Treatment for Obsessive-Compulsive Disorder (OCD)
The treatment of OCD is primarily based on two evidence-based approaches:
- Cognitive Behavioral Therapy (CBT) — specifically, Exposure and Response Prevention (ERP), which is considered the most effective psychological treatment for OCD.
- Medication — most commonly, Selective Serotonin Reuptake Inhibitors (SSRIs).
These two treatment options may be used individually or in combination, depending on each person’s needs.
According to the International OCD Foundation (IOCDF), the combination of ERP and medication is often the most effective approach particularly in cases where symptoms are severe, significantly affect daily functioning, or occur alongside other mental health conditions.
It is important to emphasize that the prescription and monitoring of medication is the sole responsibility of a psychiatrist. The psychiatrist will carefully assess the individual’s needs, adjust dosage as necessary, and monitor for potential side effects to ensure both safety and long-term effectiveness of treatment.
For more information about medication for OCD, please visit:
https://iocdf.org/ocd-treatment-guide/medication/
Source: IOCDF, https://iocdf.org/ocd-treatment-guide/
What does Exposure and Response Prevention (ERP) Involve?
ERP consists of two equally important stages:
1. Exposure
In this stage, the individual is gradually and systematically exposed to stimuli (situations, images, objects, or thoughts) that trigger anxiety, doubt, or distress.
2. Response Prevention
At the same time, with the therapist’s support, the individual is encouraged to refrain from carrying out compulsions (whether physical rituals or mental acts) that they might normally use to relieve the anxiety caused by obsessions. Through this process, the person gradually learns to manage the distress and tolerate uncertainty.
Example of ERP for Harm-Related Obsessions
To illustrate the process, here is an example of ERP that could be applied to harm-related obsessions such as the persistent fear of harming a loved one with sharp objects (e.g., knives).
Exposure stage: The process begins with easier, low-level targets. For example, the individual might start by reading words related to knives or viewing pictures and videos of such objects. Later, they might spend time in the kitchen near knives without touching them, then gradually progress to holding a knife briefly in the presence of the therapist. At a more advanced stage, treatment goals may include staying in a room with a knife without supervision, or handling a knife while in the presence of a loved one.
Response prevention stage: At this stage, the individual is encouraged to refrain from engaging in the compulsive behaviors they would normally resort to in order to reduce distress, but which in the long run maintain the disorder. Specifically, the individual is asked not to remove the knife, not to seek reassurance about the safety of the area, and to avoid repeating “safe” thoughts or behaviors aimed at relieving their anxiety.
Here, the individual is encouraged to avoid engaging in compulsive behaviors that typically reduce distress but maintain the disorder in the long run. In this case, the person may practice not removing the knife from the room, not seeking reassurance about safety, and not repeating “safe” thoughts or actions intended to neutralize anxiety.
Where does Treatment Take Place?
ERP is not limited to the therapist’s office. In addition to in-office sessions, many interventions can be carried out in real-life environments where difficulties occur at home, in the workplace, or in public spaces when therapeutically appropriate. Online sessions are also possible, offering flexibility and access for individuals who may have practical limitations or prefer remote support.