Compulsive Behavior, Obsessive-Compulsive Disorder
Conditions
Brief summary
This project seeks to identify causal neural mechanisms underlying unwanted, repetitive behaviors (compulsions). Using non-invasive brain stimulation coupled with practice in a computer task, we will modulate activity in a target brain region and measure effects on compulsive behaviors and related measures. This work could ultimately lead to the ability to treat compulsions more effectively by targeting the regions of the brain that can help or hinder attempts to overcome compulsions.
Interventions
BEHAVIORALSham Training
Computer-based task practice in a non-active/inert task.
DEVICESham Transcranial Magnetic Stimulation
Sham stimulation of non-brain areas. Delivered in a continuous Theta Burst Stimulation (TBS) pattern.
BEHAVIORALHabit Override Practice
Computerized "brain training" to provide practice in overriding avoidance habits.
DEVICETranscranial Magnetic Stimulation
Non-invasive method for temporary, focal stimulation of brain areas. Delivered in a continuous Theta Burst Stimulation (TBS) pattern.
Sponsors
Rebecca Price
National Institute of Mental Health (NIMH)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
Participants will: 1. Be between the ages of 18 and 60 years 2. Endorse problematic compulsive behaviors, per self-report and clinician-administered measures. 3. Agree to video taping of structured clinical interview 4. Report that they will reside in the Pittsburgh area for at least 5 weeks
Exclusion criteria
1. Failure to meet standard MRI inclusion criteria: those who endorse claustrophobia, those who have cardiac pacemakers, neural pacemakers, surgical clips in the brain or blood vessels, surgically implanted metal plates, screws or pins, cochlear implants, implanted uterine devices, metal braces, or other metal objects in their body, especially in the eye. Dental fillings do not present a problem. Plastic or removable dental appliances do not require exclusion. History of significant injury or surgery to the brain or spinal cord that would impair interpretation of results. Pregnancy, determined by pregnancy tests on females. 2. Medical contraindications for Transcranial Magnetic Stimulation (TMS): 1. Presence of a neurologic disorder or medication therapy known to alter seizure threshold (e.g., stroke, aneurysm, brain surgery, structural brain lesion, brain injury, frequent/severe headaches) 2. Recurrent seizures or epilepsy in participant or family history of hereditary epilepsy 3. Pregnancy 4. Metallic implants in body or other devices that may be affected by magnetic field 5. Significant heart disease or cerebrovascular disease 6. Medications with strong seizure threshold lowering potential or which may interfere with the efficacy of TMS (e.g., clozapine, stimulants) 3. Acute suicidality or other psychiatric crises requiring treatment escalation 4. Changes made to treatment regimen within 4 weeks of baseline assessment 5. Reading level \<6th grade as per participant self-report 6. Presence of bipolar, psychotic, autism spectrum, or substance use disorder (i.e. current problematic use of mood altering drugs such as cocaine, opiates, amphetamines, and barbiturates) 7. Presence of movement disorder or tics affecting manual responses 8. Inability to read text from 2 feet away (corrective lenses allowed)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intensity of urges to perform compulsive behaviors in response to laboratory triggers | 60min post-intervention | Custom-made laboratory assessment of ability to override compulsive behaviors in response to idiographic triggers: self-reported urge intensity (0-100 scale) |
| Brain activation in target region | 10-60min post-intervention | Mean Cerebral Blood Flow (CBF) in orbitofrontal cortex collected via functional Magnetic Resonance Imaging (fMRI) |
| Effort to resist compulsive behaviors in response to laboratory triggers | 60min post-intervention | Custom-made laboratory assessment of ability to override compulsive behaviors in response to idiographic triggers: self-reported effort needed to resist (0-100 scale) |
| Duration of compulsive behaviors in response to laboratory triggers | 60min post-intervention | Custom-made laboratory assessment of ability to override compulsive behaviors in response to idiographic triggers: duration of compulsive behavior performance (% of total time allotted) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Goal-directed cognition | 90min-1 week | Neuropsychological test of flexible goal-directed cognition (two-step task): switch score (higher score=better performance) |
| Yale-Brown Obsessive Compulsive Scale (Y-BOCS) | 1 week | Clinician-administered measurement of obsessions and compulsions (range: 0-40; higher score=worse outcome) |
| WHO Disability Assessment Scale 2.0 | 1 week | Self-report measure of general functioning and disability (0-100; higher score=worse outcome) |
| Obsessive Compulsive Inventory-Revised (OCI-R) | 1 week | Self-report measure of obsessions and compulsions (0-72; higher score=worse outcome) |
| Effort to resist compulsive behaviors in response to laboratory triggers | 1 week | Custom-made laboratory assessment of ability to override compulsive behaviors in response to idiographic triggers: self-reported effort needed to resist (0-100 scale) |
| Duration of compulsive behaviors in response to laboratory triggers | 1 week | Custom-made laboratory assessment of ability to override compulsive behaviors in response to idiographic triggers: duration of compulsive behavior performance (% of total time allotted) |
| Intensity of urges to perform compulsive behaviors in response to laboratory triggers | 1 week | Custom-made laboratory assessment of ability to override compulsive behaviors in response to idiographic triggers: self-reported urge intensity (0-100 scale) |
| Brain activation in target region | 1 week | Mean Cerebral Blood Flow (CBF) in orbitofrontal cortex collected via functional Magnetic Resonance Imaging (fMRI) |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORRebecca B Price, PhD
University of Pittsburgh
Outcome results
None listed