Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging

The scope of our research is to understand how people with OCD regulate emotions and which brain regions and networks support this, particularly when using cognitive reappraisal strategies. Functional magnetic resonance imaging, electroencephalography, eye tracking, and psychophysiological measures can be used to investigate behavior and brain activity during emotion regulation tasks in clinical populations.

We have shown that OCD patients may recruit different neural pathways during the experience and the regulation of negative emotions, mainly the frontal parietal control network.

Our findings help clarify our CV affects emotional regulation potential guide more target therapeutic interventions in the future.

In future work, we will explore how different therapies modify the activity of networks involved in emotional regulation and explore whether these changes are associated with clinical improvements.

[Narrator] To begin, complete the psychometric scales validated in the respective population and the various questionnaires in the correct order. First, proceed with the sociodemographic questionnaire, followed by the clinical questionnaire. Then sequentially complete the obsessive compulsive inventory and the emotion regulation questionnaire. Finally, collect information on the Yale Brown Obsessive Compulsive Scale, if the patients with OCD have not completed it at recruitment. After completing all the scales, explain the cognitive reappraisal task to be performed inside the scanner, and train the participants in the emotion regulation strategies to be used. Train participants in distancing and reinterpretation strategies before scanning. While presenting pictures with disturbing scenarios, instruct participants to cognitively reframe the scene in one of the ways mentioned on the screen. Specifically instruct participants not to use non-cognitive strategies such as looking away during the task. Acquire magnetic resonance imaging, or MRI data, using a 3 Tesla scanner with a 32 channel head coil. Before starting the acquisition, instruct participants to lie supine on the scanning bed. Add additional cushioning around the head to ensure comfort during the scan, minimizing movement. Provide participants with ear protection, a response box in their right hand, and an emergency stop button in their left hand in case they need to stop the scanner urgently. Use an MRI compatible response pad to record participants' emotional ratings during scanning. Include an anatomical magnetization prepared rapid acquisition gradient ECHO, or MP RAGE sequence in the scanning session for registration purposes. Set the following parameters as mentioned. Have the participants perform a cognitive reappraisal task inside the scanner. Use the referenced software and an MRI compatible angled mirror system to display task instructions and visual stimuli during scanning. During this task, acquire a multi-band Echo planer imaging, or EPI sequence, sensitive to fluctuations in the blood oxygenation level dependent or bold contrast with the scanning parameters as mentioned. Begin each block with an instruction, observe, maintain or regulate, presented for four seconds in the middle of the screen. Afterward, show two different stimuli of equivalent valence for 10 seconds each. Ask participants to rate the intensity of their negative emotion on a scale from one to five, one representing a neutral feeling and five representing an extremely negative feeling. Display a fixation cross in the middle of the screen for 10 seconds after each block to minimize carryover effects. After the MRI session, interview participants to ensure they followed the instructions and adequately performed the task and inquire about the emotional regulation strategies used. Pre-process the neuroimaging data using the referenced software. Use an exclusion criterion of mean frame wise displacement or FD greater than 0.5 millimeters to account for in scanner movements, looking at the mean FD values from the generated quality check report. Additionally, visually inspect the output reports to evaluate the accuracy of co-registration and identify any potential issues during the pre-processing pipeline. Use the FSL maths function from the referenced software to spatially smooth the resulting time series. Apply a full width at half maximum kernel of eight millimeters for smoothing. For processing the FMRI data, adjust the matrix dimensions of the FMRI time series data from pre-processing to ensure compatibility between software. Use the 3D re-sample function from the referenced software with the specific template as the master image. For first level or single subject analyses, define contrasts of interest in SPM 12. Model conditions for the 20 seconds during which images were on the screen, excluding instruction, rating, and cross fixation periods. Convolve the blood oxygenation level dependent response at each voxel with the canonical hemodynamic response function. Apply a high pass filter of 128 seconds. Use the mean cerebral spinal fluid and white matter signals as covariates as well as variables to correct for movement calculated during FMRI prep pre-processing. For second level or group analyses, perform two sample T tests to compare groups across the contrasts of interest for both the full sample and each emotion regulation subgroup. Conduct whole brain analysis using cluster threshold in correction with a voxel P less than 0.001 uncorrected and a cluster P less than 0.05 family-wise error, or FWE, corrected. Results for the test with the full sample revealed that the maintain condition significantly differed from the observed condition and that the regulate condition differed from maintain. Controls showed better regulation than patients with OCD. For the distancing subgroup, the maintain condition significantly differed from the observed condition, but the regulate condition no longer significantly differed from maintain. The success variable was also not significantly different between groups. In the reinterpretation subgroup, the maintain condition significantly differed from the observed condition and the regulate condition differed from maintain. Control showed better regulation than patients with OCD. In both strategy subgroup, the maintain condition significantly differed from the observed condition, but the regulate condition no longer significantly differed from maintain. The success variable was not significantly different between groups. In the psychometric scales, patients with OCD scored significantly higher than controls in all OCI-R subscales, with the exception of hoarding. For the reinterpretation subgroup, controls presented higher activation than patients with OCD in the precuneus for the maintain more than observe contrast. On the other hand, for the both strategies subgroup, patients with OCD presented increased activation in the right posterior insula and the bilateral precentral gyri.