The Neurocircuitry of Relief During Avoidance Learning in Patients With Obsessive-compulsive Disorder

NCT ID: NCT04685018

Last Updated: 2020-12-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

40 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-01-10

Study Completion Date

2022-05-01

Brief Summary

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To investigate the neuro-mechanisms underpinning persistent avoidance in OCD patients

Detailed Description

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Many compulsions displayed by obsessive-compulsive disorder (OCD) patients serve to protect against perceived threat and can, therefore, be conceptualized as 'avoidance responses'. Exposure treatment with response prevention (ET+RP) is aimed at exposing patients to their obsessive thoughts and perceived threats while preventing engagement in compulsive avoidant responses. This induces extinction of threat perception and fearful arousal and hence reduces the motivation to avoid. While successful in many patients, however, as much as 40% dropout during treatment or display persistent avoidance after ET+RP. There is a clear need for treatment improvement for these often highly disabled patients.

Improving ET+RP outcomes requires a deeper understanding of the mechanisms that drive excessive and persistent avoidance in OCD patients. Psychological theories ascribe an important role to the relief that follows avoidance when the anticipated threat is successfully averted. This positive feeling arguably functions as a reward to reinforce the foregoing avoidance actions. Indeed, fMRI studies have found that the neurocircuitry of relief overlaps with that of reward, including the ventral tegmental area, ventral striatum and orbitofrontal cortex. Here, the authors will test the hypothesis that excessive-persistent avoidance is linked to exaggerated activation of the relief circuitry in OCD patients. For that purpose, we will acquire functional brain images of OCD patients in an MRI scanner and compare to healthy participants, while they participate in a computer task that is designed to model avoidance learning and relief.

Conditions

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Obsessive-Compulsive Disorder

Keywords

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Avoidance behavior Reward Conditioning Extinction Anxiety Disorders OCD fMRI

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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HC

Mentally and medically healthy adults between 18 and 60 years, free from any current or previous medical or psychiatric condition.

fMRI acquisition

Intervention Type DEVICE

Participants from the two groups will perform an avoidance-relief task inside an MRI scanner

OCD

Adults between 18 and 60 years, with a diagnosis of Obsessive-Compulsive Disorder and medication-free or with stable medication regimen for at least 3 weeks prior to the study.

fMRI acquisition

Intervention Type DEVICE

Participants from the two groups will perform an avoidance-relief task inside an MRI scanner

Interventions

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fMRI acquisition

Participants from the two groups will perform an avoidance-relief task inside an MRI scanner

Intervention Type DEVICE

Other Intervention Names

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Behavioral task

Eligibility Criteria

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Inclusion Criteria

* Healthy volunteers 18-60 years old;
* Participants are motivated and give written informed consent;
* Adequate demand of Dutch language;
* Subjects have never participated in a fear conditioning task;
* Diagnosis of OCD (for OCD group only);
* Contraindications for the MRI exam.

Exclusion Criteria

* Current neurological (e.g. Epilepsia), respiratory, cardiovascular, metabolic, gastrointestinal, endocrine (especially diabetes), renal or urinary diseases, psychiatric disorder or other relevant medical histories (except for OCD in the OCD group);
* Being pregnant or lactating;
* Alcohol intake greater than 14 alcoholic units per week (one alcoholic unit = 10 gr ethanol);
* History of cannabis use or any other drug of abuse during the 3 months prior to the study;
* The medical doctor has asked to the participant to stay away from stressful situations;
* Electronic implants (e.g., pacemaker);
* Pain or other condition of the hand or the wrist.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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KU Leuven

OTHER

Sponsor Role lead

Responsible Party

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Bram Vervliet

Principal Investigator Prof. Dr. Bram Vervliet

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Psychiatry | UZ Leuven campus Gasthuisberg

Leuven, , Belgium

Site Status RECRUITING

Countries

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Belgium

Central Contacts

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Bram Vervliet, Prof. Dr.

Role: CONTACT

Phone: +32 16 3 26 145

Email: [email protected]

Chris Bervoets, Prof. Dr.

Role: CONTACT

Phone: +32 16 34 08 77

Email: [email protected]

Facility Contacts

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Bram Vervliet, Prof. Dr.

Role: primary

Chris Bervoets, Prof. Dr.

Role: backup

References

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Vervliet B, Lange I, Milad MR. Temporal dynamics of relief in avoidance conditioning and fear extinction: Experimental validation and clinical relevance. Behav Res Ther. 2017 Sep;96:66-78. doi: 10.1016/j.brat.2017.04.011. Epub 2017 Apr 23.

Reference Type RESULT
PMID: 28457484 (View on PubMed)

Milad MR, Furtak SC, Greenberg JL, Keshaviah A, Im JJ, Falkenstein MJ, Jenike M, Rauch SL, Wilhelm S. Deficits in conditioned fear extinction in obsessive-compulsive disorder and neurobiological changes in the fear circuit. JAMA Psychiatry. 2013 Jun;70(6):608-18; quiz 554. doi: 10.1001/jamapsychiatry.2013.914.

Reference Type RESULT
PMID: 23740049 (View on PubMed)

Leknes S, Lee M, Berna C, Andersson J, Tracey I. Relief as a reward: hedonic and neural responses to safety from pain. PLoS One. 2011 Apr 7;6(4):e17870. doi: 10.1371/journal.pone.0017870.

Reference Type RESULT
PMID: 21490964 (View on PubMed)

Gillan CM, Morein-Zamir S, Urcelay GP, Sule A, Voon V, Apergis-Schoute AM, Fineberg NA, Sahakian BJ, Robbins TW. Enhanced avoidance habits in obsessive-compulsive disorder. Biol Psychiatry. 2014 Apr 15;75(8):631-8. doi: 10.1016/j.biopsych.2013.02.002. Epub 2013 Mar 16.

Reference Type RESULT
PMID: 23510580 (View on PubMed)

Other Identifiers

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bram vervliet

Identifier Type: -

Identifier Source: org_study_id