| Summary: | Although cognitive behavioral therapy (CBT) is effective for patients with obsessive-compulsive disorder (OCD), 40% of OCD patients show a poor response to CBT. This study aimed to identify the cortical structural factors that predict CBT outcomes in OCD patients. A total of 56 patients with OCD received baseline structural MRI (sMRI) scanning and 14 individual CBT sessions. The linear support vector regression (SVR) models were used to identify the predictive performance of sMRI indices, including gray matter volume, cortical thickness, sulcal depth, and gyrification value. The patients’ OC symptoms decreased significantly after CBT intervention (<i>p</i> < 0.001). We found the model with the comprehensive variables exhibited better performance than the models with single structural indices (MAE = 0.14, MSE = 0.03, R<sup>2</sup> = 0.36), showing a significant correlation between the true value and the predicted value (r = 0.63, <i>p</i> < 0.001). The results indicated that a model integrating four cortical structural features can accurately predict the effectiveness of CBT for OCD. Future models incorporating other brain indicators, including brain functional indicators, EEG indicators, neurotransmitters, etc., which might be more accurate for predicting the effectiveness of CBT for OCD, are needed.
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