Treatments for obsessive-compulsive disorder

Photo of man at a therapy session
PantherMedia / Dmitriy Shironosov

Obsessive-compulsive disorder (OCD) can really interfere with everyday activities and make it almost impossible to live a normal life. But there are treatments that can help to get it under control: particularly cognitive behavioral therapy, but medication too.

People with obsessive-compulsive behavior (OCD) have constant repetitive thoughts or an urge to do things that they don't want to do, and that they realize are pointless or even harmful. Some are so afraid of germs that they constantly wash their hands. Others might check over and over again whether they have really turned off the oven, or can't stop constantly counting to 20.

They find their thoughts and urges distressing. Many are ashamed and try to hide it from other people. But they often can't stop the thoughts or behaviors even if they want to. When they try to suppress their urges, people with OCD may feel anxious or frightened. Psychological treatment and medications can help to fight the urges or at least reduce them to a manageable level.

What does cognitive behavioral therapy involve?

There are different types of psychological treatment. OCD is usually treated with cognitive behavioral therapy (CBT). This treatment combines two therapeutic approaches: cognitive therapy and behavioral therapy.

Cognitive therapy is about learning to recognize and understand your own thought patterns. The aim is to identify the thoughts that are at the root of the compulsive behavior, and then change them. This may involve asking questions like: Is it helpful to check ten times whether the door is locked? Will my rituals really make me safer?

Behavioral therapy deals specifically with the compulsive behavior itself. One particular type of behavioral therapy that is commonly used for people with OCD is called “exposure and response prevention.” In this treatment, people are gradually confronted with the things that trigger their compulsive behavior (exposure). If, for instance, someone has a compulsion to constantly wash their hands, the therapist could ask the person to touch something that they think is dirty. After that, the person with OCD would try not to immediately wash their hands (response prevention). Over time, the confrontation teaches them that their feeling of fear and restlessness goes away even if they don't perform their compulsive behavior. Having a therapist for support is very important, especially when starting treatment or when the exercises get harder.

Cognitive behavioral therapy is offered as group or individual therapy. In Germany, it usually involves a series of weekly sessions, each lasting 50 minutes. Some people already feel much better after several sessions, while others may need longer before they notice a clear improvement. In order for the therapy to be successful, it's important that you feel comfortable with your therapist. You can use the trial sessions to find out if the chemistry is right.

Involving family members in therapy can also help. For example, they can help people with OCD deal with their compulsions at home. This is especially important after the therapy, to help make the positive effects last.

What can I expect from cognitive behavioral therapy?

Cognitive behavioral therapy has been tested in a number of studies with children, teenagers and adults who have OCD. The studies show that this therapy is very effective. It can help people keep their symptoms under control, relieve their anxiety, and cope better in everyday life again.

You need to be committed and patient when doing this kind of therapy: It can take a while to get OCD under control, and it takes a lot of courage to face your urges and fears. The therapy can be very demanding, especially at first. But many people say it was worth it because they were able to deal with their OCD much better afterwards.

Which medications can help?

Some medications that are used to treat (antidepressants) can also be used for OCD. Selective serotonin re-uptake inhibitors (SSRIs) are commonly used for this purpose. These medications increase the concentration of a neurotransmitter (chemical messenger) in the brain known as serotonin.

A number of studies have shown that SSRIs can relieve OCD symptoms: Because many of these studies only lasted up to three months, further research is needed on the long-term effects of SSRIs. But the few studies that lasted more than twelve months already suggest that SSRIs do help over the long term as well.

They can have a variety of side effects. These include nausea, nervousness, and trouble sleeping. Sexual desire may be reduced too.

The side effects mainly occur during the first few weeks of use. If a particular SSRI is poorly tolerated, a different one can be tried out. When stopping treatment with an SSRI, the dosage is gradually reduced over several weeks to prevent side effects.

Various studies suggest that teenagers are more likely to feel suicidal when taking SSRIs, and also actually attempt to take their own lives more often. Teenagers should see their doctor or therapist more regularly at the beginning of treatment so that any risk of suicide can be identified early on.

Which is more effective: Cognitive behavioral therapy or medication?

Several studies have looked into how cognitive behavioral therapy compares to medication in the treatment of OCD. They suggest that cognitive behavioral therapy is somewhat more helpful than antidepressants are. For this reason, cognitive behavioral therapy is the treatment of choice for obsessive compulsive disorder.

But there may be good reasons for using medication, like having to wait a while before starting therapy. Also, cognitive behavioral therapy can demand a great deal of commitment and strength. Some people's urges are so strong that they would hardly be able to make it through the therapy without medication. The medication can help relieve the symptoms enough to make it possible to do the therapy. Some people might prefer medication to psychological treatment for personal reasons.

These two treatment approaches can also be combined. This may be particularly suitable for people with OCD who also have depression.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on July 27, 2021
Next planned update: 2024

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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