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Objectives: Although cognitive behavioral therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD), the treatment mechanisms remain poorly understood. This study aimed to investigate the effects of CBT on changes in the intrinsic whole-brain functional network of OCD patients. Materials and Methods: Twenty drug-naive and noncomorbid OCD patients were recruited, and resting-state functional magnetic resonance imaging was performed before and after 12 weeks of CBT. Moreover, 20 healthy controls were scanned twice with a 12-week interval. A graph-theory degree centrality (DC) approach and functional connectivity method were used to analyze the whole-brain functional network hub and connectivity changes in OCD patients before and after CBT treatment. Results: A significant group × time interaction on DC was found in the left dorsolateral prefrontal cortex (DLPFC); the DC in the left DLPFC was significantly reduced after CBT treatment. Resting-state functional connectivity (RSFC) between the left DLPFC and right orbitofrontal cortex was increased in the OCD patients at baseline, and normalized after CBT treatment. RSFC changes between the left DLPFC and default mode network (DMN) positively correlated with changes in clinical symptoms in OCD patients. Conclusions: These findings suggest that CBT can modulate changes in intrinsic functional network hubs in the cortico–striato–thalamo-cortical circuit in OCD patients. Cognitive control network and DMN connectivity may be a potential imaging biomarker for evaluating CBT treatment for OCD.

In this study, we explored different spontaneous functional connectivity patterns between the anterior prefrontal cortex and other brain regions in nonmedicated patients with obsessive-compulsive disorder in a resting state, and examined the relationship between the abnormal spontaneous functional connectivity patterns of the anterior prefrontal cortex and clinical symptoms in patients with obsessive-compulsive disorder. Twenty nonmedicated patients with obsessive-compulsive disorder and 20 sex-matched and age-matched healthy individuals underwent resting state functional MRI scanning. Compared with the healthy controls, significantly increased positive functional connectivity with the right anterior prefrontal cortex was observed in the right insula and the middle cingulate cortex in patients with obsessive-compulsive disorder. Our findings suggest that abnormal intrinsic or spontaneous functional connectivity in the cognitive control system in a resting state may underlie the pathophysiology of obsessive-compulsive disorder.