State of the Research · October 2026
OCD Treatment
In 2026: What
Works Best
By Justin La Rose, RP, M.Psy · Registered Psychotherapist (CRPO) · Clinical Director, The OCD Clinic
Evidence last reviewed: October 2026
As of 2026, the best treatment for OCD is Exposure and Response Prevention (ERP), a form of CBT, and the first-line medications are SSRIs. A 2026 review in the BMJ and the International OCD Foundation's guidelines agree on that. When those aren't enough, there's an order to what comes next: other therapies, then brain stimulation, with ketamine and psychedelics still in research.
I'll be straight with you. If all the world needed was information and intelligence to overcome OCD, I wouldn't have a clinic dedicated just to OCD. But the order matters. The BMJ review notes people can live with OCD for ten years or more before it's even recognized, and you'd rather not spend those years on the wrong thing, right? So here's the order, plainly, with the sources. Don't trust me. Check them.
The short answer
- First-line therapy: ERP is the first-line psychological treatment for OCD in a 2026 BMJ state-of-the-art review and in the International OCD Foundation's treatment guide (Abramowitz et al., 2026; IOCDF).
- Why ERP works: Across 30 studies with 1,793 patients, ERP had a large effect compared with placebo and a moderate effect compared with other active treatments, so its specific techniques are doing the work (Abramowitz et al., 2026).
- Not everyone responds: About 20% of people don't respond to ERP, and about half don't respond to their first SSRI, which is why the guidelines lay out next steps (Abramowitz et al., 2026).
- Combining treatments: In pooled trials, ERP plus medication did about as well as ERP alone and better than medication alone; the IOCDF calls the evidence on combining them inconclusive (Abramowitz et al., 2026).
What's new in OCD treatment in 2026?
What's new in OCD treatment in 2026 is mostly refinement, not revolution. The core treatments haven't changed. What's changed is the order, how care gets delivered, and how honest the field is about what's still unproven. Here's where the research stands as of October 2026, following the BMJ review (Abramowitz et al., 2026). For each new study as it lands, with what it does and doesn't show, see OCD research updates.
What's settled
- ERP is still the first-line therapy, and SSRIs or clomipramine are still the first-line medications.
- ERP works because of what you actually do in it, not just because you like your therapist.
- ERP by video works, and the evidence for it is strong and growing.
- About one in five people don't respond to ERP. That's not a reason to skip it. It's a reason to have a plan B.
What's new
- The IOCDF's 2025 guidelines spell out the order, with ACT, I-CBT and metacognitive therapy as second-line options.
- ERP built on inhibitory learning, where every exposure is an experiment that tests what the fear predicts, is promising, but OCD-specific trials are still few. It's how we run ERP, and I'd rather tell you that than oversell it.
- Internet-based CBT programs beat waiting lists, but face-to-face CBT still came out ahead of therapist-guided internet programs across 25 trials (Zhang et al., 2023). Reps still work best with a coach in the room.
- Care is being adapted for culture, faith and identity, so the work respects who you are instead of fighting it.
What's still being tested
- Psilocybin and ketamine: trials are under way, and neither is part of regular care.
- TMS: it helps some people with severe OCD, but the best targets and settings are still unclear.
- Whether bringing a partner or family member into ERP improves results. The review flags it as an open question. In my room, partners are often the ones carrying the reassurance, so I'm watching this one closely.
- Who responds best to which treatment, so care can be matched to the person from day one.
What is the best treatment for OCD?
The best treatment for OCD is ERP, with SSRI medication as the other first-line option, and many people use both. Everything else comes after, in steps. It's like a ladder: you start on the bottom rung because it has the strongest evidence, and you climb only when that rung, done properly, hasn't been enough. This is the stepped-care order in the IOCDF guidelines, summarized in the BMJ review:
| Step | Treatments | When |
|---|---|---|
| First line | ERP; SSRI medication or clomipramine; or both | Where almost everyone should start |
| Second line | ACT, cognitive therapy, I-CBT, metacognitive therapy; other medications or added medications | When first-line treatment, done properly, isn't enough |
| Third line | TMS, deep brain stimulation | Severe OCD that hasn't responded to the above |
| Research only | Ketamine, psilocybin and other psychedelics | Clinical trials, not regular care |
Notice the words done properly. A lot of people who think they've failed the first rung never actually stood on it.
What does ERP therapy for OCD involve?
ERP therapy for OCD involves facing the thoughts and situations OCD makes you avoid, on purpose and in steps, and dropping the rituals you'd normally use to escape them. At its heart, OCD is a phobia of your own thoughts, and ERP treats it the way you'd treat any phobia. The person afraid of getting sick from the floor touches the floor. Then doesn't wash. Research protocols typically run 12 to 20 sessions.
It's like the gym. You don't walk in and lift 300 pounds on day one. We start with the two-pound weights, and trust me, we can make those hard. The review found something I see every week: doing the practice between sessions, especially in sessions five through nine, predicts how well people do (Abramowitz et al., 2026). It's just reps. More on what ERP therapy is.
What medication is used for OCD?
The medications used for OCD are SSRIs, with clomipramine, an older antidepressant, as the other first-line option. The BMJ review found clomipramine slightly more effective than SSRIs but with more side effects, and higher SSRI doses working better than lower ones, up to a point. About half of people don't respond to their first SSRI, so changing the dose or the medication is common. That's not failing. That's adjusting. I'm a psychotherapist, not a prescriber, so those decisions belong with your doctor or psychiatrist. More in what is the best medication for OCD.
What if ERP doesn't work for OCD?
If ERP doesn't work for OCD, the first question I ask is: what did you actually do between sessions? Was there real exposure, with the ritual actually dropped, or was it six months of talking about the fear? If it truly was ERP, the next steps are second-line therapies like ACT and I-CBT, medication changes, intensive programs, and for severe OCD, brain stimulation. The full path is on treatment-resistant OCD, and the newer options go head to head in TMS vs ketamine vs psilocybin for OCD.
What treatments don't work for OCD?
The treatments that don't work for OCD on their own, according to the IOCDF, are these (IOCDF):
- Therapies: EMDR, hypnotherapy, psychoanalysis, Brainspotting
- Medical and alternative: non-SRI antidepressants, lithium, benzodiazepines alone, herbal remedies, homeopathy, acupuncture, biofeedback, chiropractic treatment
- Supplements: not recommended on their own, and only under medical supervision
I'd add one more: any therapy that mostly digs into what your thoughts mean. With OCD, analysing the thought is just another way of checking it. It's like the detective who can't close the case: every new clue opens three more questions. That's why talk therapy often doesn't work for OCD.
Does online therapy work for OCD?
Yes, online therapy works for OCD. The BMJ review describes the evidence for ERP by video as strong and growing. Each format has trade-offs: in person makes some exposures and the relationship easier, while video cuts the travel and lets exposures happen where the OCD actually lives, at your stove, your front door, your bathroom sink. See online OCD therapy in Ontario.
Where can you get OCD treatment?
You can get OCD treatment through public programs or privately, in person or online. These pages lay out the routes:
- OCD treatment in Ontario: public and private routes, costs and referrals
- OCD treatment in Toronto: ERP with us, in person or online
- Postpartum OCD treatment options: pregnancy and the first year after birth
Wherever you go, the goal is the same: that you fire your therapist for the right reasons.
FAQ
What Else Do People Ask About OCD Treatment?
Exposure and Response Prevention (ERP), a form of CBT, is the first-line psychological treatment in the 2026 BMJ review and the International OCD Foundation's guidelines. SSRI medication is the first-line drug treatment, and many people use both.
Both are first-line. In the trials pooled by the BMJ review, ERP plus medication did about as well as ERP alone, and better than medication alone. The right choice depends on severity, your preferences and what you can access.
ERP protocols in research typically run 12 to 20 sessions. Real life varies with severity, how long the OCD has been running and how much practice happens between sessions.
Many people get to the point where OCD no longer runs their life, but the intrusive thoughts usually still show up sometimes. Realistic improvement sounds like this: I don't love that thought, and I'm not going to run from it either. The goal is that the thoughts stop running your day, not that they never come back.
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Book Free ConsultationHow we researched this page
This page reflects the state of OCD treatment research as of October 2026. It is built on a 2026 state-of-the-art review in the BMJ (Abramowitz et al., 2026), which pooled trials and guidelines published from 2010 to 2025, and on the International OCD Foundation's treatment guide, read in October 2026. The review's authors are involved with the IOCDF and helped compile its 2025 guidelines, so the two sources are not independent. Most trials study adults in North America and Europe, and outcomes are averages that can't predict how any one person will respond.
A note on my perspective
I run a private clinic that treats OCD with ERP, and I'm paid when people book with us. Read what I write with that in mind. Public and lower-cost routes exist too, and the Ontario OCD treatment guide lays them out next to ours.
About the author
Justin La Rose, RP, M.Psy is a Registered Psychotherapist with the College of Registered Psychotherapists of Ontario (CRPO) and Clinical Director of The OCD Clinic in Toronto. He has worked in mental health for more than 25 years and treats OCD with Exposure and Response Prevention (ERP). You can confirm his registration on the CRPO public register.
Client stories on this site are composites, with names and identifying details changed. How we write client stories
How to cite this page
La Rose, J. (2026). OCD Treatment in 2026: What Works Best. The OCD Clinic. https://theocdclinic.ca/ocd-treatment