Project Title:
Neurophysiological investigation of the approach-avoidance axis in OCD: applications to neuromodulation
Project Narrative:
Despite FDA approval for deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) in the form of a Humanitarian Device Exemption, this therapy remains underutilized and poorly understood. Based on the pathologically avoidant phenotype underlying OCD and the pro-approach behavior required to overcome fear-based avoidance, we conceptualize our study of the neurophysiological underpinnings of OCD by tracking behavior and ventral striatum neural activity along the approach-avoidance axis. Doing so would create a foundational understanding of the neurobehavioral effects of DBS that will generalize to other disorders characterized by dysregulation of behavior along the approach-avoidance axis.
DBS and OCD:
Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a major cause of global disability. OCD is characterized by obsessions (i.e., unwanted intrusive thoughts) and compulsions (i.e., repetitive ritualistic behaviors), and exemplifies a pathologically avoidant phenotype where greater degrees of avoidance are associated with greater symptom severity and treatment resistance. In the 20-40% of OCD patients that are treatment refractory, deep brain stimulation (DBS) of the ventral capsule and ventral striatum (VC/VS) is an effective therapy that achieves significant benefit in 66% of patients.
While VC/VS DBS does not acutely relieve OCD symptoms, DBS often produces a “pro-approach” response including an increase in talkativeness, a desire to engage in activities, extroversion, and affiliative behavior. Our central therapeutic hypothesis is that VC/VS DBS achieves eventual benefit in OCD by providing the “boost” in pro-approach behavior that allows individuals to overcome their pathological fear-based avoidance. Thus, we focus on the approach-avoidance axis as one of the critical neurobehavioral axes underlying the pathophysiology of OCD. Our overall goal is to develop a mechanistic understanding of DBS for OCD by rigorously investigating the relationship between clinical symptoms, behaviors (i.e., approachful vs. avoidant), and neurophysiology.
#NEWS: Dr. @nicoleprovenza.bsky.social is the recipient of a new $3.7m R01 award from the #NIH & #NIMH for her project, "Neurophysiological investigation of the approach-avoidance axis in OCD: applications to neuromodulation" 🧠
#DBS #OCD #DeepBrainStimulation #ObsessiveCompulsiveDisorder #Research