A systematic review of structural neuroimaging markers of psychotherapeutic and pharmacological treatment for obsessive-compulsive disorder

Identifying individual difference factors associated with treatment response and putative mechanisms of therapeutic change may improve treatment for Obsessive Compulsive Disorder (OCD). Our systematic review of structural neuroimaging markers (i.e., morphometry, structural connectivity) of psychotherapy and medication treatment response for OCD identified 26 eligible publications from 20 studies (average study total n=54 ± 41.6 [range: 11-175]; OCD group n=29 ± 19) in child, adolescent, and adult samples evaluating baseline brain structure correlates of treatment response as well as treatment-related changes in brain structure. Findings were inconsistent across studies; significant associations within the anterior cingulate cortex (3/5 regional, 2/8 whole brain studies) and orbitofrontal cortex (5/10 regional, 2/7 whole brain studies) were most common, but laterality and directionality were not always consistent. Structural neuroimaging markers of treatment response do not currently hold clinical utility. Given increasing evidence that associations between complex behavior and brain structure are characterized by small, but potentially meaningful, effects, much larger samples are likely needed. Multivariate approaches (e.g., machine learning) may also improve the clinical predictive utility of neuroimaging data.