One of the troubles that often troubles OCD patients is the inability to suppress unreasonable behaviors (such as repeated checks, cleaning, etc.), or the inability to get rid of unreasonable thoughts (such as “I will lose control of my saliva”, “My family will be in danger”, etc.). The patient is extremely frustrated and distressed as a result, and even doubts whether they are crazy. The research presented today may help us understand the underlying reasons.
This was conducted by scientists majoring in psychiatry at the University of Michigan using a meta-analysis method. The so-called meta-analysis is to concentrate all research findings under a certain research topic, eliminate low-quality studies with flawed methods, and comprehensively compare the results of other high-quality studies. The obvious advantage of this is that a relatively large “sample” can be obtained: an independent study may only have a few dozen participating patients, but a meta-analysis is equivalent to gathering hundreds of participants. Its conclusion is also more representative.
This study synthesized data from 10 independent studies, involving head scan results of nearly 500 patients with obsessive-compulsive disorder. These independent studies all suggest that different neural circuits or brain regions may be the cause of obsessive-compulsive disorder, but the conclusions overlap and are inconclusive.
Research findings
Through this meta-analysis, researchers have identified the etiology of obsessive-compulsive disorder as the cingulo opercular network, a neural circuit in the brain that involves several interconnected regions in the center of the brain.
Previous studies have revealed that this neural circuit has the function of error avoidance, or the ability to detect potential errors and cancel certain behaviors to avoid adverse consequences. This study found that patients with obsessive-compulsive disorder have lower activity in this circuit compared to the normal population.
The patient with obsessive-compulsive disorder has not been impaired in their ability to perceive potential errors (as mentioned at the beginning of this article, knowing that a certain idea or behavior is unreasonable), and this patient is aware of it themselves, as confirmed by brain scans. But to achieve this error avoidance function, it is necessary to be able to cancel or suppress a certain behavior in a timely manner. This study confirms that the low activity of the buckle island cover network leads to the impairment of this function.
In layman’s terms, this deficiency is like when the driver steps on the brake pedal while driving (realizing the wrong signal and issuing an error avoidance command), but there is a problem with the connection between the brake pedal and the wheels, so the wheels do not stop.
Inspiration for treatment
This research conclusion supports the current mainstream treatment methods. What I mean by ‘mainstream’ is the exposure and response prevention commonly implemented in the healthcare systems of developed countries in Europe and America. This method, through systematic and gradual practice, can help patients gradually adapt to anxiety and get rid of past compulsive response patterns. Its essence is to strengthen the inhibitory function within the nervous system. According to the researcher’s analogy, it is equivalent to establishing a connection between the brake pedal and the wheel, or strengthening the original connection.
The findings of this study can also provide support for other treatment methods (such as transcranial magnetic stimulation mentioned in the column). Knowing which neural circuit is causing obsessive-compulsive disorder can make the target of magnetic field stimulation more clear.
All exploration of obsessive-compulsive disorder from the perspective of neuroscience research is aimed at clarifying its “lesions” and pathogenesis, so as to make treatment methods (whether psychological, pharmacological, or electromagnetic stimulation) more precise and accurate. Due to the unsatisfactory research findings, all treatment methods are somewhat similar to using anti-aircraft guns to kill mosquitoes, which are not precise enough and may not meet the expectations of patients. Those self proclaimed statements about how effective they are should have stopped long ago!
Patients should not overly trust the effectiveness of a certain method due to their eagerness to seek treatment. 50-70% is a reasonable expectation, and exceeding this ratio or probability is currently a miracle. But there is no need to be pessimistic about this. I see that every small discovery in recent years is gradually moving towards the goal of precise treatment. Although there are no groundbreaking discoveries, I feel that we are getting closer and closer to the day when we will “pierce through the window paper”.