OCD can be a chronic and sometimes debilitating disorder. Fortunately, effective treatments are available to help manage OCD symptoms, greatly reduce suffering and possibly experience full relief. While there is no one-size-fits-all treatment plan for people living with OCD, there are many first, second, and third-line approaches that can get individuals on a treatment journey so they can thrive.
The treatment guide below outlines the first, second, and third-line treatment approaches available to those impacted by OCD. It also outlines adjunctive treatments that can be incorporated to help improve treatment response, as well as treatments to avoid that are ineffective and potentially harmful.
Use the guide below to educate yourself on all evidence-based treatments for OCD so you are equipped with the knowledge to build out a treatment plan with your care team.
OCD Treatment Recommendations: A Scientific Approach
The guidelines for the treatment of obsessive compulsive disorder (OCD) developed by the International OCD Foundation (IOCDF) are grounded in the most reliable scientific research. Individuals with OCD should begin with the most effective, research-backed treatments and progress to other options if needed. This ensures that all recommended therapies are safe, proven, and supported by scientific evidence, rather than anecdotal stories or personal opinions.
When treating OCD, it’s important to start with the most effective options. This approach ensures you begin with treatments backed by the strongest evidence (first-line treatments) and progress to other levels as needed. How do we know what works?
First-Line Treatments
Start here: First-line treatments are the most effective and well-studied options for managing OCD. They are backed by rigorous scientific evidence and should be your first step. Toggle between the tabs along the top to read more on each first-line treatment option.
Exposure and Response Prevention (ERP) is the proven, most effective, first-line therapy for OCD in adults, children, and adolescents. ERP is a specific type of cognitive-behavioral therapy (CBT). Backed by decades of research, ERP that is guided by a knowledgeable therapist and carried out properly helps individuals extinguish fears and eliminate compulsive behaviors in a structured, supportive environment. This therapy fosters long-term relief from OCD symptoms and builds resilience against anxiety. ERP is effective in standard outpatient settings, as well as in intensive treatment programs for individuals who haven’t improved adequately with standard outpatient treatment. Whether you’re exploring treatment options or seeking a new approach after others haven’t worked, ERP offers hope. Ready to learn more about how ERP works and its benefits? Click here to continue
Adjunctive Treatments
Add These to Improve Your Response: Adjunctive treatments are other medications and therapies that are added onto first-, second-, or third-line treatments. Adjunctive treatments can enhance outcomes but are not meant to replace primary therapies, because they have not been found to be effective as stand alone treatments for OCD:
Acceptance and Commitment Therapy (ACT) helps people with OCD to change their relationship with their OCD symptoms and move towards a more values-driven life. ACT views thoughts and behaviors as adaptable and fluid. In contrast to CBT and ERP, it focuses less on reducing the uncomfortable inner experiences that obsessions can create, and more on altering how they are experienced in the moment. ACT for OCD is currently being researched, but is showing promise as an effective treatment. Explore how ACT works here.
Second-Line Treatments
If First-Line Options Fail: If first-line treatments don’t relieve symptoms or cannot be tolerated, second-line therapies offer alternative approaches:
Acceptance and Commitment Therapy (ACT) helps people with OCD to change their relationship with their OCD symptoms and move towards a more values-driven life. ACT views thoughts and behaviors as adaptable and fluid. In contrast to CBT and ERP, it focuses less on reducing the uncomfortable inner experiences that obsessions can create, and more on altering how they are experienced in the moment. ACT for OCD is currently being researched, but is showing promise as an effective treatment. Explore how ACT works here.
Third-Line Treatments
For Severe or Treatment-Resistant OCD: Third-line treatments are advanced options for individuals who haven’t found success with first- or second-line treatments, including combinations with or without adjunctive therapies. These procedures are typically reserved for severe, treatment-resistant cases and require close clinical oversight:
Transcranial magnetic stimulation (TMS) offers a non-invasive method for treating severe, treatment-resistant OCD. This procedure uses magnetic fields to target specific brain regions that are involved with OCD symptoms, helping to reduce symptoms over time. Certain forms of TMS have been FDA-approved for treating OCD, with research suggesting that around half of patients undergoing TMS for OCD will have reduced symptoms. Explore how TMS works, who qualifies, and its potential benefits and risks here.
Emerging Treatments: Experimental
Some new treatments show early promise for OCD, but require more research before becoming standard:
Early studies suggest potential benefits, but these treatments remain experimental. More research is necessary at this time; people with OCD should not engage in psychedelic use as treatment outside of controlled research or laboratory settings. Learn more about current research and treatment options.
PANDAS/PANS Treatments
Pediatric Acute Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS) are conditions that cause sudden-onset neuropsychiatric symptoms in children, triggered by immune responses to infections. Accurate diagnosis is crucial for effective treatment, including anti-inflammatory and behavioral therapies. Explore how these conditions differ, their diagnostic criteria, and the latest treatment options to help children on their path to recovery. Learn more about PANS and PANDAS diagnosis and care
Treatments to Avoid: Ineffective or Potentially Harmful
It’s important to avoid treatments that lack scientific evidence. These therapies have not been proven effective and may delay access to evidence-based care:
- Ineffective Psychosocial Treatments: EMDR (Eye Movement Desensitization and Reprocessing), Hypnotherapy, Psychoanalysis, Psychodynamic Psychotherapy, Thought Field Therapy, and Brainspotting have not been found to be effective for OCD and are not recommended for OCD. Learn more about therapies that are ineffective for OCD.
- Ineffective Medical Treatments: Non-recommended or unproven biological treatments for OCD include non-SRI antidepressants, Lithium, using antipsychotics, anticonvulsants, or benzodiazepines alone (rather than adding them to an SRI), herbal remedies, homeopathy, acupuncture, biofeedback, chiropractic treatment, and others.
Building Your OCD Treatment Plan
Start with first-line treatments like ERP therapy and SRI medications, as these have the strongest evidence for success. If additional support is needed, second- and third-line options can help manage symptoms. Work with a qualified, culturally sensitive clinician to determine the best path forward for you or your loved one.
To complement your care, consider:
- Self-help resources like books or online tools.
- Support groups to connect with others managing OCD.
- Adjunctive treatments to enhance primary therapies.
By following this evidence-based, stepped-care approach, you can identify the most effective treatments for managing OCD and improving your quality of life.