Obsessive–Compulsive Disorder (OCD): Understanding, Treatment, and New Directions in Psychotherapy

Dear Colleagues,

Obsessive–compulsive disorder (OCD) is a complex and heterogeneous mental disorder that is associated with substantial individual suffering, functional impairment, and often a chronic course. Although effective, evidence-based treatments are available, many individuals with OCD still do not benefit sufficiently from existing therapeutic approaches or do not receive adequate care at all. This persistent gap between treatment availability and patient outcomes highlights that OCD—and its treatment—may still not be fully understood, particularly with respect to its underlying biological and psychobiological mechanisms.

OCD symptoms rarely occur in isolation. They are embedded in broader psychological, cognitive, and emotional contexts, rooted in neurobiological substrates, and often co-occur with other mental health conditions. Increasing evidence suggests that factors such as learning processes, cognitive control, emotional regulation, and adverse or traumatic experiences, alongside neurobiological abnormalities (e.g., in cortico-striato-thalamo-cortical circuits), neurochemical imbalances, and genetic vulnerabilities, may shape the manifestation and maintenance of obsessive–compulsive symptoms. Advancing the treatment of OCD therefore requires not only new intervention formats, but also a deeper and more integrative understanding of the disorder itself that integrates neuroscientific and psychobiological perspectives into clinical conceptualization and practice.

At the same time, traditional treatment settings and delivery models pose substantial barriers for many patients. Limited access to specialized care, long waiting times, insufficient treatment intensity, and difficulties maintaining therapeutic gains remain major challenges in clinical practice. In response, a growing body of research explores alternative and adapted treatment approaches, intensive and compact treatment formats, blended and technology-supported interventions targeting neurobiological mechanisms, and novel ways of delivering established therapeutic principles beyond conventional settings.

Importantly, the observation that a considerable proportion of patients do not respond adequately to standard treatments underscores the need to better understand the mechanisms underlying therapeutic change through the lens of clinical data and real-world application. Clarifying how and why interventions work—and for whom—by integrating evidence from clinical trials, real-world patient cohorts, and actionable clinical outcome data represents a crucial step toward improving existing treatments, refining their components, tailoring interventions to individual patient needs, and translating these insights into tangible improvements in clinical practice.

By bringing together research that spans foundational perspectives on OCD, advances in clinical understanding, and innovative approaches to treatment delivery, this collection of contributions seeks to reflect the current movement of the field. Together, these works highlight pathways toward more accessible, effective, and conceptually grounded interventions for individuals and treatments with OCD.

Dr. Franziska Sophia Miegel
Guest Editor

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• obsessive–compulsive disorder
• clinical psychopathology
• mechanisms of change
• psychotherapeutic interventions
• treatment delivery
• accessibility of care
• innovative treatment approaches
• technology-supported interventions