Does cognitive-behavioral therapy affect goal-directed planning in obsessive-compulsive disorder?

Cross-sectional studies have reported failures in goal-directed planning in obsessive-compulsive disorder (OCD). It remains unclear whether these deficits confer vulnerability to developing OCD, or are a consequence of symptoms. The present study examined goal-directed learning before and after cognitive behavioral therapy (CBT), using treatment as a tool to reduce symptoms. Eighteen adult OCD patients undergoing 17 sessions of CBT completed an established task of model-based (i.e., goal directed) versus model-free planning as well as measures of OCD and depression before and after treatment. We thus tested whether improvements in goal-directed performance accompany improvements in OCD symptoms or if instead task performance remains stable despite symptom improvement. Results showed prior to treatment, higher OCD severity was associated with greater deficits in model-based planning. OCD severity scores significantly improved from pre- to post-treatment. Inconsistent with the state-view, OCD symptom improvement was not accompanied by improvements in model-based performance. At post-treatment, OCD severity scores were no longer correlated with model-based performance. Together, these data suggest that reducing OCD symptoms with CBT does not affect goal-directed planning. This supports a trait model of the relationship between goal-directed planning and OCD symptoms, such that problems in goal-directed planning may be an OCD risk factor.