Evidence map›Paper›PMID 41005270›Full record

Trial reportBehaviour research and therapy2025

Neural mechanisms underlying exposure and response prevention for obsessive compulsive disorder: A randomized controlled trial.

Ryan J Jacoby, Jennifer L Greenberg, Aura Hurtado, Walker Pedersen, Kristen K Ellard, Edward F Pace-Schott, Katelyn I Oliver, Mohammed R Milad, Sabine Wilhelm, Joan A Camprodon

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Behaviour research and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02467374 (Pilot), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02467374 nacompletednot on this map

Pilot: Fear Extinction and Mechanisms of Change in Obsessive Compulsive Disorder

TypeinterventionalSponsorMassachusetts General HospitalRan2014 to 2019Enrolled54ConditionsObsessive Compulsive DisorderArmsBehavior Therapy
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Ryan J JacobyDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Jennifer L GreenbergDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Aura HurtadoDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Walker PedersenDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Kristen K EllardDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Edward F Pace-SchottDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Katelyn I OliverDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Mohammed R MiladThe University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Sabine WilhelmDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: swilhelm@mgh.harvard.edu.
Joan A CamprodonDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.

Funding

Targeting Attentional and Cognitive Control to Enhance the Transdiagnostic Treatment of Repetitive Negative ThinkingK23MH120351 · NIMH · MASSACHUSETTS GENERAL HOSPITAL · PI JACOBY, RYAN J · 2020 to 2024
$977k
NIMH NIH HHS K23 MH120351
6 · The paper itself

Abstract

backgroundFear extinction is an important treatment target of obsessive-compulsive disorder (OCD). In the current randomized controlled trial, we examined the therapeutic modulation of exposure and response prevention (ERP) on neural activation during fear extinction in OCD to identify mechanisms of action and response biomarkers.

methodsThirty-four patients with OCD were randomized to either 12-weeks of ERP or a waitlist. Before, during, and 12-weeks after treatment, patients were assessed using functional magnetic resonance imaging (fMRI) during a 2-day fear extinction paradigm. Neural activation was examined in disease- and construct-relevant circuits and nodes (n = 18).

resultsThe ERP group had a significant reduction in OCD severity compared to waitlist. A voxel-wise GLM analysis of fMRI data revealed clusters of ERP > waitlist activation during fear conditioning (bilateral dorsal amygdala and right hippocampus) and extinction (right ventrolateral prefrontal cortex, located within the salience network). These changes in activation did not correlate with OCD severity changes, however. In contrast, we observed that a reduction in the activation of the left supramarginal gyrus (in the executive control network) during extinction recall correlated with OCD symptom improvement, suggesting a possible role as a response biomarker.

conclusionsThis study highlights the relevance of a dimensional approach (e.g., focused on fear extinction) for biomarker discovery in neuropsychiatry, provides insights into the mechanisms of action of ERP in OCD, and identifies a potential treatment target in the parietal cortex that could support the biomarker-driven development of novel therapies (e.g., brain stimulation protocols), including combination treatments with ERP. CLINICALTRIALS: GOV IDENTIFIER: NCT02467374.

Indexed as

BrainExtinction, PsychologicalFearImplosive TherapyObsessive-Compulsive DisorderAdultAmygdalaBrain MappingFemaleHippocampusHumansMagnetic Resonance ImagingMaleMiddle AgedPrefrontal CortexTreatment OutcomeClinical trialERPExposure and response preventionfMRIMechanismsNeuroimagingObsessive compulsive disorderOCD

Identifiers

PMID41005270
PMCPMC12951397

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.