therapists and clients also find the it easier to talk about intrusive thoughts they find embarrassing remotely or through the telephone.
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Whether through phone therapy, video call, or online CBT programs, doing CBT remotely offers the flexibility to engage in treatment that is evidence based. Especially with something as uncommon as the UCL Case Formulation Mode. OCD therapists that work online are trained to be able to work remotely and / or face to face.