Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Psychotherapy for obsessive-compulsive disorder in adults

Jonathan Abramowitz, PhD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Obsessive-compulsive disorder (OCD) is characterized by recurrent, intrusive, and distressing thoughts, images, or impulses (ie, obsessions) and repetitive mental or behavioral acts that the individual feels driven to perform (ie, compulsions) to prevent or reduce distress.

Treatment with selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, clomipramine, and cognitive-behavioral therapy (CBT) have been shown to be efficacious in the treatment of OCD. CBT is a set of techniques that are used to help people with psychological disorders modify maladaptive patterns of thinking and acting to alleviate emotional symptoms. Components of CBT for OCD include [1]:


Cognitive therapy techniques

Exposure therapy

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 23, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Abramowitz JS, Taylor S, McKay D. Obsessive-compulsive disorder. Lancet 2009; 374:491.
  2. Foa EB, Abramowitz JS, Franklin ME, Kozak MJ. Feared consequences, fixity of belief, and treatment outcome in patients with obsessive-compulsive disorder. Behav Ther 1999; 30:717.
  3. Abramowitz JS, Franklin ME, Schwartz SA, Furr JM. Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. J Consult Clin Psychol 2003; 71:1049.
  4. Abramowitz JS, Foa EB. Does comorbid major depressive disorder influence outcome of exposure and response prevention for OCD? Behav Ther 2000; 31:795.
  5. Deacon BJ, Abramowitz JS. Patient’s perception of pharmacological and cognitive-behavioral treatments for anxiety disorders. Beh Ther 2005; 36:139.
  6. Rachman S, de Silva P. Abnormal and normal obsessions. Behav Res Ther 1978; 16:233.
  7. Salkovskis P. Obsessional-compulsive problems: A cognitive-behavioral analysis. Beh Res Ther 1985; 23:571.
  8. Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull 1986; 99:20.
  9. Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46:1006.
  10. Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry 1989; 46:1012.
  11. Abramowitz JS, Deacon BJ, Olatunji BO, et al. Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychol Assess 2010; 22:180.
  12. Wilhelm S, Steketee G. Cognitive therapy for obsessive-compulsive disorder: A guide for professionals, New Harbinger, Oakland 2006.
  13. Clark, DA. Cognitive-behavioral therapy for OCD, Guilford Press, New York 2004.
  14. Abramowitz JS, Foa EB, Franklin ME. Exposure and ritual prevention for obsessive-compulsive disorder: effects of intensive versus twice-weekly sessions. J Consult Clin Psychol 2003; 71:394.
  15. Öst LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014. Clin Psychol Rev 2015; 40:156.
  16. Abramowitz, JS. Understanding and treating obsessive-compulsive disorder: A cognitive-behavioral approach, Erlbaum, Mahwah NJ 2006.
  17. Foa EB, Kozak MJ. Psychological treatment for obsessive-compulsive disorder. In: Long-term treatments of anxiety disorders, Mavissakalian MR, Prien RF (Eds), American Psychiatric Press, Inc, Washington, DC 1996. p.285.
  18. Abramowitz JA. Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: a meta-analysis. Beh Ther 1996; 27:583.
  19. Abramowitz JS. Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: a quantitative review. J Consult Clin Psychol 1997; 65:44.
  20. Abramowitz J, Franklin M, Foa E. Empirical status of cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analytic review. Rom J Cog Behav Psychother 2002; 2:89.
  21. Franklin ME, Abramowitz JS, Kozak MJ, et al. Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: randomized compared with nonrandomized samples. J Consult Clin Psychol 2000; 68:594.
  22. Abramowitz JS, Franklin ME, Street G, et al.. Effects of comorbid depression on response to treatment for obsessive-compulsive disorder. Beh Ther 2000; 31:517.
  23. Foa EB. Failure in treating obsessive-compulsives. Behav Res Ther 1979; 17:169.
  24. Chambless DL, Steketee G. Expressed emotion and behavior therapy outcome: a prospective study with obsessive-compulsive and agoraphobic outpatients. J Consult Clin Psychol 1999; 67:658.
  25. Foa EB, Liebowitz MR, Kozak MJ, et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry 2005; 162:151.
  26. Tenneij NH, van Megen HJ, Denys DA, Westenberg HG. Behavior therapy augments response of patients with obsessive-compulsive disorder responding to drug treatment. J Clin Psychiatry 2005; 66:1169.
  27. Simpson HB, Foa EB, Liebowitz MR, et al. A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatry 2008; 165:621.
  28. Simpson HB, Foa EB, Liebowitz MR, et al. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry 2013; 70:1190.
  29. Gava I, Barbui C, Aguglia E, et al. Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev 2007; :CD005333.