Medication and ERP Therapy: How A Combined Approach Breaks the OCD Cycle
Taneia Surles, MPH
30-Second Takeaway:
- When treating OCD, combining ERP therapy with medication often leads to better outcomes than either intervention on its own.
- Medication can make it easier to engage in ERP by reducing the intensity of intrusive thoughts and anxiety.
- Close collaboration between Animo Sano Psychiatry’s providers and NOCD’s ERP therapists can help to track progress and adjust treatment for the best results.
Obsessive-compulsive disorder (OCD) is a complex, chronic mental health condition characterized by a cycle of obsessions and compulsions. Breaking this cycle is possible with evidence-based, first-line treatments like exposure and response prevention (ERP) therapy and medication, such as selective serotonin reuptake inhibitors (SSRIs).
At Animo Sano Psychiatry, providers frequently collaborate with ERP therapists at NOCD to deliver a combined treatment approach. Using both medication and ERP therapy reduces the frequency of obsessions and compulsions and helps people regain control of their lives.
How Does Combined OCD Treatment Work?
Combining ERP therapy and SSRIs was shown to reduce OCD symptoms by 70-79%, compared to 42-48% with medication alone.
ERP therapy involves exercises that help confront fears head-on while resisting compulsions. However, for some people, intrusive thoughts and anxiety can make it challenging to fully engage in therapy exercises, which is where medication can help.
“Exposures tend to be helpful, as they slowly and gradually introduce patients to their intrusive thoughts and get them to a point where the thoughts aren’t as distressing,” says Maddison Henley, PA-C, Director of Clinical Operations and Clinical Education at Animo Sano Psychiatry. “In the beginning [of therapy], medication can be helpful because it provides baseline support, and ERP is working on top of that to help manage symptoms further.”
While medication alone may reduce OCD symptoms for some patients, research consistently shows that combining ERP with medication is the more effective approach for most people. In a randomized controlled trial, patients who weren’t responsive to medication alone experienced over three times the reduction in symptoms when ERP was added, compared to those who received 17 weeks of stress management training. A meta-analysis of 21 studies found that ERP therapy combined with medication, such as SSRIs, clomipramine, and risperidone, was significantly more effective than medication alone.
“I’ve seen a greater improvement in patients who combine ERP and medication management than just doing one or the other,” Henley says. “We know that ERP is really effective for managing OCD symptoms, so we tend to see a big benefit there, and just an overall improvement in their quality of life.”
Tailoring Treatment to the Individual
Adding ERP therapy can help reduce both OCD symptoms and the need for medication. While medication may not stop altogether, a patient can often lower their dose once they’ve developed effective ERP skills that help them manage symptoms more independently, Henley explains.
At Animo Sano Psychiatry, providers customize a treatment plan based on the patient’s needs. According to Henley, many of the medications used to treat OCD are also approved for anxiety and depression, which are conditions that often co-occur with OCD. “One medication can benefit all three, or whichever conditions are co-occurring, and we’ll tailor treatment depending on what other co-existing diagnoses patients have,” she says.
The severity of a person’s OCD symptoms can also guide treatment decisions. “We focus treatment on reducing the number of intrusive thoughts and compulsions, how distressing they are, and the amount of time patients are spending on them,” Henley explains. “A lot of times, we see an overall decrease in those symptoms and then subsequent improvement in anxiety.”
But co-occurring mental health conditions and severe OCD symptoms are not the only influences on treatment decisions. A person’s unique psychology, neurology, and personal preferences can also play a significant role in treatment planning.
When ERP therapy is added to a patient’s treatment plan, Henley and other providers collaborate with NOCD’s therapists to ensure the patient is progressing. “We work with them on which exposures are going to be the most beneficial for the patient, and the therapists can communicate with us on symptom changes if we change the medication,” she explains. “We’re able to work as a team to give each other feedback on what the other person is doing regarding the patient’s symptoms and then collaborate on next steps if we’re hitting a place where we’re not making progress.”
If you’re curious about whether medication could help with your OCD, reach out to Animo Sano Psychiatry to learn more.
Final Thoughts
OCD can be a debilitating condition to deal with on a day-to-day basis, but there’s effective treatment available. While some benefit from medication or ERP alone, a combination can lead to long-lasting results and better quality of life.
Edited by Maddison Henley, PA-C, CAQ-PSY
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