Enhancement of Therapeutic Learning in OCD Using tDCS
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 1/26/2019 |
| Start Date: | February 14, 2017 |
| End Date: | December 1, 2019 |
Enhancement of Therapeutic Learning in Obsessive-compulsive Disorder Using Transcranial Direct Current Stimulation
The proposed study aims to use transcranial direct current stimulation (tDCS) - a
non-invasive neuromodulatory technology - to improve learning within the context of
therapeutic exposure. Individuals diagnosed with obsessive-compulsive disorder (OCD) will
complete a two-day experimental study. On day 1, participants will receive sham (placebo) or
active tDCS followed by approximately 60-minutes of individualized exposure. on day 2,
participants will return to complete an additional 60-minutes of exposure. Subjective
distress will be repeatedly monitored during exposure to allow for the modeling of
within-trail and within-session learning and between-session recall of learning.
non-invasive neuromodulatory technology - to improve learning within the context of
therapeutic exposure. Individuals diagnosed with obsessive-compulsive disorder (OCD) will
complete a two-day experimental study. On day 1, participants will receive sham (placebo) or
active tDCS followed by approximately 60-minutes of individualized exposure. on day 2,
participants will return to complete an additional 60-minutes of exposure. Subjective
distress will be repeatedly monitored during exposure to allow for the modeling of
within-trail and within-session learning and between-session recall of learning.
Over the course of a lifetime, more than a quarter of the American population will meet
criteria for a disorder characterized by pathological fear and anxiety - obsessive-compulsive
disorder (OCD), posttraumatic stress disorder (PTSD), and other anxiety disorders - and the
global burden of these disorders is nearly as high as that of thought and mood disorders.
Exposure-based psychotherapies are among the most efficacious treatments for disordered
anxiety. However, partial response is common, and a sizeable minority of patients is
treatment refractory. To improve outcomes, the neuroscience-guided augmentation of these
proven approaches using brain-based interventions holds particular promise. This proposal
aims to harness our growing knowledge of brain plasticity and of the mechanisms of change
underlying exposure-based treatments to augment treatment-relevant learning and, ultimately,
clinical efficacy.
Exposure therapies depend on learning - more specifically, on extinction learning targeting
anxious symptomatology. Individuals with anxiety disorders, including OCD, have extinction
learning deficits and abnormal recruitment of fear extinction circuitry, particularly the
medial prefrontal cortex (mPFC). Augmentation of activity and plasticity within fear
extinction circuitry may enhance extinction and thus the efficacy of exposure therapies.
Transcranial direct current stimulation (tDCS) is a non-invasive brain modulation technology
that can alter resting membrane potential, brain plasticity, learning, and memory.
The investigators will test the effects of tDCS, applied to the mPFC, on extinction of
exposure-relevant fear. The investigators propose a two-day study to test the ability of tDCS
to augment exposure-relevant extinction learning among OCD patients. The investigators have
developed a brief behavioral test of extinction learning that encapsulates the therapeutic
exposure done during CBT; this consists of repeated in vivo exposure to individualized
symptom-provocative stimuli, accompanied by ritual prevention. On Day 1, OCD patients will
receive 20 minutes of Active-tDCS or Sham-tDCS, targeting the mPFC, immediately prior to
completing 60 minutes of therapeutic exposure. On Day 2, subjects will return to complete the
same exposure and response prevention exercise to test for exposure-relevant extinction
recall. Subjective distress will be monitored throughout the exposure and response prevention
exercise.
The investigators predict that subjects who receive Active-tDCS will show better acquisition
(faster and greater decreases subjective distress) and recall (greater percent extinction
retained) of exposure-relevant extinction learning when compared to subjects who receive
Sham-tDCS.
criteria for a disorder characterized by pathological fear and anxiety - obsessive-compulsive
disorder (OCD), posttraumatic stress disorder (PTSD), and other anxiety disorders - and the
global burden of these disorders is nearly as high as that of thought and mood disorders.
Exposure-based psychotherapies are among the most efficacious treatments for disordered
anxiety. However, partial response is common, and a sizeable minority of patients is
treatment refractory. To improve outcomes, the neuroscience-guided augmentation of these
proven approaches using brain-based interventions holds particular promise. This proposal
aims to harness our growing knowledge of brain plasticity and of the mechanisms of change
underlying exposure-based treatments to augment treatment-relevant learning and, ultimately,
clinical efficacy.
Exposure therapies depend on learning - more specifically, on extinction learning targeting
anxious symptomatology. Individuals with anxiety disorders, including OCD, have extinction
learning deficits and abnormal recruitment of fear extinction circuitry, particularly the
medial prefrontal cortex (mPFC). Augmentation of activity and plasticity within fear
extinction circuitry may enhance extinction and thus the efficacy of exposure therapies.
Transcranial direct current stimulation (tDCS) is a non-invasive brain modulation technology
that can alter resting membrane potential, brain plasticity, learning, and memory.
The investigators will test the effects of tDCS, applied to the mPFC, on extinction of
exposure-relevant fear. The investigators propose a two-day study to test the ability of tDCS
to augment exposure-relevant extinction learning among OCD patients. The investigators have
developed a brief behavioral test of extinction learning that encapsulates the therapeutic
exposure done during CBT; this consists of repeated in vivo exposure to individualized
symptom-provocative stimuli, accompanied by ritual prevention. On Day 1, OCD patients will
receive 20 minutes of Active-tDCS or Sham-tDCS, targeting the mPFC, immediately prior to
completing 60 minutes of therapeutic exposure. On Day 2, subjects will return to complete the
same exposure and response prevention exercise to test for exposure-relevant extinction
recall. Subjective distress will be monitored throughout the exposure and response prevention
exercise.
The investigators predict that subjects who receive Active-tDCS will show better acquisition
(faster and greater decreases subjective distress) and recall (greater percent extinction
retained) of exposure-relevant extinction learning when compared to subjects who receive
Sham-tDCS.
Inclusion Criteria:
- Primary diagnosis of OCD
- YBOCS severity score of at least 16 at time of screening
- Stable psychotropic medication status
Exclusion Criteria:
- Bipolar disorder
- Substance dependence in the past 3 months
- Regular anxiolytic medication use
- Psychostimulants
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