When OCD and depression occur together: can mindfulness improve exposure therapy?

When OCD and depression occur together

OCD is not simply thinking too much or preferring order. Obsessions are intrusive thoughts, images or urges that cause distress. Compulsions are behaviours or mental acts that a person feels driven to perform to reduce that distress or prevent a feared outcome.

Depression can add exhaustion, hopelessness and difficulty beginning any activity. When the two conditions occur together, taking part in demanding therapy may be especially difficult. A person may understand what they need to do while feeling that they lack the energy, flexibility or confidence to continue.

That combination was the starting point for a trial published in Scientific Reports on 15 July 2026. The researchers wanted to know whether incorporating mindfulness practices into exposure and response prevention could improve treatment for adults with OCD and major depressive disorder.

What exposure and response prevention does

Exposure and response prevention, usually abbreviated to ERP, is part of the cognitive behavioural therapy recommended for OCD.

Exposure involves approaching thoughts, objects or situations that trigger an obsession in a planned and gradual way. Response prevention means refraining from the usual compulsion or neutralising response. The purpose is not to reassure the person that nothing bad will happen or to remove anxiety immediately. With support and repetition, it is to learn that they can move through uncertainty without obeying OCD.

This can include visible actions, such as not checking a locked door again, and less obvious mental rituals, such as reviewing a memory, pursuing absolute certainty or repeating a phrase to neutralise a thought.

Therapy needs to be adapted to the individual and undertaken by agreement, not imposed as forced exposure. Its difficulty helps to explain why researchers are studying ways to improve engagement without dismantling the component that makes it effective.

What mindfulness added

Mindfulness teaches people to observe thoughts, emotions and sensations without reacting to them automatically. In OCD treatment, it is not used to prove that an obsession is false or to produce immediate calm. The aim is for the person to recognise the thought as a mental event and allow the urge to perform a compulsion to pass.

That function may fit with ERP: noticing doubt, fear or discomfort and remaining with the experience without neutralising it. There is also a risk, however. If somebody turns breathing, meditation or a phrase of acceptance into something they must perform until they feel «right», the practice may operate as another compulsion. How it is integrated, and who guides it, therefore matters.

The trial compared standard ERP with an intervention combining ERP and mindfulness. Fifty-four people were allocated to the two groups, and 40 completed the 17 sessions, 20 in each group.

What the trial found

OCD symptoms decreased in both groups, but the analysis showed a greater reduction in the group that received mindfulness alongside ERP. This group also showed greater improvements in obsessive beliefs, dispositional mindfulness and mental wellbeing.

Depressive symptoms improved significantly in both groups. Although there was an overall difference between the groups favouring the combined intervention, their trajectories over time were not significantly different. It would therefore be inaccurate to say that adding mindfulness has been shown to treat depression more effectively.

The gains were descriptively maintained four months later. A short follow-up and a final sample of 40 people, however, cannot establish whether the effect will persist in larger populations or over a period of years.

Why the result remains preliminary

The study provides an interesting signal, but it does not establish a new standard treatment. The sample was small, and 14 of the 54 people initially allocated did not complete the intervention. This attrition may affect the result if those who completed treatment differed from those who left.

All participants also had both OCD and major depression. The study does not show that the same adaptation offers an advantage to people with OCD without depression, to children or young people, or to those with other co-occurring conditions. Nor can it identify precisely which part of the intervention produced the difference.

The journal has published an early version of the manuscript that must still undergo final editing. Independent trials with larger samples and longer follow-up will be needed before it is clear who benefits from this combined approach.

What this means for someone seeking help now

The finding does not change the central recommendation: OCD treatment should be based on evidence-supported interventions, particularly cognitive behavioural therapy with ERP and, where appropriate, medication prescribed by a clinician.

Someone interested in mindfulness can ask their therapist whether incorporating it would be useful. The important question is not simply whether the practice feels calming, but whether it helps the person observe the obsession and reduce the compulsive response. If it is used to obtain certainty, neutralise thoughts or check that anxiety has disappeared, its role should be reconsidered.

It is not advisable to devise intense exposures without professional guidance or stop medication without supervision. A practitioner experienced in OCD can distinguish between a helpful adaptation, avoidance and a practice that the disorder itself has turned into a ritual.