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Review
. 2017 Jul 12:13:1825-1834.
doi: 10.2147/NDT.S121139. eCollection 2017.

Real-time functional magnetic resonance imaging in obsessive-compulsive disorder

Óscar F Gonçalves  1   2   3 , Marcelo C Batistuzzo  4 , João R Sato  5
Affiliations
Review

Real-time functional magnetic resonance imaging in obsessive-compulsive disorder

Óscar F Gonçalves et al. Neuropsychiatr Dis Treat. .

Abstract

The current literature provides substantial evidence of brain alterations associated with obsessive-compulsive disorder (OCD) symptoms (eg, checking, cleaning/decontamination, counting compulsions; harm or sexual, symmetry/exactness obsessions), and emotional problems (eg, defensive/appetitive emotional imbalance, disgust, guilt, shame, and fear learning/extinction) and cognitive impairments associated with this disorder (eg, inhibitory control, working memory, cognitive flexibility). Building on this evidence, new clinical trials can now target specific brain regions/networks. Real-time functional magnetic resonance imaging (rtfMRI) was introduced as a new therapeutic tool for the self-regulation of brain-mind. In this review, we describe initial trials testing the use of rtfMRI to target brain regions associated with specific OCD symptoms (eg, contamination), and other mind-brain processes (eg, cognitive - working memory, inhibitory control, emotional - defensive, appetitive systems, fear reduction through counter-conditioning) found impaired in OCD patients. While this is a novel topic of research, initial evidence shows the promise of using rtfMRI in training the self-regulation of brain regions and mental processes associated with OCD. Additionally, studies with healthy populations have shown that individuals can regulate brain regions associated with cognitive and emotional processes found impaired in OCD. After the initial "proof-of-concept" stage, there is a need to follow up with controlled clinical trials that could test rtfMRI innovative treatments targeting brain regions and networks associated with different OCD symptoms and cognitive-emotional impairments.

Keywords: neurofeedback; neuromodulation; obsessive-compulsive disorder; real-time fMRI; self-regulation.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Objectives for clinical intervention based on findings from neuroimaging research on emotional and cognitive OCD impairments. Abbreviation: OCD, obsessive-compulsive disorder.
Figure 2
Figure 2
Examples of brain regulation strategies along two axes depending on the degree of invasiveness (psychological versus surgical) and regulation strategy (external versus self-regulatory). Abbreviations: ECT, electroconvulsive therapy; DBS, deep brain stimulation; TMS, transcranial magnetic stimulation; tDCS, transcranial direct current stimulation.
Figure 3
Figure 3
Examples of brain self-regulation strategies along two axes depending on degree signal resolution (time versus spatial resolution) and ecological context (laboratory versus natural environment). Abbreviations: rtfMRI, real-time functional magnetic resonance imaging; rtfNIRS, real-time functional near-infrared spectroscopy; rtLORETA EEG, real-time low-resolution electromagnetic tomography with electroencephalography; rtEEG, real-time electroencephalography.
Figure 4
Figure 4
Illustration of the main components of an rtfMRI system. Abbreviations: rtfMRI, real-time functional magnetic resonance imaging; BOLD, blood oxygenation level-dependent; ROI, region of interest.
See this image and copyright information in PMC

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