If you’re living with obsessive-compulsive disorder (OCD), you’re probably searching for the treatment that will actually work. Dealing with OCD can feel overwhelming, especially when symptoms start interfering with your relationships, your job, or even simple day-to-day tasks. The good news? OCD is highly treatable. Evidence-based therapies like exposure and response prevention (ERP) therapy, medication, and other interventions have helped many people break free from the OCD cycle of obsessions and compulsions.
Here’s what actually works, and how to get started.
How is OCD treated?
Two symptoms characterize OCD:
- Obsessions: Unwanted, intrusive thoughts, images, urges, feelings, or sensations that cause fear and anxiety.
- Compulsions: Physical or mental acts done to relieve distress from obsessions or prevent something bad from happening.
Often, people become stuck in a cycle of obsessions and compulsions that can be difficult to escape, which is why specialized treatment is so necessary.
The two most effective, evidence-based treatments for OCD are:
- Exposure and response prevention (ERP) therapy, a type of cognitive behavioral therapy (CBT)
- Medication, typically selective serotonin reuptake inhibitors (SSRIs)
These treatments are often used together, but many people experience significant progress with ERP alone. If first-line treatments aren’t enough, other options, such as acceptance and commitment therapy (ACT) and transcranial magnetic stimulation (TMS), may also be helpful.
What is ERP therapy?
ERP is a specialized form of CBT proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms. It teaches you how to face intrusive thoughts (exposures) without engaging in compulsions (response prevention).
ERP works for all OCD subtypes, including harm OCD, contamination OCD, relationship OCD, and “pure O.”
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
What to expect in ERP:
- You’ll work with an ERP therapist to build a fear hierarchy using the Subjective Units of Distress Scale (SUDS).
- You’ll start with low-level exposures and gradually work your way up.
- You’ll learn how to tolerate uncertainty and distress without resorting to compulsions.
“By resisting compulsions, you break the vicious cycle of OCD and learn that you can tolerate distress and accept uncertainty,” says Patrick McGrath, PhD, NOCD’s Chief Clinical Officer.
How long does ERP take to work?
Many people begin to notice improvements in their OCD symptoms within two months. However, your progress depends on your consistency with exposures and your willingness to resist compulsions. For some, change happens in a matter of weeks. For others, it takes longer, and that’s completely okay.
“Recovery is always dependent on how committed you are to treatment,” says Tracie Ibrahim, LMFT, CST, Chief Compliance Officer at NOCD.
When is medication helpful for OCD?
Medication may be added to your treatment plan if:
- You’re struggling to complete ERP exercises
- Your symptoms are severe
- You have other mental health conditions, like depression or anxiety
Medication can reduce anxiety and distress, making ERP more manageable.
“Having a reduction in those emotions and experiences could help them tolerate exposure exercises and make headway on them,” says Jamie Feusner, MD, NOCD’s Chief Medical Officer and Professor of Psychiatry at the University of Toronto.
Which medications are used to treat OCD?
The most commonly prescribed medications for OCD include:
- SSRIs: Fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), and escitalopram (Lexapro)
- Tricyclic antidepressants (TCAs): Clomipramine (Anafranil)
- Atypical antipsychotics (as augmentation): Aripiprazole (Abilify), and risperidone (Risperdal)
OCD often requires higher doses than depression. A psychiatrist with OCD experience can help tailor your medication plan.
What if ERP and medication don’t work?
If you’ve already tried ERP and medication and still feel stuck, there are other evidence-based options you can explore:
- Acceptance and commitment therapy (ACT): Helps you accept thoughts without acting on them
- Intensive outpatient programs (IOPs): Offer more structured and frequent support
- Transcranial magnetic stimulation (TMS): A noninvasive brain stimulation technique
- Deep brain stimulation (DBS): Surgical procedure for severe, treatment-resistant OCD
- Gamma knife radiosurgery (GKRS) or focused ultrasound (FUS): Noninvasive procedures that target brain regions associated with OCD
Because OCD is such a complex mental health condition, it may take some trial and error to find the best treatment. “There is always hope—even if other treatments haven’t worked, it’s still possible to find a plan that allows you to conquer OCD,” says Dr. Feusner.
Where can I get treatment for OCD?
You’ll want to find a therapist trained in ERP. Many therapists now offer ERP through teletherapy, which is:
- Just as effective as in-person care
- Proven to work in as little as 11 hours
- Covered by many insurance plans
“When I was in office, I had to pretend my desk was their stove for some exposure exercises,” explains Dr. McGrath. “Now, I can just tell them directly to go to their stove, and I can go to mine, too. We’re both going to learn how to do this together without doing any kind of compulsions.”
You can find licensed ERP-trained providers through the NOCD Therapy directory or the IOCDF’s provider directory.
If you want a prescription for OCD medications, it’s crucial to work with a board-certified psychiatrist who has training and experience in treating OCD. An ERP therapist can refer you to a trained provider for medication management.
Frequently asked questions
What is the most effective treatment for OCD?
The most effective treatment for OCD is exposure and response prevention (ERP) therapy, often combined with medication like SSRIs. ERP helps people confront fears and resist compulsions.
Can OCD be treated without medication?
Yes. Many people experience significant improvement with ERP therapy alone. However, medication may be helpful if symptoms are severe or if ERP is difficult to tolerate at first.
How long does OCD treatment take to work?
Most people begin to see progress with ERP therapy within 8 to 12 weeks. Medication can take several weeks to reach full effect. Treatment duration depends on individual factors and consistency.
Is OCD ever completely cured?
OCD is considered a chronic condition, but it is highly treatable. With ongoing therapy and support, many people experience lasting symptom relief and improved quality of life.
Bottom line
You don’t have to live under the weight of OCD. With ERP therapy—and, if needed, medication and other interventions—you can break the cycle of obsessions and compulsions. OCD is a chronic condition, but it’s highly treatable. Help is available, and you can start feeling better.
Key takeaways
- Exposure and response prevention (ERP) therapy is an evidence-based, first-line treatment for OCD.
- Medication, especially SSRIs and clomipramine, can support ERP or help in severe cases.
- Other treatments, such as ACT, IOPs, TMS, and DBS, may be helpful if first-line options are not effective.
- Virtual ERP therapy is effective, accessible, and often covered by insurance.
- OCD is treatable, and recovery is possible with the right support.