Department of Psychiatry

Penn Behavioral Health

Obsessive-Compulsive Disorder


OCD Treatment by Therapy:

Exposure and Response (Ritual) Prevention

Cognitive-behavior therapy (CBT) is a type of psychotherapy that has been shown to be highly effective for OCD. The goal of CBT is two-fold: to change thoughts and behaviors. The cognitive portion involves the identification and analysis of unhelpful and unrealistic thoughts, which are then challenged. In the behavioral portion, the therapist and client work together to change the compulsive behaviors. This typically includes techniques such as Exposure and Response Prevention, also called Exposure and Ritual Prevention (EX/RP). In the exposure piece of the treatment, patients repeatedly expose themselves to their fears. By facing their obsessions in a systematic order, without performing compulsions, the person learns that there is nothing to fear and the obsessions begin to fade away.

Antidepressant Medications: SSRIs

The main pharmaceutical treatment for OCD is with selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that block the re-absorption of serotonin in the brain. Although SSRIs are commonly given for depression, research has shown they can also be effective for the treatment of anxiety. Common side effects may include: headaches, nausea, sexual dysfunction, and diarrhea among others. The most commonly prescribed SSRIs for OCD are:

Approved Medication

  • SSRIs:
    • Paxil (paroxetine)
    • Luvox (fluvoxamine)
    • Prozac (fluoxetine)
    • Zoloft (sertraline)
    • Celexa (citralopram)
    • Lexapro (escitalopram)
  • SRI:
    • Anafranil (clomipramine)

There is some evidence that anafranil may be slightly more effective in treating OCD, however it also tends to have a higher side effect profile, thus the trend toward prescribing newer generation SSRIs. Unfortunately, most people only find partial relief of their OCD symptoms from these medications, highlighting the importance of effective therapy strategies.

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