Obsessive-compulsive disorder (OCD) is a chronic mental health condition that causes a cycle of unwanted and distressing intrusive thoughts and compulsive physical or mental behaviors. Because OCD symptoms can affect your work, school, relationships, and ability to handle day-to-day activities, it can be a tough or even debilitating condition to live with if left unmanaged.
However, OCD is highly treatable with evidence-based treatments like exposure and response prevention (ERP) therapy and medication.
How is OCD treated?
OCD is characterized by recurring intrusive thoughts, images, urges, feelings, and/or sensations known as obsessions. To cope with the anxiety caused by obsessions or to prevent a feared thing from happening, people with OCD perform mental or physical actions known as compulsions.
Often, people become stuck in a cycle of obsessions and compulsions that can be difficult to escape—which is why specialized treatment is so important. Like any mental health condition that’s considered chronic, there is no official “cure” for OCD. However, it is highly treatable and managing your symptoms can significantly improve your quality of life.
Exposure and response prevention (ERP) therapy and medication are evidence-based treatments that are the most effective for getting OCD symptoms under control.
Exposure and response prevention (ERP) therapy
Exposure and response prevention (ERP) therapy, also sometimes known as exposure and ritual prevention or informally as “exposure therapy,” is a form of cognitive behavioral therapy (CBT) specially designed to treat all types of OCD. Decades of scientific research support ERP’s efficacy, with one study revealing that 80% of people with OCD see major improvements in their symptoms.
Before the introduction of ERP as an OCD treatment in the 1960s, healthcare providers believed that OCD was untreatable. They found that people didn’t respond well to traditional psychotherapy, medication, or behavioral therapies like systemic desensitization or aversion therapy. Researchers later discovered that being gradually exposed to feared stimuli while refraining from engaging in compulsions—the basis of ERP—reduced OCD symptoms. Additional studies performed in outpatient and inpatient settings revealed that most patients experienced a significant improvement in symptoms maintained for up to two years post-treatment.
Because of these substantial results, ERP is now seen as one of the first-line treatments for managing every OCD subtype—the theme that your symptoms typically revolve around. Some common OCD subtypes include contamination, harm, and relationships.
ERP breaks the OCD cycle by intentionally exposing you to your obsessions and teaching you how to handle them without engaging in compulsive behaviors, explains Patrick McGrath, PhD, Chief Clinical Officer at NOCD.
When you begin ERP, your therapist will help you organize your obsessions and triggers into a hierarchy based on how much distress they cause—this is known as an exposure hierarchy or “fear ladder.” Your fears are ranked on a simple scale ranging from 1 (minimal distress) to 10 (extreme distress) using the Subjective Units of Distress Scale (SUDS).
From there, you and your therapist will set treatment goals and start working through ERP therapy exercises known as exposures and response prevention techniques.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Exposures
After creating your exposure hierarchy, you’ll be guided through exercises known as exposure and response prevention.
Starting to practice exposures can seem daunting, and you may be hesitant about facing thoughts and situations that are distressing. But rest assured that you’re not expected to jump into the deep end in the beginning.
“By starting with the triggers that cause the least distress, you and your therapist can gradually work your way up the hierarchy, gaining confidence and facing difficult feelings without becoming too overwhelmed at any point,” explains Dr. McGrath.
The hierarchy you create at the beginning of your ERP journey helps you build a foundation of skills through easier exposures, helping you eventually overcome your most difficult challenges.
The exposure hierarchy can also keep you motivated throughout your ERP journey. “When you learn that you can tolerate your discomfort at a 3/10 distress level, you can aspire to the freedom and achievement you’ll feel from conquering triggers that cause a 9/10 distress level later on,” explains Dr. McGrath.
Response prevention techniques
The second half of ERP is learning response prevention techniques, which are strategies that help you refrain from engaging in compulsions. Doing exposures alone won’t accomplish anything if you’re still engaging in compulsions to relieve distress from obsessions, which is why the response prevention aspect of ERP is so crucial for seeing real results.
“By resisting compulsions, you break the vicious cycle of OCD and learn that you are able to tolerate distress and accept uncertainty,” says Dr. McGrath.
Response prevention also helps your therapist identify sneaky compulsions that might typically go unnoticed, such as avoidance. “When the fear of triggers prevents you from doing things you would normally do, avoiding them is actually compulsive and can be tough to notice, especially if it’s an ingrained habit,” explains Dr. McGrath. Mental compulsions like rumination and mental checking can also be difficult to identify.
How long does ERP therapy take to work?
Research reveals that it takes about two months to see a significant change in your symptoms. And, for some people, it may take even longer, depending on how long it takes them to get through their fear ladder.
“Recovery is always dependent on how committed you are to treatment,” says Tracie Ibrahim, LMFT, CST, Chief Compliance Officer at NOCD. “I’ve had people start feeling better after a few short weeks, and then I’ve had people who are still doing compulsions a lot, and it takes a little bit longer.”
Medication for OCD
Medication may be added to your treatment plan for several reasons, including whether or not you have co-occurring mental health conditions like major depressive disorder or generalized anxiety disorder, your unique psychology and neurobiology, and, of course, your personal choice.
Medication may also be used if you have difficulty getting through ERP exercises. “In some situations, people with OCD might try to do ERP, and they find that it’s very difficult due to the intensity of emotions they get when they try to do exposures,” explains says Jamie Feusner, MD, NOCD’s Chief Medical Officer and Professor of Psychiatry at the University of Toronto. “Having a reduction in those emotions and experiences could help them tolerate exposure exercises and make headway on them.”
If your OCD symptoms are severe, medication may help reduce their intensity. “Some people might have severe OCD and have been dealing with it for a long time and would like to have every tool they could have at their disposal to try to get better as soon as possible,” explains Dr. Feusner.
The best way to determine if medication makes sense for your treatment plan is to speak with a healthcare provider who specializes in OCD, which your ERP therapist can connect you to.
Types of medications used for OCD
There are several medications backed by research to be effective for treating OCD symptoms. These include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Atypical antipsychotics
- Aripiprazole (Abilify)
- Risperidone (Risperdal)
The best way to determine if medication makes sense for your treatment plan is to speak with a healthcare provider who specializes in OCD, which your ERP therapist can connect you to.
How to get a prescription for OCD medications
Although any licensed doctor can legally prescribe any of the drugs listed above, it’s most helpful to work with a board-certified psychiatrist who has training and experience in treating OCD. That’s because OCD specialists will have a more in-depth understanding of your symptoms and which medications could be most effective.
The IODCF provider directory is a resource for finding OCD specialists by location, and the over 650 trained OCD specialists in the NOCD Therapy directory regularly refer therapy members for medication management with trained providers.
Other treatments that may be helpful for OCD
If you’ve tried these first-line treatments and aren’t seeing any improvements in your symptoms, there are other options you can discuss with your therapist and prescriber to see if they’re right for you.
- Acceptance and commitment therapy (ACT). This form of talk therapy involves changing your relationship with your obsessions rather than directly confronting your distressing thoughts.
- Intensive outpatient programs (IOPs). IOPs deliver more intensive, high-level mental healthcare for people who need additional help that goes beyond traditional outpatient therapy sessions.
- Transcranial magnetic stimulation (TMS). TMS is a newer treatment involving short magnetic pulses that stimulate the brain’s neurons (nerve cells), and research revealed that it could also relieve symptoms of OCD.
- Deep brain stimulation (DBS). DBS is a reversible surgical procedure that uses electrical stimulation to encourage changes in brain activity, which may be helpful for extremely severe or treatment-resistant OCD.
- Gamma knife radiosurgery (GKRS). GKRS is a safe and non-invasive treatment for refractory or treatment-resistant OCD.
- Focused ultrasound (FUS). Also known as high-intensity focused ultrasound (HIFU), FUS is a noninvasive procedure that uses high-frequency sound waves to target and destroy certain tissues in the body.
Because OCD is such a complex mental health condition, understand that 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?
A starting point to getting evidence-based treatment for OCD is to find a licensed therapist who specializes in diagnosing and treating this complex mental health condition. OCD specialists are trained to recognize OCD—even in cases where it’s already been misdiagnosed—and can create an effective, individualized treatment plan tailored to your unique needs.
Though ERP therapy can be delivered in person, it can be more accessible and efficient when done through a video appointment (also known as teletherapy). In fact, research reveals that just 11 hours of virtual ERP led to significant improvements in study participants’ OCD symptoms.
Dr. McGrath explains that virtual ERP allows therapists to be more involved in their patients’ lives. “When I was in office, I had to pretend my desk was their stove for some exposure exercises,” he explains. “I had to put some red construction paper on the top to look like the flame and we pretended the knobs on the desk were the temperature knobs of the stove. I would hope people would go home and practice it the way we had practiced it in the office. 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.”
Although ERP has been proven to be a successful first-line treatment for OCD, it has been costly to access in the past. On average, an ERP session could cost around $350 out-of-pocket and was almost never covered by insurance as little as five years ago. Thankfully, this life-changing therapy has become more available in recent years. It is now covered by most major insurance plans, making it easier for more people to begin their treatment journey.
Bottom line
Living with OCD can be extremely challenging—but there is effective treatment available. First-line, evidence-based treatments like exposure and response prevention (ERP) therapy and medications like SSRIs have allowed many people with OCD to experience life-changing improvements in their symptoms.
Although OCD is a chronic condition, the proper treatment can break the cycle of obsessions and compulsions so you can focus on other aspects of your life.