Obsessive compulsive disorder - OCD treatment and therapy from NOCD
OCD Treatment

The ultimate guide to beating obsessive-compulsive disorder

Popular culture typically gets OCD wrong. OCD is not a punchline or personality quirk, and it's not just being a "neat freak." OCD is a serious mental health disorder, and we're working hard to provide education, understanding, and resources for the 1 in 40 people who struggle with it.

Dr. Patrick McGrath

By Patrick McGrath, PhD

Jan 16th, 2024

There's a lot of confusion regarding treatment for obsessive-compulsive disorder, starting with the most basic question: Is OCD even treatable, or do I have to “just live with it”?

Make no mistake: OCD is highly treatable. The key to getting your symptoms under control—so that OCD no longer rules your daily life—is understanding your treatment options and what's scientifically proven to work.

The gold-standard treatment for OCD is a type of behavioral therapy called ERP, or Exposure and Response Prevention. In fact, it's a treatment that was specifically created to treat OCD.

Anytime you're seeking treatment for a condition that's seriously impacting your life, it's important to understand the difference between “evidence-based” strategies and other potentially helpful tools such as lifestyle habits.

graph showing the difference between anecdotal and evidence based results for ocd treatments

Two evidence-based treatments for OCD

1. ERP Therapy

As mentioned above, the most successful treatment for OCD is a form of behavioral therapy called exposure and response prevention (ERP), which is why it's the recommended first-line of defense. OCD makes you feel like you have no choice but to engage in compulsions, but ERP aims to break the almost “auto-pilot” response between obsessions and compulsions.

It's customized for each person and their needs, but here's how ERP generally works: After asking you about your specific symptoms, a trained therapist who specializes in OCD creates your ERP therapy plan. Based on that, you'll work together to rank your fears or triggers based on how stressful they seem. This ranking system helps ensure the process moves at a pace that's appropriate for you.

To begin with, your therapist will typically prompt you to face a fear that brings on a mild amount of distress. When the fear thoughts come up—such as the fear that “something terrible will happen” if you don't do a compulsion—instead of responding with a compulsion, you gradually learn to tolerate the discomfort.

There's science at play here, because when you see that you handled the discomfort better than you thought you could, your brain gets a signal that there was nothing to fear in the first place (OCD is a skillful liar). And, as a result, your need to engage in compulsions goes away. It should be noted that only by refraining from performing compulsions are you able to break the OCD cycle. That's because compulsions only ever provide temporary relief from distress.

Here's a visual look at how ERP works:

ERP disrupts the cycle of triggers, obsessions, and compulsions

Conquering OCD is more accessible than ever

Research shows that remote, face-to-face ERP can be even more effective than in-person therapy, allowing you and your therapist to work in the real-life situations where OCD strikes.

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2. Medication for OCD

For some people with OCD, ERP therapy is most effective when accompanied by prescribed medication. This may be due to the severity of symptoms, a person's unique psychology and neurobiology, or other conditions that occur alongside OCD, such as major depressive disorder. In such cases, a treatment plan developed by trained professionals combining therapy with medication can provide the best chance at long-term recovery.

So what is the best medication for OCD? Medications called selective serotonin reuptake inhibitors (SSRIs) are often used to treat OCD, though other types of medication are also used, including certain tricyclic antidepressants (TCAs) and atypical antipsychotics. While SSRIs are also used to treat anxiety and depression, the dosage tends to be much higher for the treatment of OCD. Here are some examples of medications that are commonly prescribed for OCD:

What does an SSRI actually do? Well, an SSRI increases the levels of a chemical called serotonin in your brain (similarly, TCAs like clomipramine facilitate neurotransmission in the neurons that use serotonin, epinephrine, and norepinephrine). For people who aren't able to make progress in ERP, medication helps reduce their anxiety or distress to more manageable levels so they can engage fully in the exercises they'll do during ERP.

It can sometimes take 8 to 12 weeks before SSRIs take effect, so if medication is part of your treatment plan, it's important to keep taking it as directed even if your OCD symptoms don't improve right away. Some side effects are possible, including nausea, decreased libido, and trouble sleeping, but you should always talk to your healthcare provider before getting off a drug if you're thinking about quitting.

As for whether some treatment plans for OCD use medications alone, without ERP, the answer is this: Medication alone is unlikely to lead to recovery after it's discontinued, and the majority of people find the greatest success when combining medication management with ERP therapy. In the words of Kimberly Quinlan, LMFT, an OCD specialist, “medication alone is not a silver bullet for OCD recovery.”

Medication alone is not a silver bullet for OCD recovery. Although it can often feel like a lifeline to those suffering in deep despair at the hand of those obsessions, when medication is used, it is rarely effective when taken in isolation.

Kimberley Quinlan

Adjunctive strategies to support your treatment journey

As mentioned earlier, there's a big difference between an actual treatment for OCD and habits and lifestyle changes that can be helpful when you're dealing with OCD. To truly recover, evidence-based treatment is key. But that doesn't mean you won't find additional relief with some of these strategies:

Acceptance and Commitment Therapy (ACT)

There's no one therapy that works for every single person with any condition—including OCD. So what happens when you've tried ERP and don't respond to it, or you choose not to participate in ERP? In some cases, Acceptance and Commitment Therapy (ACT) can be a helpful option—and it's often used successfully in conjunction with ERP.

image illustrating Acceptance and Commitment Therapy (ACT) as described in the other text

Rather than confronting your distressing thoughts head on, ACT aims to change your relationship with your obsessions so that you view OCD thoughts with more neutrality. What do we mean by this? When people with OCD have triggering thoughts, they tend to label them as “bad.” They want to run away from their distress and avoid discomfort. ACT is about learning to accept your thoughts, emotions, and urges for what they are. By seeing the thoughts as neither good or bad, you may feel a reduced need to engage with your compulsions.

The main way ACT works is by helping you develop psychological flexibility, gaining greater control over the way you respond to uncomfortable feelings like anxiety or fear. Through a mental practice known as cognitive defusion, you learn to coexist with your obsessions and the distress that they cause, working with your therapist to identify and move towards your values. Over time, this teaches you that your obsessions don't have to dictate what you do—you are in the driver's seat, not OCD.

OCD specialist Tracie Zinman-Ibrahim, LMFT, CST, uses an example to illustrate how ACT can be applied to OCD: “When you have a mosquito bite, you don't get overly involved every time it itches. You're unlikely to spend your energy trying to figure out why it itches, why there are mosquitoes, why the mosquitoes chose you to bite, or anything like that. You simply accept that you have been bitten and that it has caused discomfort that will pass with time if you leave it alone. If you scratch at it, everything just intensifies and feels worse.”

There are far fewer studies backing ACT's effectiveness than we have for ERP, but existing evidence is promising, and supports ACT as an adjunctive strategy for managing OCD.

a meditating man

Practicing Mindfulness & Meditation

Mindfulness is a mental practice that involves bringing your attention and awareness to the present moment. Ultimately, the goal of mindfulness is to observe what's going on in the moment without judgment, reducing stress and promoting relaxation in the process.

One of the best things that you can gain from mindfulness is the ability to observe your own thoughts without judgment. In particular, if you find it difficult to disengage from intrusive thoughts and other obsessions, practicing mindfulness can help you reduce their power to cause you distress, shame, or worry.

a running woman

Prioritizing your Physical Health

Scientists have found that exercise, when used as part of a comprehensive treatment plan, can support faster and more lasting recovery from OCD. One study showed that adding exercise to an OCD treatment regimen can lead to better results. When participants with OCD used aerobic exercise to boost their heart rate, their OCD symptoms decreased faster than the symptoms of people who only saw a health counselor.

Additionally, people with OCD are disproportionately affected by sleep disorders—in fact, one study showed that 42% of people with OCD meet diagnostic criteria for delayed sleep-wake phase disorder, and another study has demonstrated that insomnia symptoms are strongly associated with more severe OCD symptoms. As a result, maintaining good sleep hygiene can also help you maximize the effectiveness of a specialized treatment plan.

a running woman

Family or Community Support

It's common knowledge among OCD therapists that the support of family, friends, and communities can be invaluable to people's recovery journey. But this isn't just based on anecdotes—it's been shown in research, as well. A recent analysis of NOCD Therapy members at risk of dropping out of treatment showed that peer outreach and support from other members of the OCD community led to 30% greater adherence to ERP treatment.

In other words, when people starting ERP therapy encounter obstacles or difficulties on their treatment journey, the support of their community can be the key difference that keeps them on the road to recovery.

Treatments that are unhelpful for treating OCD

Howie Mandel video youtube link

Howie Mandel on why specialty treatment for OCD is so important

OCD is highly treatable—but it requires the right kind of therapy.

Learn about starting specialized OCD therapy →

If you take one message away from this article, it should be this: OCD requires specialized treatment. Decades of treatment and research have illuminated the best evidence-based approaches to OCD treatment—and have also revealed many approaches that don't work. In fact, some forms of non-specialized treatment for OCD can actually make symptoms worse.

One of these approaches is often referred to broadly as “talk therapy.” Talk therapy can be a hugely beneficial tool—even a lifeline—for many people, but it isn't an effective way to treat OCD. In fact, any type of therapy that doesn't follow specialized, evidence-based techniques we introduced above is unlikely to be effective for treating OCD, and may make the condition worse.

In talk therapy, for instance, a therapist might ask you to analyze the reasoning behind your obsessions, seek meaning in your fears and worries, and search for answers to your doubts and worries. Unfortunately, doing so can quickly become compulsive, leading to increased rumination, mental review, reassurance-seeking, and other similar compulsions. And like all compulsions, these only make OCD symptoms worse over time.

Some behavioral forms of therapy can also backfire significantly. Aversive therapy, for instance, which seeks to get rid of unpleasant behaviors by linking them with unpleasant feelings, is ineffective and even harmful for OCD. One common form of this is “rubber-band snapping,” in which a therapist directs a client to snap a rubber band against their wrist whenever they have a distressing thought.

Unfortunately, this does nothing to keep obsessions from returning again and again, and even reinforces one's negative associations with unpleasant thoughts that don't actually mean anything in particular or pose any danger. In turn, it makes obsessions more frequent and distressing. Similar non-physical techniques, such as being told to Stop! unhelpful or unpleasant thoughts, are likewise ineffective for treating OCD. You can't simply stop obsessions, no matter how hard you try—but you can take their power away.

How to learn once and for all if you have OCD

If you've read this far and you're thinking “But I still don't know if I have OCD for sure?” then we need to set the record straight on how OCD is diagnosed in the first place.

Some people wonder whether self-screening is possible. Please know that the way you experience your own symptoms is entirely valid, but only a qualified therapist trained in the diagnosis and treatment of OCD can do a proper assessment to diagnose OCD. After asking you about your symptoms and health history, they’ll use criteria explained in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) to determine whether you have OCD.

The criteria include:

  • The presence of obsessions, compulsions or both.
  • Your obsessions or compulsions take up a lot of time (more than an hour per day).
  • Your obsessions or compulsions cause significant distress or interfere with your ability to show up for school, work, social activities, or other things in life that you value.
  • Your symptoms aren't related to a different mental health disorder, such as generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), body dysmorphic disorder (BDD), or something else.

The final word on OCD treatment

By some estimates, it can take an average of 14-17 years from the onset of symptoms for someone who is struggling to get the appropriate diagnosis and effective treatment for OCD.

This long struggle is, in fact, easy to avoid. Effective treatment exists, and ERP is—for the majority of people—the most foolproof place to begin.