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Treatment response remains one of the key challenges in managing patients with obsessive-compulsive disorder (OCD). This study aimed to investigate the efficacy of combining neurofeedback with pharmacotherapy in treating OCD. We conducted a single-blind, randomized clinical trial at Farschian Hospital in Hamadan, Iran. Forty-five patients with OCD were randomly assigned to three groups (n = 15 per group): experimental, placebo, and control. The experimental group received 25 neurofeedback sessions (three 45-minute sessions per week) alongside pharmacotherapy. The placebo group followed a similar protocol but without actual neurofeedback administration. The control group received pharmacotherapy alone. Data were analyzed using SPSS-22. The results demonstrated a significant improvement in the mean total obsession score, including both thought and compulsion subscales (p < 0.01). The experimental group showed significantly greater improvement in all outcome measures compared to both control groups (p < 0.05). No significant difference was observed between the placebo and control groups (p > 0.05). These findings suggest that combining neurofeedback with pharmacotherapy significantly reduces OCD symptom severity compared to either treatment alone. Neurofeedback may serve as an effective, novel, and non-invasive complementary therapy for OCD when combined with standard pharmacological treatment.Trial registration The trial was registered at the Iranian registry of clinical trials ( www.irct.ir ; registration number: IRCT2015030321313N1).