If you live with obsessive-compulsive disorder, you know how intense the urge to check, wash, ask or undo can feel. You may have heard that ERP, a type of exposure therapy where you resist the urge to do the compulsion, is the main therapy for OCD, and you may also have heard about dialectical behaviour therapy (DBT) skills for handling big emotions. So where does DBT for OCD fit? The short answer is that ERP remains the first-line therapy, and DBT skills can be a useful add-on that helps some people get through ERP. This post explains how the two fit together.
This post is general information, not a diagnosis or medical advice.
A quick look at OCD
The National Institute of Mental Health describes OCD as a disorder marked by uncontrollable, recurring thoughts called obsessions, repetitive and excessive behaviours called compulsions, or both. Symptoms often begin between late childhood and young adulthood.
Obsessions bring a surge of anxiety, doubt or disgust. Compulsions are the things a person does to get rid of that feeling, such as checking, cleaning, counting, seeking reassurance or mentally reviewing. The relief is real but short-lived, and each compulsion teaches the brain that the obsession was dangerous. That loop is what keeps OCD going.
Why ERP stays first-line
ERP is a form of cognitive behavioural therapy (CBT). Researchers describe it as the most strongly supported first-line psychotherapy for OCD, and often call it the gold standard. The National Institute of Mental Health also describes exposure therapy as a type of CBT in which a person learns to tolerate distress in a supportive setting. In ERP, you gradually face situations that trigger obsessions while choosing not to do the compulsion. Over time, your brain learns that the anxiety rises, peaks and falls on its own, and that you can handle uncertainty without the ritual.
ERP is the core of treating OCD. Nothing in this post suggests replacing it. If you want to learn more about how we approach it, see our page on OCD.
Where DBT skills come in
ERP works, but it asks a lot. Researchers writing about OCD note that many people stay symptomatic or find ERP hard to stick with because of strong emotions and the discomfort of exposures. Some people drop out early. Others hold back from the harder steps on their list.
That's where DBT therapy for OCD is sometimes considered, not as a stand-alone treatment, but as a skills add-on. DBT was originally developed to help people manage overwhelming emotions. It teaches practical skill sets, including mindfulness, emotion regulation, getting along with others and distress tolerance. The OCD researchers who are now studying it point out that distress tolerance skills may help some people ride out the discomfort that comes during exposures.
Think of it this way. ERP is the workout. DBT skills are more like learning to breathe and pace yourself, so you can finish the workout instead of quitting halfway. The skills don't do the work of ERP, and they are not meant to.
Distress tolerance and OCD
When we talk about distress tolerance, OCD urges are the main target. It is the DBT skill set most often linked with OCD. It is about getting through intense moments without making things worse. For someone with OCD, "making things worse" often means doing the compulsion.
Distress tolerance in OCD might look like:
Noticing the urge without obeying it. Naming "this is an urge to check" creates a little space.
Self-soothing. Using the senses, such as a warm drink or calming music, to take the edge off without neutralizing the obsession.
Riding the wave. Remembering that urges peak and pass, like a wave.
Radical acceptance. Accepting that the uncertainty is uncomfortable, instead of fighting it.
There is an important line here. Any skill used to make the obsession go away, or to feel certain, can turn into a new compulsion. A therapist helps make sure skills support exposure rather than become a way to avoid it.
What the research says so far
Research on DBT skills for OCD is still early. A randomized controlled trial published as a protocol in 2026 is now testing a 12-week distress tolerance program for adults with OCD, compared with standard ERP. The study is designed to measure OCD severity and distress tolerance, but results haven't been published yet.
So the honest picture is:
ERP has strong support and remains the main treatment.
DBT skills for OCD are being tested, but there isn't enough evidence yet to call them a treatment for OCD on their own.
Some people may find that a few DBT skills make ERP feel more manageable.
DBT vs ERP, how they compare
When people search "DBT vs ERP," they are often trying to choose between them. It helps to see them as doing different jobs.
ERP targets the OCD cycle directly by breaking the link between obsessions and compulsions.
DBT skills target the emotional overwhelm that can make exposure hard to start or finish.
ERP is the core treatment. DBT is an optional support around it.
ERP asks you to lean into uncertainty. DBT offers tools to stay steady while you do.
For most people, the question isn't which one to pick. It's whether a few extra skills would help them complete ERP.
Who might benefit from adding DBT skills
Adding DBT skills alongside ERP may be worth discussing with your therapist if you:
Feel so overwhelmed during exposures that you stop partway through
Have struggled to start ERP because the anxiety feels unbearable
Notice strong emotions like shame, anger or sadness mixed in with your OCD
Want more ways to cope during hard days between sessions
Your therapist can help you decide whether this blend makes sense for you, and in what order.
Questions to ask a therapist
If you are considering skills support alongside ERP, these questions can help you find a good fit:
How do you use ERP with clients who have OCD like mine?
When would you add DBT skills, and which ones?
How do you make sure a coping skill doesn't turn into a compulsion?
How will we track whether things are improving?
A clear, confident answer to these questions is a good sign. It's also fine to ask them during a free consultation before you commit.
What combined sessions might look like
A plan that blends the two often looks like this:
Assessment and goals. You and your therapist map your obsessions, compulsions and what you want to change.
Skills first, briefly. You learn a small number of distress tolerance skills you can use during exposures.
ERP as the main work. You build an exposure ladder and work through it step by step.
Skills as backup. You use skills to stay in an exposure, not to escape it.
Review. You check together that no skill has quietly become a compulsion.
Some people also explore other approaches with their therapist. If you're curious, our post on EMDR and OCD looks at another option people ask about.
Getting support
We offer support for OCD in person and online, and every service is available at each of our locations.
Sessions with our therapists range from $130 to $200, depending on the clinician.
Depending on your plan, insurance may cover up to 100% of the cost. Check your plan for the details.
We accept Health Spending Accounts (HSAs).
We can direct bill many insurers, including for sessions with an RP (Qualifying). Desjardins is the exception: through TELUS eClaims, we can direct bill Desjardins for sessions with an RSW, RP or psychologist, but not for an RP (Qualifying).
Book a free 15-minute consultation with our admin team to ask about ERP and whether skills support could help you.
If you're in crisis: if you or anyone else is in immediate danger, call 911. If you're having thoughts of suicide, call or text 9-8-8 any time.
OCD is hard, and so is facing it. The right support can help you keep going.
Last reviewed: October 2026
Sources
National Institute of Mental Health, Obsessive-Compulsive Disorder (OCD)
National Institute of Mental Health, Psychotherapies
Kumar M, Singh V, Kumar R, et al. Efficacy of distress tolerance techniques of dialectical behavior therapy in persons with obsessive-compulsive disorder: a study protocol for a randomized controlled trial, Trials, 2026