The cognitive reappraisal component of CBT (Table 3) trains patients to change their thoughts and emotional responses to OCD symptoms and is known to engage dorsal prefrontal regions [35–36, 39, 51]. Cognitive reappraisal is therefore likely to be useful for patients presenting with emotion regulation deficits mediated by dorsal cognitive circuitry. Cognitive training programs for OCD targeting executive functions including organizational strategies and planning (see Table 3) have been tried in a small number of studies [168–171]. The programs were found to improve the executive functions targeted [168–171] and, in three studies, OCD symptoms [169–171]. Preliminary findings suggest that methylphenidate augmentation may be beneficial in treatment-resistant OCD [172]. Further, some patients with OCD who report their symptoms to be exacerbated by executive function problems also note that their symptoms have improved during treatment with methylphenidate [38]. Methylphenidate increases central dopamine and norepinephrine activity, which improves executive and attentional functioning and emotion regulation [173], in addition to influencing reward mechanisms as reported above. However, there are some case reports that methylphenidate can worsen OCD symptoms [174] and for some patients antipsychotic
