Can OCD be treated without medication?

December 4, 2018

WRITTEN BY

Patrick Carey

Patrick joined our team to help people get better information about mental health. He drinks coffee and wishes he had a dog.

Yes, to give a simple answer.

Although lots of people find medication (usually serotonin reuptake inhibitors or clomipramine) helpful in making their obsessive-compulsive disorder (OCD) symptoms less severe, there are certainly ways to feel better without medication.

Cognitive behavioral therapy (CBT), which helps the patient identify their thought patterns and the ways they affect their feelings and behavior, has been the preferred form of psychotherapy in the US and Europe for decades. It’s fairly effective for a wide range of things. There are also plenty of CBT offshoots, like Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT).

For OCD, another CBT offshoot has been demonstrated most effective in a number of studies since the 1980s: exposure and response prevention, or ERP. Most of these studies suggest it’s about as effective as SRIs or clomipramine. A combination of ERP and either SRIs or clomipramine has been shown to be most effective.

We’re always talking about ERP, because it’s helped a number of us and experts still consider it the best non-medication option for most people with OCD. But it’s worth knowing that 1) it's highly recommended that you first consult with a licensed professional; and 2) like any other option, ERP doesn’t work for everyone. This second point is especially true for some people with comorbid conditions like depression and bipolar disorder, where it can either exacerbate the other condition or just end up less effective because of it. That’s another good reason to check with a therapist first.

There’s a detailed explanation of ERP and other treatment options in our Education section. But let’s go through a quick explanation...

ERP is a specific form of CBT that has two simultaneous components: exposure and response prevention. In an exposure, someone faces a situation that's likely to trigger obsessions and cause distress. The response prevention part means they're resisting their compulsions so their anxiety level can naturally decrease and they can get used to tolerating distress.

Exposures are planned with a clinician, who will help you identify the triggers that are especially difficult for you–people, places, objects, thoughts, and feelings. We’ll get into this more soon, but by creating a hierarchy of your exposures you can make sure things are challenging but not overwhelmingly so.

Response prevention can be difficult, because the natural urge is to get rid of unwanted feelings. However, when we think about our lives and all the things we’d like to do, it becomes clear that compulsions are getting in the way. Because this is often the most difficult part of ERP for people to understand– what does it mean to just prevent your compulsions from happening?– we’ll do another post on response prevention soon. In the meantime, if you have RP strategies that work well, let us know on Facebook, Twitter, or Instagram at @treatmyocd.