How to Choose the Right Kind of Therapy for OCD

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Jaimie Eckert

Published on Apr 15, 2020; Updated on Aug 4, 2020

Trying to find a therapist for OCD feels a bit like strolling down the supplements aisle.  Probably all of them are good for you, but which is the right one to target your exact problem?  Likewise, how can you choose the right kind of therapy for OCD? In this brief article, we’ll check out the main treatment options available for obsessive-compulsive disorder.

The Worst Kind of Therapy for OCD

Here’s a funny story.  Before I was diagnosed with OCD, I worked with a counselor to deal with some of the negative thoughts that were fueling my depression.  She prescribed a certain type of therapy, and proceeded to laud its far-reaching benefits and its near-universal application.

“I prescribe this kind of therapy for everyone,” she gushed.  “Literally everyone – except people with OCD, because it can backfire on them.”

Famous last words.

I was obsessively faithful about doing my therapy homework, but after a few months I realized I had gone from having moderate depression to having severe depression.  My mind, reeling for an answer (us OCD people are always looking for answers) remembered my counselor’s statement. 

I’m glad she said it.  It was the only reason I ever looked up OCD to find out more. This CBT stuff is backfiring, I thought. She said this method only backfires on people with OCD. Could I have that?

Like most of the general population, I had a very ignorant understanding of what OCD is – I thought it was just for those people who wash their hands a lot and like to sort their socks by color.

I’ve learned a lot since my diagnosis and subsequent treatment.  If you’re looking to begin therapy for your OCD, I applaud your decision.  Just make sure you start the right kind of therapy!  Below I’ve created a chart that will hopefully give you some tips for choosing a method that will be most helpful to your situation — I’ve also included some unusual and extreme treatment options that you might find outlandish, but it’s a broad guide to let you know what’s available!

Also — check out my complete guide on how to survive periods of crisis (like coronavirus!) with OCD.

6 Treatment Options for OCD

Therapy Type Synopsis Good For:
CBT (Cognitive Behavioral Therapy) Involves inward reflection on emotional states and intentionally searching for what thought pattern or “misbelief” lies at the core of negative emotions, then actively challenging it. Highly effective for depression; can be somewhat helpful for OCD but be extremely cautious, as it can backfire on Pure-O individuals and cause excessive rumination.
ACT (Acceptance-Commitment Therapy) Involves identifying triggers that cause you anxiety, accepting that you cannot always resolve these disturbing thoughts, and –together with your therapist — committing yourself to acting on present realities rather than feared potentialities. Everyone with OCD, but especially those on the obsessive end of the spectrum, such as HOCD, ROCD, Scrupulosity, and Pure-O.
Exposure Therapy Involves intentionally exposing self to the anxiety source (at once or in incremental stages, in real life or in imagination) to desensitize the mind to the feared stimulus. As exposure occurs, the individual is encouraged to resist escaping it and to resist attempting to “solve” or negate the problem with compulsive behavior. Most often used for those experiencing external compulsions, such as contamination OCD, symmetry OCD, compulsive researching, or various forms of checking.  Also useful for dealing with avoidance behaviors.
Psychosurgery Several forms of last-resort intervention involving brain surgery.  May involve drilling into the brain and burning away specific tissue with a heated probe, or sending concentrated gamma waves through the skull to destroy a certain area of brain tissue.  Such surgeries are said to give relief to 50-60% of patients. Possibly helpful for OCD patients with very severe symptoms who are unresponsive to either medication or any of the various kinds of psychotherapy.   
Deep Brain Stimulation (DBS) Involves opening the skull, but does not destroy any brain tissue.  Instead, electrical diodes are inserted (similar to a pacemaker) that send electrical impulses to the brain. It is a very new treatment that is still experimental, but good results have been reported. Possibly helpful for OCD patients with very severe symptoms who are unresponsive to either medication or any of the various kinds of psychotherapy.   
Electroconvulsive Therapy (ECT) A psychiatrist uses a machine to send electrical shocks to the brain without surgically opening the skull. The shock triggers a controlled seizure, which is said to improve the neurotransmitter situation in the brain. Possibly helpful for OCD patients with very severe symptoms who are unresponsive to either medication or any of the various kinds of psychotherapy.   

How to Choose the Right Kind of Therapy for OCD: Thoughts on Thought-Stopping

You may have noticed that I did not include “thought stopping” in my list.  Why not?

Again, I digress for a story. ?

I tried out a counselor once at the beginning of my treatment and informed her right away that I had been diagnosed with OCD and did not wish to follow traditional CBT.  She smiled, nodded, and wrote down a few notes on her pad.  When I began describing my symptoms, she stuck her pen behind her ear and said, “what we’re going to learn together is how to do thought-stopping.”

I was like, wait — what? SERIOUSLY?

How did all these therapists get degrees and still give bad advice to people with OCD?

Thought-stopping was a popular treatment for OCD several decades ago.  Supposedly you would even get a rubber band around your wrist and you were supposed to snap yourself whenever you started having intrusive thoughts or rumination.  But the thought-stopping crusade was an epic fail in the OCD world, as it usually made patients worse, not better.  As Dr. Fred Penzel says,

“Although you can resist performing a compulsion, you cannot refuse to think an obsessive thought.”

Dr. Fred Penzel

How terrible to be told to do something that isn’t possible, then feel like your failure is your own fault!

If your therapist attempts to take you down the “thought-stopping” trail, stop right there.  You probably don’t have a therapist who is as up-to-date in psychology as he or she should be.

How to Choose the Right Kind of Therapy for OCD: What About Medication?

I’m sure you have noticed that I did not include medication in my list of possible interventions. This is not because I am anti-medication. But at the same time, I have read a lot of conflicting information and simply cannot make up my mind about the use of SSRI’s and Benzos for treating OCD.

I am not a medical expert. I am a student of the Bible and my primary role with OCD has been overcoming my own religious OCD and helping others find spiritual answers in dealing with scrupulosity. But I am not a scientist, so I cannot speak with deep persuasion on this topic.

People who seek treatment for OCD will commonly be prescribed antidepressants, but you should be aware that the research is very mixed in its results.  I don’t deny that many people with OCD are helped by taking such medication, but since I personally cannot speak with personal experience, I would just urge you to do your own research on it. From a Biblical perspective, we certainly have solid evidence in favor of utilizing modern medicine at its best (feel free to get in touch with me if you would like specific references on this).


So there you have it, a quick compilation of the main interventions used to treat OCD.  How can you choose the right kind of therapy for OCD? You can try several varieties of psychotherapy, brain stimulation, or medication. These are your main options, boiled down in the most simple form. I’ve personally had the most success with ACT and Exposure Therapy, but that’s just me.

Let’s talk in the comments below – what has helped you the most?  

  • Thank you so much for posting this! Therapy can be overwhelming and so it’s so helpful to have someone who has lived with this condition for a long time and knows what can be unhelpful. I’m glad you pointed out that CBT can cause excessive rumination in people who are very obsessive. I definitely lean more on the obsessive side of Scrupulosity. And I would often try to get to the bottom of a thought or feeling and sometimes it would help but other times it would cause me to go on a spiral for hours as I make epic mind maps trying to figure it out. I’m definitely going to look into the ones you suggested. Again thank you so much. You are like a spiritual brain surgeon! Partnering with God to truly save lives. If you ever doubt your purpose or calling just remember that. But also like no pressure! 😅 God works together all things for the good of those who love Him and are called according to His purpose. So no matter what happens He can turn it around for good.

    • “Spiritual brain surgeon,” lol I like that! When I was a kid I read the book by Ben Carson about how he went from being a poor inner city kid to being a world famous brain surgeon, and he inspired me to want to be a brain surgeon and save people’s lives. For a long time if you asked me what I wanted to be when I grew up, I would have told you that. But, I never ended up being very good at math and science, so I didn’t pursue medicine. I totally love the metaphor you’ve used; it’s very meaningful to me! Thank you, you made my day! 🙂

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