Decreased inter- and intra-network connectivity after group cognitive behavioral therapy in patients with unmedicated obsessive-compulsive disorder

doi:10.5498/wjp.v15.i8.107860

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World Journal of Psychiatry

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World J Psychiatry. Aug 19, 2025; 15(8): 107860
Published online Aug 19, 2025. doi: 10.5498/wjp.v15.i8.107860

Table 1 Comparison of general demographic information between groups

mean ± SD	OCD (n = 33)	HC (n = 26)	t/χ²	P value
Sex (male)	16	11	0.15	0.78
Age	32.24 ± 7.38	28.23 ± 7.36	1.98	0.06
Education	15.18 ± 2.07	15.45 ± 1.76	-0.93	0.61
Age at onset	24.56 ± 9.15	/	/	/
Duration (months)	84.12 ± 79.15	/	/	/
Y-BOCS total	25.81 ± 4.78	/	/	/
Y-BOCS obsession	13.03 ± 2.91	/	/	/
Y-BOCS compulsion	12.88 ± 3.48	/	/	/
HAMD	12.94 ± 5.80	1.09 ± 1.44	11.06	0.000^b
HAMA	9.42 ± 3.80	0.77 ± 1.11	11.34	0.000^b

^bP < 0.001, differences were considered statistically significant.

Y-BOCS: Yale-Brown Obsessive-Compulsive Scale; HAMD: Hamilton Depression Scale; HAMA: Hamilton Anxiety Scale.

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Table 2 Seed points of the default mode, dorsal attention, frontoparietal, and salience networks

	Abbreviation	X (L/R)	Y (L/R)	Z (L/R)
DMN
Dorsal medial prefrontal cortex	dmPFC	-8	50	34
Ventral medial prefrontal cortex	vmPFC	-2	44	-12
Posterior cingulate cortex	PCC	-2	-48	28
Precuneus	Pcu	-2	-60	50
Superior frontal gyrus	SFG	-8/12	20/18	62/62
Inferior frontal gyrus	IFG	-42/50	26/30	-14/-6
DAN
Frontal eye fields	FEF	-24/24	2/-2	62/56
Superior occipital gyrus	SOG	-18/26	-66/-64	50/54
FPN
Anterior inferior parietal lobule	aIPL	-54/50	-48/-44	48/46
Dorsolateral prefrontal cortex	DLPFC	-38/44	32/42	30/26
SAN
Anterior insula	aINS	-30/32	20/20	-2/-4
Dorsal anterior cingulate cortex	dACC	6	30	40

DMN: Default mode network; DAN: Dorsal attention network; FPN: Frontoparietal network; SAN: Salience network; dmPFC: Dorsomedial prefrontal; vmPFC: Ventral medial prefrontal; PCC: Posterior cingulate cortex; Pcu: Precuneus; SFG: Superior frontal gyrus; IFG: Inferior frontal gyrus; FEF: Frontal eye field; SOG: Superior occipital gyrus; aIPL: Inferior parietal lobule; DLPFC: Dorsolateral prefrontal cortex; aINS: Anterior insula; dACC: Dorsal anterior cingulate cortex; L: Left; R: Right.

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Table 3 Comparison of demographic information before and after group cognitive-behavioral therapy treatment

	Before (n = 33)	After (n = 21)	t	P value
Sex (male)	16	11	/	/
Age	32.24 ± 7.38	32.50 ± 7.22	-0.315	0.75
Education	15.18 ± 2.07	16.04 ± 1.85	0.17	0.87
Age at onset	24.56 ± 9.15	24.32 ± 9.07	-0.37	0.72
Y-BOCS total	25.81 ± 4.78	16.41 ± 6.70	6.65	0.000^b
Y-BOCS obsession	13.03 ± 2.91	8.59 ± 3.11	5.40	0.000^b
Y-BOCS compulsion	12.88 ± 3.48	7.82 ± 4.47	5.37	0.000^b
HAMD	12.94 ± 5.80	6.83 ± 4.50	2.91	0.005^a
HAMA	9.42 ± 3.80	5.11 ± 3.25	3.41	0.001^a

^aP < 0.05, differences were considered statistically significant.

^bP < 0.001.

Y-BOCS: Yale-Brown Obsessive-Compulsive Scale; HAMD: Hamilton Depression Scale; HAMA: Hamilton Anxiety Scale.

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Table 4 Comparison of neuropsychological assessment results between groups

		OCD (n = 33)	HC (n = 26)	t	P value
MoCA-B	MoCA-B	27.79 ± 1.59	29.00 ± 0.87	-3.25	0.002^a
Visuospatial ability	Rey-O emulation time (second)	160 ± 80.67	128.63 ± 48.44	1.67	0.100
	Rey-O recall time (second)	79.57 ± 40.10	87.63 ± 25.01	-0.84	0.404
	Rey-O recall score	15.26 ± 7.97	21.27 ± 6.18	-2.99	0.004^a
	Rey-O recall organization score	4.53 ± 1.77	5.41 ± 1.10	-2.27	0.027^a
Memory	AVLT-N1	4.12 ± 1.60	4.36 ± 1.22	-0.60	0.548
	AVLT-N2	5.94 ± 2.01	7.18 ± 1.26	-2.81	0.007^a
	AVLT-N3	7.00 ± 2.19	8.55 ± 1.99	-2.65	0.011^a
	AVLT-N4 short-delayed recall	5.73 ± 2.18	7.36 ± 2.01	-2.81	0.007^a
	AVLT-N5 long-delayed recall	5.30 ± 2.42	7.05 ± 2.06	-2.77	0.008^a
	AVLT-N6	5.45 ± 2.47	7.36 ± 1.89	-3.07	0.008^a
	AVLT-reaccreditation	9.82 ± 2.11	10.91 ± 1.07	-2.52	0.015^a
Attention	SDMT-correct count	53.03 ± 12.47	61.18 ± 7.71	-2.99	0.004^a
	SDMT-error count	0.30 ± 0.63	0.72 ± 1.24	-1.47	0.150
	PASAT-correct count	32.79 ± 4.13	35.77 ± 2.93	-2.93	0.005^a
	DST-recite along	9.61 ± 1.32	9.59 ± 1.01	0.05	0.964
	DST-recite backwards	5.94 ± 1.69	7.05 ± 1.79	-2.32	0.024^a
	DST total score	15.54 ± 2.67	16.64 ± 2.42	-1.54	0.129
Executive function	SCWT-A (second)	21.27 ± 4.83	19.96 ± 3.43	1.18	0.24
	SCWT-B (second)	34.27 ± 10.86	28.32 ± 3.75	2.90	0.006^a
	SCWT-C (second)	63.76 ± 22.39	56.45 ± 9.93	1.44	0.157
	SCWT-C error count	0.46 ± 1.30	0.73 ± 2.33	-0.56	0.581
	STT-A practice (second)	7.33 ± 3.27	7.09 ± 3.54	0.26	0.791
	STT-A test (second)	39.30 ± 12.59	32.18 ± 8.80	2.30	0.025^a
	STT-B practice (second)	13.18 ± 5.04	10.59 ± 1.99	2.67	0.011^a
	STT-B test (second)	85.21 ± 22.79	70.96 ± 13.62	2.90	0.005^a
	CCST spontaneous classification	4.36 ± 1.24	6.22 ± 1.02	-5.83	0.000^b
	CCST classification of leads	8.79 ± 1.53	7.86 ± 1.81	1.97	0.056
	CCST total classification	13.15 ± 2.09	14.09 ± 2.07	-1.63	0.107
	Tower of Hanoi: Three discs moving steps	12.31 ± 4.46	8.82 ± 2.38	3.72	0.001^a
	Time (second)	40.50 ± 20.35	23.36 ± 17.39	3.22	0.002^a
	Tower of Hanoi: Four discs moving steps	23.97 ± 5.99	22.09 ± 6.93	1.06	0.293
	Time (second)	82.03 ± 33.93	62.04 ± 32.24	2.17	0.035^a
	Tower of Hanoi: Five discs moving steps	52.42 ± 9.67	42.23 ± 6.29	4.32	0.000^b
	Time (second)	171.16 ± 58.92	111.91 ± 29.40	4.81	0.000^b
Speech	Surname and city alternate correct number	26.81 ± 5.85	34.18 ± 5.79	-4.56	0.000^b
	Surname correct number	13.22 ± 3.47	17.77 ± 4.43	-4.23	0.000^b
	City correct number	13.59 ± 3.91	16.41 ± 4.46	-2.46	0.017^a
	Number of errors	1.22 ± 2.15	0.91 ± 1.63	0.57	0.570
	Repetition number	2.91 ± 4.60	1.36 ± 2.17	1.65	0.106
	Animal and fruit alternate correct number	15.97 ± 3.40	18.14 ± 3.06	-2.41	0.020^a
	Number of errors	0.21 ± 0.48	0.55 ± 0.91	-1.57	0.127
	Repetition number	0.09 ± 0.29	0.41 ± 1.10	-1.32	0.197

^aP < 0.05, differences were considered statistically significant.

^bP < 0.001, uncorrected.

MoCA: Montreal Cognitive Assessment; Rey-O: Rey-Osterrieth Complex Figure; ROCF complex image test; AVLT: Auditory-verbal learning test; SDMT: Symbol Digit Modalities Test; PASAT: Paced Auditory Serial Addition Test; DST: Digit Span Test; SCWT: Stroop Color Word Test; STT-A: Shape Trails Test A; STT-B: Shape Trails Test B; CCST: California Card Sorting Test.

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Table 5 Changes in neuropsychological assessments before and after treatment

Cognitive function	Test	Before GCBT	After GCBT	t	P value
Visuospatial ability	Rey-O emulation time (second)	160.73 ± 80.67	87.56 ± 21.48	2.67	0.000^b
Visuospatial ability	Rey-O recall score	15.26 ± 7.97	21.00 ± 5.45	-2.03	0.049
Memory	ALVT-N1	4.12 ± 1.60	6.11 ± 1.62	-3.31	0.002
	ALVT-N2	5.94 ± 2.01	7.56 ± 1.94	-2.15	0.038
	ALVT-N3	7.00 ± 2.19	9.22 ± 1.64	-2.82	0.007
	ALVT-N4	5.73 ± 2.18	8.56 ± 1.67	-3.60	0.001
	ALVT-N5	5.30 ± 2.42	8.11 ± 1.69	-3.26	0.002
	ALVT-N6	5.45 ± 2.48	8.33 ± 1.73	-3.26	0.002
Attention	SDMT correct number	53.03 ± 12.47	63.33 ± 12.07	-2.21	0.033
Executive function	STT-A time (second)	39.30 ± 12.59	29.89 ± 10.00	2.07	0.045
	CCST total score	13.15 ± 2.09	15.22 ± 1.30	-2.81	0.008
	Time taken to move four discs (second)	82.03 ± 33.93	33.44 ± 11.29	6.86	0.000^b

^bP < 0.001, uncorrected.

Rey-O: Rey-O: Rey-Osterrieth Complex Figure; ROCF Complex Image Test; AVLT: Auditory verbal learning test; SDMT: Symbol Digit Modalities Test; STT-A: STT-A: Shape Trails Test A; CCST: California Card Sorting Test; GCBT: Group cognitive-behavioral therapy.

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Table 6 Comparison of default mode network, dorsal attention network, frontoparietal network, and salience network intra- and inter-network functional connectivity before and after group cognitive-behavioral therapy

	Before-GCBT	After-GCBT	t	P value
Intra-network
DMN
dmPFC-vmPFC	0.38 ± 0.24	0.22 ± 0.23	2.37	0.022
vmPFC-LSFG	0.22 ± 0.20	0.09 ± 0.20	2.18	0.035
vmPFC-LIFG	0.33 ± 0.24	0.13 ± 0.26	2.68	0.010
Pcu-RIFG	0.23 ± 0.22	0.06 ± 0.20	2.70	0.010
LIFG-RIFG	0.62 ± 0.25	0.43 ± 0.18	3.00	0.004
DAN
LFEF-LSOG	0.50 ± 0.28	0.35 ± 0.24	2.04	0.047
LFEF-RSOG	0.37 ± 0.26	0.15 ± 0.25	3.01	0.003^a
Inter-network
DMN-DAN
vmPFC-RFEF	0.13 ± 0.22	-0.04 ± 0.16	2.99	0.004^a
vmPFC-RSOG	0.16 ± 0.22	0.04 ± 0.15	2.17	0.035
RIFG-LFEF	0.20 ± 0.26	0.04 ± 0.24	2.03	0.048
RIFG-RFEF	0.25 ± 0.27	0.10 ± 0.19	2.17	0.035
RIFG-RSOG	0.22 ± 0.21	0.08 ± 0.21	2.26	0.028
DMN-FPN
LSFG-LDLPFC	0.03 ± 0.24	-0.13 ± 0.23	2.26	0.029
RIFG-RaIPL	0.20 ± 0.26	-0.01 ± 0.26	2.62	0.012
RIFG-LDLPFC	0.24 ± 0.28	-0.00 ± 0.26	3.02	0.004
RIFG-RDLPFC	0.04 ± 0.21	-0.19 ± 0.21	3.85	0.000^b
RIFG-RDLPFC	0.04 ± 0.21	-0.19 ± 0.21	3.85	0.000^b
DMN-SAN
LSFG-dACC	0.20 ± 0.25	0.03 ± 0.21	2.47	0.017
LIFG-LaINS	0.24 ± 0.24	0.11 ± 0.19	2.11	0.040
RIFG-LaINS	0.07 ± 0.17	0.34 ± 0.28	5.13	0.000^b
RIFG-RaINS	0.34 ± 0.28	0.09 ± 0.19	3.53	0.001^a
RIFG-dACC	0.34 ± 0.29	0.09 ± 0.26	3.13	0.003^a
DAN-SAN
RFEF-RaINS	0.34 ± 0.20	0.20 ± 0.13	2.91	0.005^a
LSOG-LaINS	0.29 ± 0.23	0.12 ± 0.26	2.38	0.022
LSOG-RaINS	0.24 ± 0.20	0.11 ± 0.23	2.09	0.043

^aP < 0.05, differences were considered statistically significant, uncorrected.

^bP < 0.001, uncorrected.

DMN: Default mode network; DAN: Dorsal attention network; FPN: Frontoparietal network; SAN: Salience network; dmPFC: Dorsomedial prefrontal cortex; vmPFC: Ventral medial prefrontal cortex; PCC: Posterior cingulate cortex; Pcu: Precuneus; SFG: Superior frontal gyrus; IFG: Inferior frontal gyrus; FEF: Frontal eye field; SOG: Superior occipital gyrus; aIPL: Inferior parietal lobule; DLPFC: Dorsolateral prefrontal cortex; aINS: Anterior insula; dACC: Dorsal anterior cingulate cortex; L: Left; R: Right; GCBT: Group cognitive-behavioral therapy.

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Table 7 Correlations between functional connectivity and neuropsychological assessments after group cognitive-behavioral therapy

	dmPFC-vmPFC		VmPFC-RSOG		LIFG-LaINS		RIFG-LDLPFC		vmPFC-LIFG		LFEF-LSOG		LSOG-LaINS		LIFG-RIFG
	DMN		DMN-DAN		DMN-SAN		DMN-FPN		DMN		DAN		DAN-SAN		DMN
	r	P value	r	P value	r	P value	r	P value	r	P value	r	P value	r	P value	r	P value
Rey-O emulation time			-0.84	0.010	-0.87	0.005^a
Rey-O recall score	-0.73	0.042^a					-0.86	0.006^a
AVLT-N1							-0.87	0.005^a
AVLT-N4							-0.79	0.019^a
SDMT correct number	-0.76	0.028^a							-0.77	0.025^a
STT-A test	0.70	0.050									0.78	0.022^a	0.77	0.024^a
CCST score	-0.80	0.016^a							-0.76	0.024^a
Tower of Hanoi: Three discs moving steps			-0.73	0.040^a	-0.89	0.003^a	0.74	0.036^a
Time taken to move the three discs (second)															0.86	0.006^a
Tower of Hanoi: Four discs moving steps															0.77	0.024^a
Time taken to move the four discs (second)															0.85	0.007^a

^aP < 0.05, differences were considered statistically significant, uncorrected.

DMN: Default mode network; DAN: Dorsal attention network; FPN: Frontoparietal network; SAN: Salience network; dmPFC: Dorsal medial prefrontal cortex; vmPFC: Ventral medial prefrontal cortex; PCC: Posterior cingulate cortex; Pcu: Precuneus; SFG: Superior frontal gyrus; IFG: Inferior frontal gyrus; FEF: Frontal eye field; SOG: Superior occipital gyrus; aIPL: Inferior parietal lobule; DLPFC: Dorsolateral prefrontal cortex; aINS: Anterior insula; dACC: Dorsal anterior cingulate cortex; L: Left; R: Right; AVLT: Auditory Verbal Learning Test, Auditory Word Learning Test; SDMT: Symbol Digit Modalities Test, Symbol Digit Transformation Mode Test; STT-A: Shape Trails Test A, Shape Connectivity Test A; CCST: California Card Sorting Test; GCBT: Group cognitive-behavioral therapy.

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Citation: Zhang ZF, He Y, Su YQ, Liu JM. Decreased inter- and intra-network connectivity after group cognitive behavioral therapy in patients with unmedicated obsessive-compulsive disorder. World J Psychiatry 2025; 15(8): 107860
URL: https://www.wjgnet.com/2220-3206/full/v15/i8/107860.htm
DOI: https://dx.doi.org/10.5498/wjp.v15.i8.107860