Obsessive compulsive disorder - OCD treatment and therapy from NOCD

OCD Treatment: A Complete Guide

By Taneia Surles, MPH

Feb 17, 2025 • 17 minute read

Reviewed byPatrick McGrath, PhD

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. 

Thankfully, several decades of research show that OCD is highly treatable with evidence-based treatments like exposure and response prevention (ERP) therapy and medication.

What are the most effective treatments for OCD?

OCD is a complex mental health condition characterized by re-occurring 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. 

Decades of scientific research support ERP’s efficacy, with one study revealing that 80% of people with OCD see major improvements when they do this specialized therapy. Regarding medication, selective serotonin reuptake inhibitors (SSRIs), in particular, are considered the first-line medication for treating OCD, as they have a success rate between 40-60% for patients with OCD.

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. CBT is an umbrella term for various talk therapies based around the idea that the way you think, act, and feel are intertwined, and that negative thoughts and feelings can entrap you in a cycle.

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 subject 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. 

With the guidance of a therapist who specializes in ERP, you will better accept uncertainty and doubt as being a part of life, instead of viewing them as unacceptable.

“OCD wants you to believe that compulsions will make you feel better or keep obsessions from happening, but it doesn’t work,” says Dr. McGrath. “Obsessions always come back. In reality, compulsions teach you to run from obsessions, which only gives them more power.” 

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.

OCD wants you to believe that compulsions will make you feel better or keep obsessions from happening, but it doesn’t work. Obsessions always come back. In reality, compulsions teach you to run from obsessions, which only gives them more power.

Patrick McGrath, PhD

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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.

By resisting compulsions, you break the vicious cycle of OCD and learn that you are able to tolerate distress and accept uncertainty.

Patrick McGrath, PhD

Dr. McGrath says that a common response prevention technique is the non-engagement response. Non-engagement responses are brief, easy phrases to help you acknowledge the uncertainty of intrusive thoughts without paying them any mind. Saying things like “Maybe, maybe not,” “So what?” or “Okay, fine” can help you sit with the discomfort without feeling the need to respond to intrusive thoughts.

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.

While response prevention might seem straightforward, it’s best to practice this exercise with a therapist who’s received specialized training rather than trying it alone. Your therapist can guide you through specific techniques and help you avoid common mistakes that could hinder your progress.

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Habituation and inhibitory learning

Two processes that contribute to ERP being so effective for managing OCD are habituation and inhibitory learning.

  • Habituation refers to the brain’s natural process of adjusting to the distress caused by obsessions and compulsions. When you repeatedly confront your triggers without giving in to compulsions, your brain starts to realize that you can handle the discomfort that comes from fear or uncertainty. In time, this means your obsessions actually cause less distress than they used to. 
  • Inhibitory learning occurs when you repeatedly prove your OCD fears and worries wrong. As you learn a new way to respond to OCD, your new experiences take the place of your previous beliefs. 

Dr. McGrath shares that there are other signs that ERP is working. “Sometimes, something you worried about could actually happen, and you’ll learn that you’re more capable of handling unexpected, uncomfortable experiences than you thought,” he explains. “You and your therapist might also work to focus on your values and choices as a way to resist OCD’s influence. In doing so, you can bring a new sense of confidence and courage to other areas of your life.”

Sometimes, something you worried about could actually happen, and you’ll learn that you’re more capable of handling unexpected, uncomfortable experiences than you thought.

Patrick McGrath, PhD

Treatment for different OCD subtypes

ERP is effective for all OCD subtypes. However, treatment is customized to the symptoms you may be experiencing relating to how your OCD presents through different subtypes or themes.

Here are some examples of response prevention techniques for different OCD subtypes:

Harm OCD Obsession: “I’m afraid I’ll hit someone while driving.”
Compulsion: Avoiding driving
Response Prevention Technique: Driving away from your block without circling back again

Contamination OCD Obsession: “What if I get someone’s germs and become deathly ill?”
Compulsion: Excessively washing hands 
Response Prevention Technique: Delaying washing hands after touching presumed “dirty” surfaces

Relationship OCD Obsession: “Does my partner really love me?”
Compulsion: Seeking constant reassurance that your partner loves you
Response Prevention Technique: Writing “It’s possible that we break up one day” in your journal

POCD Obsession: “What if I’m sexually attracted to children?”
Compulsion: Avoiding situations where children may be present
Response Prevention Technique: Spending time at a family gathering where children are around

Sexual Orientation OCD Obsession: “What if I’m straight and I don’t know it?”
Compulsion: Watching porn to check if you have a groinal response
Response Prevention Technique: Watching content related to fears, such as movies or shows with heterosexual couples

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 can be helpful as part of a broader treatment plan for OCD when combined with ERP. However, it’s crucial to note that medication alone is unlikely to allow you to manage the symptoms of OCD in the long term. 

“Medication by itself typically does not remove OCD symptoms 100%,” says Jamie Feusner, MD, NOCD’s Chief Medical Officer and Professor of Psychiatry at the University of Toronto. “If [a person with OCD] gets a 35% reduction of symptoms, that’s considered a full response–just like it is for ERP. Many people taking medications have a response of around a 40-60% reduction in symptoms.”

In the mental health context, a “full response” to treatment means that a person’s symptoms have reduced enough that they are able to function better in day-to-day life. Some people may describe this as a return to feeling normal, while others may notice that they are better equipped to handle stress—it all depends on the individual, their OCD, and their response to treatment. 

How medications can improve OCD symptoms

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 (MDD) or generalized anxiety disorder (GAD), your unique psychology and neurobiology, and, of course, your personal choice.

According to Dr. Feusner, medication may also be added to your treatment plan 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,” he explains. “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 reuptake inhibitors (SSRIs)

The first-line medication prescribed for OCD is a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). The immediate effect of SSRIs is to increase the amount of serotonin—a chemical that regulates mood and behavior—between nerve cells in certain parts of the brain. This allows your brain to receive higher levels of serotonin to reduce symptoms.

Because there is no conclusive evidence of a serotonin deficiency in people with OCD, SSRIs most likely work instead through gradual changes that occur as a result of higher serotonin levels. SSRIs are also frequently prescribed for anxiety and depression, so if you’re managing other mental health conditions, these medications might be especially helpful.

“When you take SSRIs for anxiety or depression, it tends to work for most people within two to four weeks,” says Dr. Feusner. “With OCD, it usually takes anywhere from about six weeks to about 12 weeks to start working. There’s also a chance that the drugs might not work sufficiently. At that point, a provider might prescribe another type of SSRI or something else entirely.”

Dr. Feusner also notes that SSRIs are prescribed at higher doses for treating OCD in comparison to other mental health disorders. “People with OCD often need higher doses of SSRIs than you’d need for treating depression or other anxiety problems because those are also treated by SSRIs effectively—but the dose for OCD often needs to be three, four, five, or even six times higher,” he explains.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are antidepressants that enhance communication between neurons in the brain. Clomipramine (Anafranil)—the TCA most often prescribed for OCD—was created in 1964 to treat depression, but 20 years later, researchers discovered that it was also effective for OCD. 

Clomipramine slows the reabsorption rate of serotonin and norepinephrine in the brain, allowing the two chemicals to stay between nerve cells longer. Over several weeks, this can boost communication in these cells, which can improve mood, reduce symptoms of depression and anxiety, and minimize the intensity and frequency of obsessions and compulsions in people with OCD.

Atypical antipsychotics

Atypical antipsychotics work by modulating certain neurotransmitters in the brain, which can stabilize mood. Although originally approved to treat schizophrenia and bipolar disorder, the versatility of these drugs has led to their use in treating various mental health conditions, including depression and, in some cases, OCD. According to one study, one in three patients with SSRI-resistant OCD respond well to atypical antipsychotics.

Dr. Freusner explains that these add-on medications are considered if you’ve tried a primary SSRI, clomipramine, or venlafaxine and have been at a high dose long enough to determine whether the medications are effective. 

When medications are used in OCD treatment 

As mentioned, in comparison to ERP, medication alone is unlikely to lead to full recovery. However, many people find the greatest reduction in their symptoms when medication is combined with ERP.

In a randomized trial of patients who benefited from OCD medication, one group that didn’t experience sufficient benefits from medication alone added ERP, while the other group did stress management training for 17 weeks. Those who did ERP therapy with medication experienced over three times the reduction in symptoms than the other group.

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. 

Potential side effects of OCD medication

Every medication comes with potential side effects, and that’s no different with OCD medications. However, just because a side effect is listed on a prescription medication doesn’t necessarily mean it will impact you. 

Some common side effects across SSRIs, TCAs, and atypical antipsychotics include:

  • Dry mouth 
  • Constipation 
  • Blurred vision
  • Dizziness
  • Drowsiness
  • Weight gain
  • Sexual dysfunction (i.e., difficulty becoming aroused or having an orgasm)
  • Nausea
  • Insomnia

If you experience side effects and want to stop or switch medications early into treatment, Dr. Feusner recommends sticking with them to see if they have any effect on your OCD symptoms before adjusting your treatment plan. “People can have side effects early on and they need to eventually wait to see if the benefits outweigh the side effects,” he explains.

If you take medication as part of your treatment plan, be sure to keep an open line of communication with your provider and carefully follow your dosage instructions.

Other treatments that may be helpful for OCD

While most people with OCD benefit from just ERP or a combination of ERP and medication, this isn’t the case for everyone. 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.

Here are some alternative or additional evidence-based treatments that may be recommended to manage your OCD symptoms: 

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. 

Key takeaways:

  • Exposure and response prevention (ERP) and medication are evidence-based, first-line treatments for managing OCD symptoms.
  • ERP is a specialized type of cognitive behavioral therapy (CBT) that breaks the OCD cycle through exercises that intentionally expose you to your fears and triggers.
  • Common medications prescribed to treat OCD symptoms include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and atypical antipsychotics.
  • It’s best to get treatment from therapists and prescribers who have received extensive, specialized training in treating OCD.

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