Joseph O'Neill,1 Jamie D Feusner,2 1Division of Child Psychiatry, 2Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA Abstract: This article reviews issues related to a major challenge to the field for obsessive–compulsive disorder (OCD): improving access to cognitive-behavioral therapy (CBT). Patient-related barriers to access include the stigma of OCD and reluctance to take on the demands of CBT. Patient-external factors include the shortage of trained CBT therapists and the high costs of CBT. The second half of the review focuses on one partial, yet plausible aid to improve access – prediction of long-term response to CBT, particularly using neuroimaging methods. Recent pilot data are presented revealing a potential for pretreatment resting-state functional magnetic resonance imaging and magnetic resonance spectroscopy of the brain to forecast OCD symptom severity up to 1 year after completing CBT. Keywords: follow-up, access to treatment, relapse, resting-state fMRI, magnetic resonance spectroscopy