Treatment-Resistant OCD: Next Steps When OCD Treatment Doesn't Work
Written by Colter Bloxom, LPC. Colter is a licensed psychotherapist and the owner and Executive Director of Thrive Therapy. He specializes in the treatment of anxiety, OCD, identity issues, and more.
If you’ve been in therapy, tried different medications, and still feel like your obsessive-compulsive disorder (OCD) symptoms aren’t improving, then you’re probably feeling exhausted and frustrated. You might even be wondering if you’re out of options. In the therapy world, this is called “treatment-resistant obsessive-compulsive disorder (OCD).” And if this describes you, you’re not alone — up to half of people with OCD may not respond to first-line treatments.
But just because standard treatments haven’t worked doesn’t mean there’s no path forward. Many people with OCD struggle to find the right treatment at first, especially since not all therapists actually know how to treat OCD effectively. If you’ve hit a wall in your recovery, there are still steps you can take.
Finding the right treatment can take time, but that doesn’t mean relief is impossible or that you need to feel this way forever. If therapy or medication hasn’t worked for you, there are still other options to explore.
In this article, I’ll walk through what treatment-resistant OCD actually is, what alternative options exist, and what you can do next.
What is treatment-resistant OCD?
Most people with OCD respond well to therapy and medication for OCD. But for some people, it isn’t enough or just isn’t helpful. If you’ve gone through therapy, tried medication, and still feel like OCD is taking over your life, you might fall into the category of treatment-resistant patients — which basically just means that first-line treatments haven’t been effective enough. You might also see it called "refractory obsessive-compulsive disorder."
Having treatment-resistant or refractory OCD doesn't mean that you are resistant or defying treatment. It just means that you might need alternative forms of support.
Treatment-resistant OCD criteria
There isn’t a medical definition of treatment-resistant OCD, but generally, it means that:
- You’ve tried first-line OCD treatments without success. This usually includes ERP and at least one medication, like an SSRI (selective serotonin reuptake inhibitor) or clomipramine.
- Your OCD symptoms still interfere with daily life, even after treatment.
- You struggle to engage in ERP because your anxiety is too severe, or you can’t resist compulsions long enough to make progress.
- You’ve tried medication, but it hasn’t worked — or the side effects have been too much to keep taking it.
If this sounds familiar, that doesn’t mean there’s nothing left to try. It just means you might need a different treatment option or a more intensive level of care.
What’s the first-line treatment for OCD?
For OCD, the most effective first-line treatment is a type of cognitive behavioral therapy called exposure and response prevention (ERP). This therapy gradually exposes you to situations that trigger your obsessions while helping you resist compulsions.
Research shows that ERP is the most effective way to treat OCD, but it’s important to work with a therapist who actually specializes in it. Studies have found that over half of people who were labeled as having “treatment-resistant OCD” improve when they actually get specialist treatment.
A lot of therapists will say they treat OCD, but many don’t actually use ERP — and what you might not know is that some types of therapy can actually make OCD worse. General cognitive-behavioral therapy (CBT), talk therapy, or other approaches that focus on “challenging” obsessive thoughts don’t work well for OCD and can even reinforce compulsive thinking.
OCD doesn’t respond to logic. A general talk therapist might encourage you to challenge your irrational thoughts associated with OCD, but if you live with OCD, then you may already know that lingering doubt will remain. Other therapists might even try to provide you with reassurance — like reassuring you that your obsessions aren’t true — and that can become a compulsion and keep you even more stuck in the OCD loop.
If you haven’t worked with an OCD specialist using ERP, that’s an important first step before considering more intensive treatments.
Alternative OCD treatment: What to do when standard treatment doesn’t work
If ERP and medication haven’t helped, other treatments are available. Some people with severe OCD need a higher level of care or alternative treatments before seeing progress. Treatment resistance can be frustrating to deal with, but it doesn't mean that nothing will ever work.
Intensive outpatient and inpatient programs (IOP for OCD)
If once-a-week therapy hasn’t been enough, a structured program might be necessary. Intensive outpatient programs (IOPs) offer multiple hours of ERP therapy per week, while residential or inpatient programs provide 24/7 support. These programs can help people with treatment-resistant OCD break through barriers that outpatient therapy hasn’t been able to address.
Transcranial magnetic stimulation (TMS)
TMS is a non-invasive procedure that stimulates regions of the brain that are involved in OCD. It’s FDA-approved for OCD treatment and can help some treatment-resistant patients who haven’t responded to therapy or medication.
Deep brain stimulation (DBS)
DBS is a surgical procedure that involves implanting electrodes in the brain to regulate abnormal activity. It’s typically only considered for people with severe OCD who haven’t responded to any other treatments.
Medication adjustments or augmentation strategies
Pharmacological treatment (medications) can also be helpful for OCD. If SSRIs haven’t worked, some psychiatrists recommend trying higher doses, different medications, or adding another drug (like an antipsychotic) to enhance effectiveness. If medication hasn’t worked for you, it may be worth talking to a psychiatrist about other options.
Every case of OCD is different, so what works for one person might not work for another. The key is finding the right combination of treatments that actually makes a difference.
Next steps when medication doesn’t work for OCD
If you’ve tried medication and it hasn’t helped, here’s what you can do next:
- Talk to your psychiatrist about adjustments. Some people need a different SSRI, a higher dose, or an add-on medication. If you’ve only tried one or two medications, it might be worth exploring other options before assuming medication won’t help.
- Make sure you’re doing ERP with a trained therapist. If therapy hasn’t helped, it might not be that therapy doesn’t work —it could be that you haven’t worked with a specialist who actually knows how to work with people with OCD. If you’re not sure, ask your therapist how they approach OCD treatment and whether they specifically use ERP.
- Consider an IOP for OCD. If traditional therapy hasn’t been enough, a higher level of care can offer the intensive support needed to break out of the OCD cycle. Many OCD patients who don’t respond to outpatient therapy make progress in an IOP because of how much support you get.
- Explore alternative treatments like TMS. If you’ve exhausted therapy and medication options, TMS might be a good next step. Talk to your provider about whether it’s a viable treatment option for you.
- Advocate for yourself. If your provider isn’t offering solutions that actually help, don’t be afraid to seek a second opinion. Finding the right OCD treatment can take time, but you deserve care that actually makes a difference.
Get OCD treatment with Thrive
If you’ve been struggling with OCD and feel like nothing has worked, you’re not alone. Many people with treatment-resistant OCD need more than just standard outpatient therapy. That’s why I designed Thrive Therapy’s Intensive Outpatient Program (IOP) specifically for people with OCD, anxiety, and related mental health concerns.
Our Phoenix-based IOP meets three days per week for a total of 9 hours and provides structured, evidence-based treatment—including exposure and response prevention (ERP)—to help you break free from the cycle of OCD. Unlike many IOPs that focus on substance use, ours is designed specifically for mental health, which is rare. If standard outpatient therapy hasn’t been enough, an IOP might be the next step in your recovery.
If you’re ready to explore more intensive treatment options, reach out today for a free consultation. I’d love to help you figure out what’s next.
