Obsessive-compulsive disorder (OCD) is associated with substantial impairments in quality of life and is among the most disabling psychiatric disorders. Exposure therapy is among the first-line of treatments for obsessive-compulsive disorder (OCD) . Extinction learning is thought to be a core mechanism of therapeutic exposure. Fear and safety signal learning are traditionally associated with activity and connectivity within the canonical corticolimbic "fear circuit", which includes the amygdala, medial prefrontal cortex (mPFC), and hippocampus. Transcranial direct current stimulation (tDCS) is a neuromodulation technology that can augment brain plasticity, learning, and memory. The proposed study will test if obsessive-compulsive disorder (OCD) is associated with inhibitory safety learning deficits and if transcranial direct current stimulation (tDCS) normalizes functional connectivity and safety signal processing to recover extinction deficits in obsessive-compulsive disorder (OCD).
18 years of age or older
speak English fluently, and
able to provide written and verbal informed consent.
meet criteria for OCD as determined by structured clinical interview
active severe substance use disorder(s)
acute suicidality
history of bipolar or psychotic disorder(s)
significant developmental disabilities
Parallel
Active transcranial direct current stimulation
DeviceMultifocal transcranial direct current stimulation will be delivered. The anode will be placed over the frontal pole (Fpz, 10-20 electroencephalogram \[EEG\]) and will be surrounded by 5 return electrodes (cathodes). Current will be set at 1.5mA and will be ramped in and out for 30 seconds at the beginning and end of a 20-minute stimulation period.
Sham transcranial direct current stimulation
DeviceMultifocal transcranial direct current stimulation will be delivered. The anode will be placed over the frontal pole (Fpz, 10-20 electroencephalogram \[EEG\]) and will be surrounded by 5 return electrodes (cathodes). Current will be set at 1.5mA and will be ramped in and out for 30 seconds at the beginning of a 20-minute period.
Blood oxygen level-dependent (BOLD) response to create functional brain activation maps
Brain activity will be estimated with blood oxygen level-dependent (BOLD) response, which will be measured with magnetic resonance imaging (MRI).
Skin conductance response (SCR) will be measured by collecting electrodermal activity data from the left hand
Skin conductance data will be used as an index of anxious reactivity to experimental cues.
Threat expectancies will be measured by asking participants to rate the probability of receiving a shock using a 0-100 scale with zero equal to 0% chance and 100 equal to 100% chance; higher values are indicative of worse anxious reactivity
Threat expectancies will be used as an index of anxious reactivity to experimental cues.
Functional brain connectivity will be measured blood oxygen level dependent (BOLD) response
Correlations in brain activity between regions and networks measured with blood oxygen level dependent (BOLD) response captured with magnetic resonance imaging (MRI)
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Yale University
Lead sponsor
National Institute of Mental Health (NIMH)
Collaborator
