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OCD Treatment

TMS For OCD Treatment

OCD is a highly disabling condition. The World Health Organization (WHO) ranks OCD in the top 10 most disabling ailments, as it causes severe impairment in social and occupational relationships and daily living.

At TMS Health and Wellness, we offer advanced brain-based treatments for OCD, including deep Transcranial Magnetic Stimulation (dTMS) and Neurofeedback therapy, to provide non-invasive options for patients who have not found relief with traditional methods.

Why do we need TMS for OCD?


1. First-line Treatments for OCD do not Always Work

Unfortunately, about half of all patients with OCD fail to respond to traditional medications. Moreover, OCD often requires higher doses of these medicines, which comes at the cost of serious side effects, causing many patients to stop their treatment. Even in patients who do take their medications as prescribed, it is common that there is never complete relief from symptoms.

Another option commonly employed by practitioners for OCD is behavioral therapy in the form of exposure and response prevention (ERP) and cognitive therapy. ERP involves exposing the patient to the same cues that evoke distressing and obsessive thoughts. While effective for some, patients often feel frustrated and overwhelmed after repeated exposure to distressing cues, resulting in high dropout rates from behavioral therapies.

Because of these limitations, there has been a growing need for safer, more tolerable, and more targeted neuromodulation options like TMS and Neurofeedback that directly address the brain circuits involved in OCD.

 

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2. Second-line options for OCD Carry Serious Risks

If drug and behavioral therapies fail, the next step sometimes employed by practitioners is a procedure known as ventral capsulotomy. It involves surgically implanting a deep-brain stimulator (DBS), which targets the area of the brain linked to OCD. Though this procedure has shown promise in treatment-refractory patients, DBS carries serious risks like any other surgery.

In the face of treatment-resistant OCD, there has been a pressing need to develop new, effective, safe, and tolerable therapies to minimize the enormous burden of this condition. One of these therapies is TMS or dTMS.

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What is dTMS, and How is it Different from Conventional TMS?

Up till now, clinical trials using TMS for OCD were largely done with non-deep TMS, which showed limitations because the magnetic pulses only had access to the superficial cortical areas of the brain.

However, advances in neuroscience over the last few decades have paved the way for a novel third option for treating OCD, called deep transcranial magnetic stimulation (dTMS).

dTMS therapy is now FDA-approved as an add-on treatment for OCD. The most popular method to apply dTMS in OCD is the Brainsway Method. It uses a lightweight helmet with magnetic pulses generated through a built-in coil known as an H-coil to penetrate the brain’s deeper areas implicated in OCD. Hence, dTMS allows for stimulation of a larger and deeper brain volume than conventional TMS.

Like conventional TMS, dTMS is an entirely non-invasive therapy and is done as an outpatient procedure with virtually no systemic side effects.

How Does dTMS Target OCD Circuits?

 

The areas implicated explicitly in OCD are the orbitofrontal cortex (OFC) and the anterior cingulate cortex (ACC). These areas are located in the frontal lobes (that sit in the very front of the brain) and are responsible for error detection and emotional, reward, and behavioral regulation.

Research shows that the OFC and ACC:

  1. Are hyperactive at rest in people with OCD compared to healthy patients
  2. Become overly active when symptoms are provoked
  3. Resume their regular activity after successful treatment with either medical or behavioral therapy

Typically, these regions are intimately connected to the basal ganglia — a cluster of nerve cells responsible for movement and regulating emotions and behavior. The basal ganglia receive input from the cerebral cortex. These signals are then conveyed to another brain region called the thalamus, which relays this information back to the cortex.

In OCD, hyperactivity in the frontal lobes disrupts normal communication between the basal ganglia and thalamus. This causes the thalamus to become overactive and “out of control.” The failure of the frontal lobes to inhibit the thalamus is what triggers unrelenting intrusive thoughts and compulsive behaviors.

The use of dTMS in OCD is based on this maladaptive network activity. By either exciting or suppressing these target regions (depending on the magnetic pulses’ frequency and protocol), dTMS can help normalize activity in these circuits and reduce OCD symptoms.

Neurofeedback Therapy for OCD

Alongside dTMS, Neurofeedback therapy is another non-invasive, brain-based treatment we offer for OCD. Neurofeedback uses real-time EEG (brainwave) monitoring to help patients learn how to shift their brains out of patterns associated with hypervigilance, intrusive thoughts, and compulsive urges, and into more regulated, calm states.

Neurofeedback can be especially helpful for:

  • Reducing anxiety and tension that fuel obsessive thinking
  • Improving emotional regulation and resilience
  • Supporting better sleep and stress response
  • Reinforcing gains made with dTMS and psychotherapy

At TMS Health and Wellness, Neurofeedback is often combined with dTMS and other modalities to build a more comprehensive and durable response to treatment.

Customized Treatment Plans: 3 Symptoms at a Time

OCD can look very different from one person to another: some struggle with contamination fears and washing rituals, others with checking, unwanted intrusive thoughts, symmetry obsessions, or mental rituals that no one else even sees.

For this reason, each customized treatment plan at TMS Health and Wellness is built around your three most distressing symptoms at a time (for example: intrusive thoughts, checking behaviors, and reassurance-seeking). We coordinate your dTMS protocol, Neurofeedback plan, and supportive therapies to target these three primary symptom clusters until we see clear improvement.

Once those symptoms have begun to soften and become more manageable, we reassess, update your plan, and shift our focus to the next set of priority symptoms. This structured, symptom-based approach helps ensure that treatment leads to meaningful changes in daily life, not just on rating scales — less time stuck in rituals, fewer intrusive thoughts, and more freedom in your day.

How Effective is dTMS for OCD?

dTMS therapy has optimized the odds for people with OCD to receive treatment that will benefit them finally.

A 2019 clinical study published in the American Journal of Psychiatry showed a statistically significant (30%) improvement in OCD symptoms in the dTMS group after six weeks of daily sessions, as measured by the Yale-Brown Obsessive-Compulsive Scale. The treatment was as effective as the medications available for treating OCD. Nonetheless, dTMS achieved quicker results relative to medical therapy.

This study was rare because it entailed provoking OCD symptoms in the participants prior to each treatment session. The idea behind provoking OCD symptoms was to activate the relevant brain circuitry.

Are there any Downsides to TMS for OCD?

Deep TMS is a safe therapy with minimal to no side effects. As noted in the above study, the most common side effect reported by patients was a headache, which typically subsided shortly after treatment.

To be successful, TMS does require daily sessions. Because the sessions only last for about 15 to 20 minutes on average, this daily commitment is manageable for the majority of patients — especially compared to the burden of uncontrolled OCD.

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Summary

Though OCD is a treatable illness, not all patients respond to the currently available treatments. Even when patients do respond, it is rare to see them completely recover from the condition.

Thanks to novel treatments like deep TMS and Neurofeedback, there is now more hope for people with refractory OCD. Being non-invasive therapies with minimal adverse effects, these approaches are considered strong alternatives or add-ons for people who fail to respond to first- or second-line treatments.

dTMS therapy is now FDA-approved as an add-on treatment for OCD. There are two TMS machines that have been approved to deliver OCD treatment to date — Brainsway and MagVenture — as they are the only machines able to penetrate the brain’s deeper areas implicated in OCD. Brainsway uses a lightweight helmet with magnetic pulses generated through a built-in coil known as an H-coil, and MagVenture uses the Cool D-B80 angulated coil, which allows for stimulation of larger and deeper brain volume than conventional TMS. At TMS Health and Wellness, we have both machines available for OCD treatment, and we often integrate them with Neurofeedback and personalized, three-symptom-focused treatment planning to maximize your chances of meaningful, lasting improvement.

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