New research could improve the odds that people with obsessive-compulsive disorder (OCD) will receive a therapy that really works for them—something that eludes more than a third of those who currently get OCD treatment. The study, performed at the University of Michigan, suggests the possibility of predicting which of two types of therapy will help teens and adults with OCD: One that exposes them to the specific subject of their obsessive thoughts and compulsive behaviors, or one that focuses on general stress reduction and a problem-solving approach.

While the researchers caution that it’s too early for their work to be used by patients and mental health therapists, they’re planning and conducting further studies that will test the framework and see if it also applies to children with OCD or obsessive tendencies.

Comparing Therapies

The new study, published in the American Journal of Psychiatry, examines advanced brain scans of 87 teens and adults with moderate to severe OCD who were randomly assigned 12 weeks of one of the two types of therapy. The researchers found that in general, both types of therapy reduced the symptoms that participants experienced. The approach known as “exposure therapy,” a form of cognitive behavioral therapy or CBT, was more effective and reduced symptoms more as time went on, compared with stress-management therapy, or SMT.

But when the researchers looked back at the brain scans taken before the patients began therapy, and linked them to individual treatment response, they found striking patterns. The brain scans were taken while patients performed a simple cognitive task and responded to a small monetary reward if they did the task correctly.

Those who started out with more activation in brain circuits for processing cognitive demands and reward during the tests were more likely to respond to CBT—but those who started out with less activation in those same areas during the same tests were more likely to respond well to SMT.

“We found that the more OCD-specific form of therapy, the one based on exposure to the focus of obsession and compulsion, was better for relieving symptoms, which in itself is a valuable finding from this head-to-head randomized comparison of two treatment options,” says Stephan Taylor, MD, the study’s senior author and a professor of psychiatry at Michigan Medicine, U-M’s academic medical center.

“But when we looked at the brain to see what was behind that response, we found that the more strength patients had in certain brain areas were linked to a greater chance of responding to exposure-based CBT.”