Does DBT therapy work for OCD? The short answer is no. ERP remains the best option for treating OCD, as it helps disrupt the cycle of OCD symptoms, whereas DBT focuses on emotional regulation.
Living with obsessive-compulsive disorder (OCD) can be hard enough on its own. So when you’re ready to embark on getting treatment, it makes sense to investigate all the options, so you’re as prepared as possible.
One kind of therapy that might come up when researching treatments for OCD is dialectical behavior therapy (DBT). DBT is well-known for its effectiveness in treating borderline personality disorder (BPD) and emotional dysregulation. Given that OCD can involve strong emotional reactions—like distress—some people have wondered if DBT might help with the condition.
While DBT can teach helpful skills like distress tolerance and emotional regulation, it is not the most effective treatment for OCD. In fact, DBT on its own can sometimes worsen symptoms of OCD. The most effective, clinically supported, first-line treatment for OCD is exposure and response prevention (ERP) therapy. Unlike DBT, ERP directly targets OCD symptoms, like intrusive thoughts and compulsions, helping you break free from the OCD cycle.
If you’re wondering if DBT could still play a role in your treatment, read on to learn more about how it works, who it’s for, and why ERP remains the best option for treating OCD.
What is DBT?
DBT is a type of cognitive behavioral therapy (CBT) developed by psychologist Marsha Linehan to help people who struggle with emotional dysregulation, self-harm, and suicidal thoughts. It was originally designed for borderline personality disorder (BPD) but has since been adapted for other mental health conditions, including depression, eating disorders, and substance use disorders.
At its core, DBT helps people balance acceptance and change—learning to accept difficult emotions while also working on healthier ways to manage them. The therapy is structured, and focuses on building four key skills:
1. Mindfulness
Mindfulness is the practice of being fully present in the moment, and observing your thoughts, feelings, and sensations without judgment. It serves as the foundation for all other DBT skills, helping you develop greater self-awareness and emotional regulation.
By practicing mindfulness, you can learn to step back from distressing thoughts and emotions instead of reacting impulsively. This can be helpful if you struggle with anxiety, depression, or overwhelming emotions, as it allows more time to respond thoughtfully—rather than getting stuck in negative thought patterns.
2. Distress tolerance
Distress tolerance skills help you cope with intense emotions and crises without engaging in harmful behaviors. Instead of trying to immediately change or escape emotional pain, these skills encourage you to sit with discomfort in a healthy way.
Some of the key distress tolerance techniques include:
- Self-soothing: engaging in comforting activities like listening to music or taking a warm bath
- Distraction techniques: shifting focus to something else to avoid acting impulsively
- Radical acceptance: acknowledging reality as it is, rather than resisting or denying painful situations
By developing distress tolerance, you can learn to navigate emotional pain with resilience rather than avoidance.
3. Emotion regulation
Emotion regulation focuses on understanding, managing, and reducing the intensity of overwhelming emotions. If you struggle with mood swings or intense emotional responses, these skills can help bring more stability to your life.
Important emotional regulation strategies include:
- Identifying and recognizing emotions rather than reacting automatically
- Reducing emotional vulnerability through healthy habits (e.g., sleep, nutrition, and exercise)
- Balancing emotional urges by trying to practice the opposite of the urge, which encourages more positive behaviors
By strengthening these skills, you can gain more emotional balance and control over how you react to stressful situations.
4. Interpersonal effectiveness
Interpersonal effectiveness focuses on improving communication and relationship skills. This skill-building exercise teaches you how to assert your needs, set healthy boundaries, and navigate conflict while maintaining self-respect and respect for others.
Some of the core interpersonal effectiveness strategies include:
- Identifying your communication style and be more mindful of how you communicate
- Setting and maintaining boundaries in relationships
- Navigating difficult conversations in a way that strengthens, rather than damages, connections with others
If you struggle with people-pleasing, difficulty saying no, or intense emotional reactions in relationships, interpersonal effectiveness can help build healthier, more fulfilling connections.
While DBT can be a helpful approach for many mental health challenges, it’s important to consider whether it’s the right fit for a specific condition—like OCD—before assuming it will be effective.
Does DBT Work for OCD?
The short answer? Not really.
While there may be some evidence suggesting that DBT can help with certain aspects of OCD, it is not widely recognized as an effective treatment for the disorder. There isn’t enough research to confirm its effectiveness across a large population of people with OCD. Exposure and response prevention (ERP) therapy remains the most researched, evidence-based, and clinically supported treatment for OCD.
ERP is preferable to DBT because DBT does not directly target the obsessions and compulsions that define OCD, nor does it teach you how to resist engaging in compulsions when you feel anxious. Instead, it focuses on managing emotions, which may be helpful for some people but does not disrupt the OCD cycle.
As Tracie Ibrahim, Chief Compliance Officer and Therapist at NOCD, explains, “DBT is about distress tolerance and learning how to regulate yourself when you’re dysregulated, and OCD is not a dysregulation disorder.”
DBT is about distress tolerance and learning how to regulate yourself when you’re dysregulated, and OCD is not a dysregulation disorder.
Tracie Ibrahim
That means that while some people with OCD might benefit from learning certain DBT skills alongside ERP exercises (more on this below), DBT itself is not an effective standalone treatment for OCD. In fact, the official website for DBT therapy does not even include OCD as a condition the therapy can treat—further reinforcing that DBT is not the best approach for OCD.
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 about using DBT alongside ERP?
In some cases, therapists might use DBT in addition to ERP, but only if you have co-occurring conditions that require more direct support for emotional regulation. For example, you might benefit from learning DBT skills to manage emotional instability, while also engaging in ERP for OCD if you experience the following:
- Co-occurring conditions (like BPD, depression, or PTSD) that require emotional regulation
- Intense emotional responses that make it harder to engage in ERP
- Intense difficulty tolerating distress
However, Ibrahim says the two forms of therapy usually aren’t practiced at once, in the same session: “I might send someone with emotional regulation issues or a personality disorder to somebody else for DBT, while I do OCD specific therapy, but they don’t go together.” If your ERP therapist is trained in DBT, they might be able to guide you through both treatments one at a time.
Ibrahim reiterates that DBT and ERP serve different purposes, and DBT should never replace ERP as the primary treatment for OCD.
Why ERP is the best treatment for OCD
ERP is a specialized form of cognitive behavioral therapy (CBT) designed to help you face your obsessions and resist compulsions. Instead of trying to regulate emotions like DBT does, ERP helps you gradually face your fears while learning to sit with uncertainty, and resist compulsions. This process helps rewire the brain’s fear response and teaches you that you don’t need to perform compulsions to feel safe. Unlike DBT, which teaches distress tolerance more generally, ERP teaches you how to tolerate the specific distress you feel when intrusive thoughts arise—which is why it is more effective for OCD.
Bottom line
If you’re wondering whether DBT is an effective therapy for OCD, the answer is that there is not enough research to confidently recommend it—especially as a standalone treatment. While DBT is great for emotional regulation and distress tolerance, it does not address the core mechanisms of OCD the way ERP does.
That doesn’t mean DBT is useless—some people with OCD may find certain DBT skills helpful, especially if you have co-occurring conditions. But if you’re looking for the most effective, research-backed way to treat OCD, ERP remains the best option.
If you or a loved one is struggling with OCD, the best thing you can do is find a therapist who specializes in ERP. With the right support, you can take your life back from OCD.
Key takeaways
- DBT is not an evidence-based treatment for OCD. Even the official DBT therapy website does not list OCD as a condition it is designed to treat.
- ERP remains the best option for OCD treatment. It is the most researched and clinically supported therapy, directly addressing obsessions and compulsions.
- Some people with OCD may use DBT skills, but DBT itself is not a standalone treatment for OCD. It may be helpful for co-occurring conditions, but does not replace ERP.