OBJECTIVE Cognitive behavioral therapy (CBT) is efficacious for hoarding disorder (HD), though results are modest. HD patients show an increase in activity in the dorsal anterior cingulate cortex (dACC) when making decisions. The aim of this study is to determine whether CBT's benefits follow improvements in dACC dysfunction or abnormalities previously identified in other brain regions. METHOD In this randomized clinical trial of 64 treatment-seeking HD patients, patients received group CBT, delivered weekly for 16 weeks, versus wait list. Functional magnetic resonance imaging was used to examine neural activity during simulated decisions about whether to acquire and discard objects. RESULTS During acquiring decisions, activity decreased in several regions, including right dorsolateral prefrontal, right anterior intraparietal area, both right and left medial intraparietal areas, left and right amygdala, and left accumbens. During discarding decisions, activity decreased in right and left dorsolateral prefrontal, right and left rostral cingulate, left anterior ventral insular cortex, and right medial intraparietal areas. None of the a priori brain parcels of interest significantly mediated symptom reduction. Moderation effects were found for left rostral cingulate, right and left caudal cingulate, and left medial intraparietal parcels. CONCLUSIONS Therapeutic benefits of CBT for HD do not appear to be mediated by changes in dACC activation. However, pretreatment dACC activation predicts outcome. Findings suggest the need to re-evaluate emerging neurobiological models of HD and our understanding of how CBT affects the brain in HD, and perhaps shift focuses to new neural target discovery and target engagement trials. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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囤积症认知行为疗法随机试验后神经活动的变化。

目的 认知行为疗法 (CBT) 对囤积障碍 (HD) 有效，但效果有限。HD 患者在做出决定时表现出背侧前扣带皮层 (dACC) 的活动增加。本研究的目的是确定 CBT 的益处是否随着 dACC 功能障碍或先前在其他大脑区域发现的异常的改善而出现。方法 在这项针对 64 名寻求治疗的 HD 患者的随机临床试验中，患者接受了团体 CBT，每周进行 16 周，而不是等候名单。功能性磁共振成像用于检查在关于是否获取和丢弃对象的模拟决策期间的神经活动。结果 在获取决策期间，多个区域的活动减少，包括右背外侧前额叶、右前顶内区、左右内侧顶内区、左右杏仁核和左伏隔核。在放弃决定期间，左右背外侧前额叶、左右嘴侧扣带回、左前腹侧岛叶皮层和右内侧顶内区域的活动减少。没有任何感兴趣的先验大脑包裹显着介导症状减轻。发现左吻侧扣带回、左右尾侧扣带回和左内侧顶内包裹体有调节作用。结论 CBT 对 HD 的治疗益处似乎不受 dACC 激活变化的影响。然而，预处理 dACC 激活可预测结果。研究结果表明需要重新评估新兴的 HD 神经生物学模型以及我们对 CBT 如何影响 HD 大脑的理解，也许将重点转移到新的神经目标发现和目标参与试验上。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。