To observe the efficacy of psychotherapy combined with fluoxetine versus fluoxetine alone in refractory OCD. A total of 60 patients with refractory OCD who met the diagnostic criteria of CCMD-2R OCD were enrolled. They were randomly divided into 30 cases with psychotherapy combined with fluoxetine and 30 cases with fluoxetine alone, and systematically treated for 8 weeks. The Y-BOCS scale was used to evaluate the efficacy. The results showed that the study group was significantly better than the control group after treatment, with an effective rate of 76.66% and 46.66%, respectively, and there was a significant difference between the two groups. It is concluded that cognitive apprehension therapy for refractory OCD can more effectively control symptoms and improve prognosis. Refractory cases account for about 20% of OCD patients. There is still no consensus on the pathological mechanism, but most scholars believe that it may be related to low 5-HT function in the brain. Therefore, it is believed that improving the function of 5-HT receptors in the brain and increasing the level of 5-HT in the synaptic gap play a role in treating OCD. Cognitive-behavioral theory suggests that what can disturb the patient’s mind is mainly the patient’s perception of events, and that the deficits in judging and evaluating a person’s behavioral performance are caused by his or her cognitive deficits. Once the cognitive deficits are improved and corrected, the adverse emotions and behaviors will improve accordingly. We believe that the pathogenesis of OCD is multifaceted, with both psychological and biological causes. Therefore, the treatment should take both into account. We have achieved good results with cognitive apprehension therapy and fluoxetine as the main psychotherapy. However, medication is not a substitute for psychotherapy, because it does not help to solve the causes of the disease, nor does it help to overcome the defects in personality development to improve psychological recovery after the disease. Therefore, psychotherapy such as cognitive apprehension deserves to be promoted in clinical practice in the treatment of refractory OCD.