Basolateral amygdala–ventromedial prefrontal cortex connectivity predicts cognitive behavioural therapy outcome in adults with obsessive–compulsive disorder

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Cognitive behavioural therapy (CBT), including exposure and ritual prevention, is a first-line treatment for obsessive–compulsive disorder (OCD), but few reliable predictors of CBT outcome have been identified. Based on research in animal models, we hypothesized that individual differences in basolateral amygdala–ventromedial prefrontal cortex (BLA–vmPFC) communication would predict CBT outcome in patients with OCD.


We investigated whether BLA–vmPFC resting-state functional connectivity (rs-fc) predicts CBT outcome in patients with OCD. We assessed BLA–vmPFC rs-fc in patients with OCD on a stable dose of a selective serotonin reuptake inhibitor who then received CBT and in healthy control participants.


We included 73 patients with OCD and 84 healthy controls in our study. Decreased BLA–vmPFC rs-fc predicted a better CBT outcome in patients with OCD and was also detected in those with OCD compared with healthy participants. Additional analyses revealed that decreased BLA–vmPFC rs-fc uniquely characterized the patients with OCD who responded to CBT.


We used a sample of convenience, and all patients were receiving pharmacological treatment for OCD.


In this large sample of patients with OCD, BLA–vmPFC functional connectivity predicted CBT outcome. These results suggest that future research should investigate the potential of BLA–vmPFC pathways to inform treatment selection for CBT across patients with OCD and anxiety disorders.

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