Is CT for OCD an underutilized intervention? A review of misconceptions and evidence for efficacy

Abstract

Cognitive therapy (CT) for obsessive-compulsive disorder (OCD) is often underemphasized, despite accumulating empirical support. This brief communication revisits historical concerns regarding CT, tracing their origins to early trials characterized by poor fidelity to OCD-specific protocols, conceptual overlap between CT and ERP, and the use of generic cognitive techniques that may function as reassurance-like interventions. We reviewed contemporary evidence showing that when CT was delivered using OCD-specific protocols that target maladaptive beliefs (e.g., inflated responsibility, perfectionism, intolerance of uncertainty), outcomes were comparable to ERP. We also examined symptom worsening from two clinical trials and found that CT showed no evidence of systematic symptom deterioration or iatrogenic harm. Clinical and guideline implications are considered, emphasizing that CT should not replace ERP but be recognized as a complementary, evidence-based option. Clarifying misconceptions about CT may reduce barriers to care, broaden access to effective treatment, and support more flexible, patient-centered approaches to OCD.