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Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD. To evaluate whether DCS potentiates the effect of concentrated ERP among patients with difficult-to-treat OCD. The study was a randomized placebo-controlled triple-masked study with a 12-month follow-up. Part