Resting-state functional connectivity of goal-directed and habitual-learning systems: The efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder

There is an imbalance between goal-directed and habitual-learning system in patients with obsessive-compulsive disorder (OCD). At present, the relationship between cognitive behavior therapy (CBT) as a first-line therapy and goal-directed and habitual-learning disorder is still unclear. We attempted to discuss the effect of CBT treatment in patients with OCD, using abnormalities in goal-directed and habitual-learning-related brain regions at baseline as predictive factors. A total of 71 subjects, including 35 OCD patients and 36 healthy controls, were recruited. The OCD patients underwent 8 weeks of CBT. These patients were divided into two groups based on treatment response (Nresponders = 18, Nnonresponders = 17). Further subgroup analysis was conducted based on disease duration (Nshort = 17, Nlong = 18) and age of onset (Nearly = 14, Nlate = 21). We collected resting-state ROI-ROI functional connectivity data and apply repeated-measures linear mixed-effects models to investigate the differences of different subgroups. CBT led to symptom improvement in OCD patients, with varying degrees of effectiveness across subgroups. The orbitofrontal cortex (OFC) and insula, key regions for goal-directed behavior and habitual-learning, respectively, showed significant impacts on CBT efficacy in subgroups with different disease durations and ages of onset. The findings suggest that the goal-directed system may influence the efficacy of CBT through goal selection, maintenance, and emotion regulation. Furthermore, we found that disease duration and age of onset may affect treatment outcomes by modulating functional connectivity between goal-directed and habitual-learning brain regions. •The study examines how CBT affects OCD patients and brain function related to learning patterns.•The research uncovers diverse responses to CBT based on disease duration and age of onset.•The findings emphasize the role of the goal-directed system in influencing CBT’s effectiveness.