top of page

<-- Back to Resources page

Therapies That Can Make OCD Worse: Why Specialized OCD Treatment Matters

One of the most difficult truths about OCD treatment is this: Not all therapy helps OCD.

​

In fact, some therapy approaches can unintentionally reinforce OCD symptoms, even when the therapist is compassionate, intelligent, and genuinely trying to help.

​

At River City OCD Clinic, we regularly meet individuals who spent years in treatment before discovering: “I don’t think my OCD was actually being treated.”

 

Unfortunately, that experience is far more common than most people realize. The International OCD Foundation’s 2025 white paper, America’s OCD Care Crisis, describes widespread problems involving delayed diagnosis, misdiagnosis, lack of specialized training, and limited access to evidence-based treatment.

 

And one of the biggest contributors to that crisis is that many therapists list OCD as a specialty on profiles and directories without having formal ERP training, supervision, or consultation.

Many people with OCD never receive specialized treatment

Why OCD Requires Specialized Treatment

OCD is not simply “overthinking” or generalized anxiety. OCD is maintained by:

 

 

Because of this, treatments that focus primarily on:

 

 

…can accidentally become part of the OCD cycle itself.

​

 

The IOCDF specifically identifies Exposure and Response Prevention (ERP) as the gold-standard psychological treatment for OCD. ERP enhanced with Acceptance and Commitment Therapy (ACT) can further help individuals build:

 

 

Without those components, therapy can unintentionally reinforce the very fears people are trying to escape.

Treatments That May Be Ineffective or Harmful for OCD

The IOCDF has specifically identified several interventions that may be ineffective or potentially harmful when used as primary treatments for OCD.

EMDR as a Primary Treatment for OCD Is Not Supported By Research

Thought-Stopping

Thought-stopping is another intervention that sounds helpful on the surface but often backfires badly in OCD treatment. This approach typically involves trying to interrupt or suppress intrusive thoughts by:

​

  • Snapping a rubber band on the wrist

  • Saying “STOP!” aloud

 

The problem is that OCD already tends to involve excessive attempts to suppress, neutralize, or control intrusive thoughts.

​

And research consistently shows that the harder people try not to think something, the more attention and importance the brain often gives it.

 

ERP and ACT-based approaches instead teach individuals that intrusive thoughts do not require control, neutralization, or escape.

​

Ironically, recovery from OCD often begins not when thoughts finally disappear, but when people stop treating their presence as an emergency.

This one surprises many people.

​

Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for PTSD. However, the IOCDF notes that EMDR is currently not considered an evidence-based stand-alone treatment for OCD itself.

​

This distinction is important because OCD is maintained by mechanisms that are specifically targeted through ERP (compulsions, reassurance-seeking, rumination, etc.).

​

Some preliminary studies suggest EMDR may eventually prove helpful as an adjunctive or complementary intervention in certain OCD cases, particularly when significant trauma or PTSD symptoms are also present.

 

However, the IOCDF emphasizes that the current research base remains limited, and more rigorous studies are needed before EMDR could be considered a frontline OCD treatment.

​

The concern is that individuals with OCD may spend months or years receiving treatments aimed primarily at emotional processing or trauma reprocessing while the compulsive cycle itself remains largely untouched.

 

At River City OCD Clinic, our OCD therapists in Louisville are trained to carefully distinguish between trauma and OCD symptoms. While trauma and OCD can absolutely coexist, they are not always treated the same way.

​

For individuals with OCD, effective treatment ultimately requires learning how to face intrusive thoughts, uncertainty, and discomfort directly while reducing compulsive responses, which is precisely what ERP and ACT-enhanced ERP are designed to target.

Excessive Reassurance

Many therapists naturally want to comfort distressed clients.

​

But repeatedly saying things like:

​

  • “You would never do that.”

  • "You’re definitely okay.”

  • "That thought doesn’t mean anything.”

  • “I promise you’re safe.”

 

…may create short-term relief while strengthening long-term dependence on certainty.

​

For OCD, reassurance functions as a compulsion, and compulsions strengthen and maintain the disorder.

Endless Analysis and Overprocessing

Insight is not the same thing as recovery.

​

Many individuals with OCD already spend hours analyzing:

 

  • Their intentions

  • Their thoughts

  • Their memories

  • Their feelings

 

They are often attempting to figure out whether or not those internal experiences are “good” or “safe.”

​

Therapy that becomes endless discussion, over-processing, or emotional checking can accidentally reinforce rumination rather than reduce it.

Traditional Cognitive Restructuring

Cognitive therapy can absolutely be helpful in OCD treatment when used skillfully and mindfully.

​

However, if therapy turns into:

 

“Let’s prove your fear is irrational.”

 

…clients often become trapped trying to achieve perfect certainty before moving forward.

 

OCD almost always demands another question ("What if..?") afterward, so the exercise often devolves into another form of reassurance-seeking.

Relaxation or Distraction Strategies

Relaxation skills can be helpful for stress management.

​

But when treatment becomes organized around:

 

“How do we make anxiety disappear immediately?”

 

…the person may continue learning that anxiety itself is dangerous and intolerable. The elimination of anxiety then becomes the primary goal of treatment.

 

ERP and ACT-based approaches instead help people learn:

​

“I can experience anxiety and still move toward what matters.”

Life Coaching

Life coaching is another area where caution is important when discussing OCD treatment. There is no single standardized model, licensure process, or evidence-based framework that defines life coaching.

 

Training and qualifications vary enormously from person to person. This does not mean all life coaching is harmful. Some individuals may find coaching helpful for accountability, organization, or goal-setting.

​

However, there is currently no meaningful scientific evidence showing that life coaching alone effectively treats OCD. This becomes especially concerning when coaches begin attempting to treat intrusive thoughts, response prevention, or even trauma-related symptoms.

​

Without a foundation in specialized ERP training, well-intended guidance can unintentionally reinforce the OCD cycle rather than interrupt it.

Energy Therapies or Tapping

Various “energy therapies”  are generally based on the idea that emotional suffering comes from disruptions in an invisible energy system within or around the body, which practitioners attempt to “correct” through tapping, touching certain points on the body, or other physical techniques.

​

At present, there is no compelling scientific evidence that these energy therapies effectively treat OCD.

 

In some cases, the visualization components used during these therapies may resemble a mild form of exposure.

 

However, these interventions typically do not include the structured response prevention, or behavioral learning processes that make ERP effective.

Equine Therapy (and Other Animal-Assisted Therapies)

Animal-assisted therapies, including equine therapy, can absolutely be enjoyable, emotionally meaningful, and calming experiences for many people. ​​However, there is currently no strong evidence showing that equine therapy alone effectively treats OCD itself.

​

This distinction matters because many individuals with OCD are not simply struggling with stress. They are struggling with compulsions, reassurance-seeking, rumination, avoidance, and intolerance of uncertainty.

​

Spending time with animals may help someone feel temporarily calmer, but feeling calmer is not automatically the same thing as addressing the psychological mechanisms that maintain OCD. Supportive experiences can complement treatment, but they should not be confused with specialized OCD treatment itself.

What You Must Lose to Overcome OCD

What you must lose to overcome OCD

The Ethical Responsibility of Treating OCD Competently

This part is important.

 

We genuinely need more therapists who are competent in treating OCD, especially in Kentucky and surrounding regions where access to specialty care remains limited.

​

But wanting to help people with OCD is not the same thing as being trained to treat OCD.

 

Therapists ethically should not provide specialized treatment outside the scope of their competence, training, supervision, or consultation experience. And unfortunately, many clinicians receive very little formal ERP training during graduate school programs.

​

According IOCDF's 2025 report:

​

  • More than 80% of individuals with OCD do not receive the recommended therapy for OCD

  • Only 2% of individuals with OCD had documented evidence in their medical records of receiving ERP

  • More than 72% of individuals with OCD did not get referred to a therapist trained in providing ERP

​

The IOCDF report offers a biting conclusion:

 

"This suggests that most mental health clinicians are not following the well established practice guidelines for OCD and are failing to either provide or refer OCD patients for the most effective treatment for their condition."​

Final Thoughts...

At River City OCD Clinic, we strongly encourage therapists interested in treating OCD to pursue:

​

  • ERP-specific training

  • Ongoing professional consultation in evidence-based approaches for OCD

  • Structured courses from reputable organizations like IOCDF

  • Regular attendance at annual conferences for continuing education in OCD treatment

  • Training in ACT from reputable organizations

  • Supervision with experienced OCD specialists

  • Continued learning around mental compulsions and newer OCD models

 

Seeking consultation is not weakness.

​

It is professionalism.

 

And frankly, the people struggling with OCD deserve that level of care.

Services That Target OCD Using Evidence-Based Approaches are Accessible in Kentucky, Indiana, and Many Locations Today

At River City OCD Clinic, our clinicians specialize in ACT-enhanced ERP for OCD and anxiety disorders. We offer individual therapy, group therapy, telehealth services, and specialized OCD treatment throughout Kentucky and across participating PSYPACT states (learn more by visiting Dr. Street Russell's profile page). Dr. Street Russell also provides professional consultation​ for therapists in need of OCD training.

bottom of page