ERP Therapy vs. Medication for OCD: What Research Shows
Over the past several decades, extensive research has compared Exposure and Response Prevention (ERP)—the leading behavioral therapy for OCD—to pharmacological treatments, primarily Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine, sertraline, and fluvoxamine. The evidence consistently demonstrates that ERP produces stronger, longer-lasting improvement than medication alone for most individuals with OCD, although the benefit of a combined approach is the most effective.
Effectiveness of ERP
ERP, a specialized form of Cognitive Behavioral Therapy (CBT), helps individuals confront intrusive thoughts and feared situations while resisting compulsive rituals.
Meta-analyses show that 60–80% of patients who complete ERP experience significant symptom reduction (Foa et al., 2005; Abramowitz, 2006).
ERP directly targets the behavioral and learning mechanisms that maintain OCD, enabling clients to relearn safety and tolerate uncertainty.
Long-term follow-up studies indicate that ERP benefits are durable, with many maintaining progress years after treatment (Franklin & Foa, 2011).
Effectiveness of Medication
SSRIs are the most effective class of medication for OCD, though their impact is more moderate:
Approximately 40–60% of patients experience partial symptom relief with SSRI treatment (Fineberg et al., 2015).
Symptoms often return after discontinuation, suggesting medication tends to suppress rather than fundamentally change OCD patterns.
Effective doses for OCD are typically higher than for depression or generalized anxiety, and some individuals experience side effects such as fatigue, sleep changes, or sexual dysfunction (Stein et al., 2019).
Combined Treatment
Combining ERP and medication can produce the greatest overall improvement, especially for those with severe symptoms or co-occurring conditions.
Simpson et al. (2008) found that adding ERP to an SSRI regimen resulted in significantly greater improvement compared to medication alone.
Conversely, when ERP is implemented effectively, adding medication may offer minimal additional benefit (Foa et al., 2005).
ERP remains the gold standard and first-line treatment for Obsessive-Compulsive Disorder. While SSRIs can help reduce symptom intensity, ERP addresses the core behavioral patterns that keep OCD active. For many individuals, the most effective strategy is a personalized blend of ERP and medication, coordinated between a licensed therapist and a prescriber.
At Still Minds Psychology you will work step by step with an ERP specialist to treat your OCD. Getting evidenced based case is incredibly important in treating OCD, as traditional talk therapy can actually make OCD symptoms worse. Get help today and learn more about OCD treatment at Still Minds Psychology.
References
Abramowitz, J. S. (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry, 51(7), 407–416.
Fineberg, N. A., Brown, A., Reghunandanan, S., & Pampaloni, I. (2015). Evidence-based pharmacotherapy of obsessive-compulsive disorder. International Journal of Neuropsychopharmacology, 18(12), pyv094.
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., ... & Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151–161.
Franklin, M. E., & Foa, E. B. (2011). Treatment of obsessive-compulsive disorder. Annual Review of Clinical Psychology, 7, 229–243.
Simpson, H. B., Foa, E. B., Liebowitz, M. R., Huppert, J. D., Cahill, S., Maher, M. J., ... & Petkova, E. (2008). Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA, 306(11), 1221–1229.
Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., ... & Simpson, H. B. (2019). Obsessive-compulsive disorder. Nature Reviews Disease Primers, 5(1), 52.
