Obsessive Compulsive Disorder Therapy: ERP & More OCD Treatments

Obsessive Compulsive Disorder Therapy: ERP & More OCD Treatments

Obsessive-compulsive disorder (OCD) is a common psychological disorder that, as the name suggests, is characterized by obsessions and compulsions.

These obsessions and compulsions are much more prevalent and debilitating than they are in the general population.

This article will cover the ways that OCD symptoms present themselves, as well as the different ways that OCD can be treated (including ways that OCD can potentially be self-treated).

Finally, this article will cover some overlooked aspects of OCD that may be considered positive.

Before you start reading this article, I recommend you to download these 3 Positive CBT exercises for free. With these exercises, you will not just be able to understand positive CBT on a theoretical level, but you’ll also have the tools to apply it in your work with clients or students.

You can download the PDF for free on this page: https://bit.ly/2VmfP5r


What Is An Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a:

“relatively common, frequently debilitating neuropsychiatric disorder” that is “characterized by repetitive thoughts (obsessions) and repetitive behaviours (compulsions) that are experienced as unwanted” (Pauls et al., 2014).

In the context of OCD, obsessions can be further defined as: “intrusive, repetitive thoughts, images, or impulses”, and compulsions can be further defined as “purposeful, repetitive overt and covert behaviors or rituals performed in an effort to relieve obsessional distress” (Olatunji et al., 2013).

As the definitions above and symptoms below indicate, OCD is not defined by the simple presence of obsessions or compulsions, but by the pervasiveness of these obsessions and compulsions, as well as their unwanted nature.

We can define someone with OCD as someone who experiences pervasive and unwanted obsessions and compulsions, with these obsessions and compulsions negatively affecting their lives.

A good way to further explore what OCD is and what it looks like is to examine some of the symptoms that accompany OCD.


OCD Diagnosis: 20+ Symptoms

While people with OCD may experience different symptoms and different severities of those symptoms, here is a list of over 20 symptoms that people with OCD experience (Abramowitz et al., 2010; Goodman et al., 1989):

  • Contamination obsessions
  • Decontamination compulsions
  • Obsessions about causing harm by various means
  • Checking, reassurance-seeking, and related compulsions
  • Unacceptable (violent, sexual, religious) obsessional thoughts about mental rituals
  • Obsessions about symmetry
  • Compulsions involving ordering and repeating
  • Spending too much time on obsessions
  • Experiencing interference from obsessions
  • Experiencing distress from obsessions
  • Yielding to obsessions
  • Lacking control over obsessions
  • Spending too much time on compulsions
  • Experiencing interference from compulsions
  • Experiencing distress from compulsions
  • Yielding to compulsions
  • Lacking control over compulsions
  • Inflated sense of responsibility
  • Ascribing too much importance to thoughts
  • Feeling the need to control thoughts
  • Overestimating the possibility of bad things happening
  • Disliking uncertainty and ambiguity
  • Perfectionism

Now that the symptoms of OCD have been established, the next thing to look at is OCD treatments, starting with exposure and response prevention (ERP).


OCD Treatment: Exposure and Response Prevention (ERP)

Exposure and response prevention (ERP) is a behavioral treatment for OCD that is a form of cognitive behavioral therapy (CBT). ERP comes from a study by Meyer (1966), where the author “exposed patients directly to anxiety-evoking stimuli and then prevented them from carrying out their compulsive rituals” (Abramowitz, 1996). This was the first effective behavioral treatment for OCD to be reported.

ERP is still used today as a treatment for OCD and has recently been shown to be effective for reducing OCD symptoms, as well as for reducing depression symptoms and improving quality of life (Shinmei et al., 2017). ERP can also be successfully used to treat young children with OCD, as long as a few treatment modifications are made, including the involvement of family members in the treatment plan (Herren et al., 2016).

Certain commentators have suggested that ERP leads to higher dropout rates than other types of therapy, but a meta-analysis has found ERP dropout rates to be no higher than other therapies (Ong et al., 2016). This indicates that ERP should be one of the first-line treatments for OCD.


Cognitive Behavioral Therapy (CBT) for OCD

While ERP is a form of CBT, there are other forms of CBT used to treat OCD. An extensive meta-analysis has found CBT to be an effective treatment for reducing OCD symptoms, and that these symptom reductions generally persist after treatment (Olatunji et al., 2013). Another meta-analysis of CBT also found it to be more effective for reducing obsessive-compulsive symptoms than pharmacological intervention alone (Sánchez-Meca et al., 2014).

These findings are especially promising since there are many ways for people to receive CBT treatment aside from the traditional, in-person therapy route. For example, people can complete self-directed CBT programs online, or people can video conference with a therapist rather than having to visit in person (Wolters et al., 2017).

Cognitive Behavioral Therapy (CBT) For OCD

Even for people who can visit a therapist in person, online CBT can supplement a treatment plan, or online CBT can be the main treatment plan with in-person therapy serving as the supplement. CBT is also a good option for specific types of OCD, such as OCD with comorbid autism spectrum disorder (ASD) (Kose et al., 2018), postpartum OCD (Challacombe et al., 2017), pediatric OCD (Wu et al., 2016), and pharmacoresistant OCD (Vyskocilova et al., 2016).

As is the case with other disorders, CBT is an appealing treatment plan for its adaptability to both the patient and the specific expression of the patient’s disorder.


10+ Other OCD Therapy Techniques

While CBT is an effective treatment for OCD on its own, some people may still experience OCD symptoms after completing CBT, necessitating adjunct therapies. One of these, music therapy, has been shown to reduce obsessions as well as symptoms of anxiety and depression as an adjunct to CBT (Shirani Bidabadi & Mehryar, 2015). Mindfulness-based cognitive therapy (MBCT) has also been shown to be an effective treatment for people with OCD who have already completed CBT but had some symptoms persist (Key et al., 2017).

Other therapeutic interventions that have been found to be effective on their own include cognitive restructuring (CR) (identifying and rejecting maladaptive thoughts) and detached mindfulness (DM) (identifying and rejecting maladaptive meta-cognitions) (Ludvik & Boschen, 2015).

A single case study has also indicated that acceptance and commitment therapy (ACT) with ERP is effective for improving well-being and reducing OCD symptoms in a patient with OCD (Wheeler, 2017). The treatment of OCD with short-term psychodynamic therapy (STPP) has also recently been outlined based on the success of STPP in treating anxiety disorders (Leichsenring & Steinert, 2016).

Deep brain stimulation with implanted electrodes has also been shown to be effective, but this is likely to be attempted only with severe, treatment-refractory cases of OCD (Denys et al., 2010).

As for pharmacological treatments, the following have been shown to be effective, including in conjunction with non-pharmacological therapy, as indicated above (Baldwin et al., 2014; Adams et al., 2017; Pignon et al., 2017):

  • Tricyclic antidepressants (TCAs): clomipramine
  • Selective serotonin reuptake inhibitors (SSRIs): citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
  • Ketamine
  • Antipsychotics (as supplements to SSRIs): aripiprazole, haloperidol (only in cases of comorbid Tourette syndrome), risperidone

These are not all of the treatments which have been used for OCD but are some of the most common and most effective treatments used for all kinds of OCD.


Self Help: How To Treat OCD

Since CBT is one of the best treatments for OCD, and CBT can be self-directed, CBT is likely the best way one can treat their own OCD. There are a number of developments that support the self-treatment of OCD, such as self-directed Internet-delivered cognitive behavioral therapy (iCBT) (Rees et al., 2016). Even more useful for modern life is research into app-delivered ERP (Boisseau et al., 2017).

For now, these programs still involve a therapist in some way, and therapist-led programs are still likely to be the most effective. With that said, one can enter a completely self-directed CBT program with resources from around the internet. For example, this 50-page PDF serves as an introduction to CBT and can help someone start treating their own OCD.

Again, severe cases of OCD are best treated by a therapist in some capacity, but that packet is a good starting point.


The Positive Side Of OCD

Recent research has examined OCD in the context of the “OCD paradox”, the idea that a disorder that leads one to have fewer offspring (if any) could somehow propagate through evolutionary selection (Polimeni et al., 2005). The paper suggests that since OCD has been described for thousands of years, and since the lifetime prevalence of 1%-2.5% exceeds “classic mutation rates”, there must be some evolutionary advantage of OCD. These researchers propose that OCD has not been propagated through individual selection but has rather been propagated through group selection as a “behavioral specialization”.

The authors end by pointing to “checking, washing, counting, needing to confess, requiring precision and hoarding” as potentially advantageous features of OCD that could defend against “predation, disease, and starvation” in a group. The paper acknowledges that research has not yet determined whether OCD was propagated through group selection or not, and that even if it was, modern-day OCD remains a debilitating disorder. This idea of OCD as a “behavioral specialization”, however, is an interesting way to think about a disorder that is most often thought of as a burden.

Research also indicates that people with OCD may perform better on challenging tasks than healthy controls, possibly due to “high activation in the frontal and medial networks” of the brain (Ciesielski et al., 2011). This is part of a series of “puzzling findings” that indicate that OCD may help people avoid distraction on challenging tasks. More research needs to be done before any definitive claims can be made, but it is possible that OCD serves some sort of adaptive role when it comes to executive functioning.


A Take Home Message

While we may all experience obsessions and compulsions at certain points, OCD is a serious condition that greatly affects the lives of those who deal with it. It is important that people acknowledge this so that people who struggle with this can be best accommodated. As the last section indicates, though, there may be certain aspects of OCD that are in fact adaptive.

This is just another case of why we should educate ourselves about mental health disorders rather than give in to stigma. If we educated ourselves about disorders, we can help the people around us who live with these disorders without dismissing what they have to offer. In a world where around a third of adults will experience a common mental disorder in their lifetimes (Steel et al., 2014), this education is crucial.

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About the Author

Joaquín Selva, Bc.S., Psychologist is a behavioral neuroscience researcher and scientific editor. Joaquín was both a teaching assistant and a research assistant and conducted research that led to the publication of three peer-reviewed papers. Since then, his work has included writing for PositivePsychology.com and working as an English editor for academic papers written by non-native English speakers.


  1. Israel


  2. haleco

    Thanks for keeping up with my posts Beth!


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