The Effectiveness of Cognitive-Behavioral Therapy in Treating OCD


Efficacy of Cognitive-Behavioral Therapy

A number of studies have demonstrated that CBT is more effective than placebo and other psychotherapies for the treatment of OCD, is comparable to serotonergic medications,13,14,15,16,17 and may even be more effective than medication in some cases.18,19 A recent meta-analysis showed that CBT outperformed controls in all 16 studies used in the meta-analysis.20 However, many patients remain symptomatic after treatment, suggesting the need for continued research on improving efficacy of treatments.21

Although it is difficult to separate the effects of behavior therapy and cognitive therapy given that they contain similar components, exposure and response prevention (ERP) appear to be critical elements within CBT, with 55-75% of patients reporting sizable improvement and maintenance of gains following treatment. Given the vast number of studies demonstrating the efficacy of ERP,22,23 it continues to be the first-line CBT treatment for individuals with OCD.

However, studies supporting the efficacy of cognitive therapy have grown over the years24,25,26 and suggest that cognitive treatments are not only effective in improving symptoms and reducing emotional distress, but may also be effective in improving treatment adherence and reducing treatment drop-out.17  Although some studies shows that ERP outpaces cognitive treatments,17,27 others show that cognitive strategies may be equivalent in efficacy to behavioral strategies.28,20,29

Lata K. McGinn, PhD, is an associate professor of psychology at the Ferkauf Graduate School of Psychology, Yeshiva University, Albert Einstein College of Medicine, in The Bronx, New York.


  1. McGinn LK and Sanderson WC. (1999). Treatment of Obsessive Compulsive Disorder.  New Jersey: Jason Aronson, Inc.
  2. Beck AT and Emery G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
  3. Salkovskis PM. (1985a). Obsessional–compulsive problems: a cognitive–behavioural analysis. Behavior Research Therapy. 25: 571–583.
  4. Salkovskis PM and Warwick HMC. (1985b). Cognitive therapy of obsessive-compulsive disorder: treating treatment failures. Behavioural Psychotherapy. 12:  243-255.
  5. Leahy RL, Holland S. and McGinn, LK (2011). Treatment Plans and Interventions for Anxiety and Depressive Disorders. NY: Guilford Press.
  6. Dollard J and Miller NE  (1950).  Personality and psychotherapy: An analysis in terms of learning, thinking and culture. New York: McGraw-Hill.  
  7. Mowrer OA (1939). A stimulus-response analysis of anxiety and its role as a reinforcing agent. Psychological Review. 46: 553-565.
  8. Mowrer OA. (1960). Learning theory and behavior. New York: Wiley. 
  9. Foa EB and Goldstein A (1978). Continuous exposure and response prevention of obsessive-compulsive disorder. Behavior Therapy. 9: 821-829.
  10. Foa EB, Steketee GS and Obzarow B. (1985). Behavior therapy with obsessive-complsives: from theory to treatment. In M. Mavissakalian (Ed.), Psychological and Pharmacological Treatment (pp. 49-129).  New York: Plenum.
  11. Meyer V. (1966). Modification of expectation in cases with obsessional rituals. Behaviour Research and Therapy. 4: 273-280.
  12. Meyer V and Levy R (1973). Modification of behavior in obsessive-compulsive disorders. In H. E. Adams and P. Unikel (Eds.), Issues and Trends in Behavior Therapy (pp. 77-138). Springfield, IL: Charles C. Thomas.
  13. Abramowitz JS (1997). Effectiveness of psychological and pharmacological treatments for obsessive–compulsive disorder: a quantitative review. Journal of Consulting and Clinical Psychology. 65: 44–52.
  14. Hofmann SG and  Smits JA (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry. 69: 621–632.
  15. Huppert JD, et al (2004). Differential response to placebo among patients with social phobia, panic disorder, and obsessive-compulsive disorder. American Journal of Psychiatry. 161: 1485–1487.
  16. McKay D, et al (2014). Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry Research. 225(3): 236-246.
  17. McKay, D, et al. (2015). Efficacy of obsessive-compulsive disorder. Psychiatry Research. 225: 236-256.
  18. Kobak KA, et al. (1998) Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacology. 136: 205–216.
  19. Foa, EB, et al. (2005). Randomized placebo controlled trial of exposure with ritual prevention, clomipramine, and their combination in the treatment of obsessive–compulsive disorder. American Journal of Psychiatry. 162: 151–161.
  20. Olatunji BO, et al (2013b). Cognitive behavior therapy for obsessive-compulsive disorder, Journal of Psychiatric Research. 47(1): 33-41. doi:10.1016/j.jpsychires.2012.08.020.
  21. Abramowitz. JS, et al. (2002). Empirical status of cognitive-behavioral methods in the treatment of OCD. Romanian Journal of Cognitive Behavioral Therapy, 2: 89–104.
  22. Deacon B and Abramowitz JS (2004). Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. Journal of Clinical Psychology. 60: 429–441.
  23. National Institute for Health and Clinical Excellence (NICE) (2006). Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. The British Psychological Society & The Royal College of Psychiatrists.
  24. Freeston R, et al. (1997). Cognitive-behavioral treatment of obsessive thoughts: A controlled study. Journal of Consulting and Clinical Psychology. 65: 405–413.
  25. van Oppen P, et al. (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behavior Research and Therapy. 33: 379–390.
  26. Wilhelm S. (2005). Effectiveness of cognitive therapy for obsessive-compulsive disorder: an open trial. Journal of Cognitive Psychotherapy. 19: 173–179.
  27. Olatunji BO (2013a). Behavioral versus cognitive treatment of obsessive compulsive disorder: An examination of outcome and mediators of change. Journal of Consulting and Clinical Psychology. 81(3): 415-428.
  28. Abramowitz JS (1997). Effectiveness of psychological and pharmacological treatments for obsessive–compulsive disorder: a quantitative review. Journal of Consulting and Clinical Psychology. 65: 44–52.
  29. Rosa-Alcázar AI, et al. (2008). Psychological treatment of obsessive-compulsive disorder: a meta-analysis. Clinical Psychology Review. 28: 1310–1325.