Both matter, and the relationship between them is important. CBT/ERP is a well-supported treatment for OCD and anxiety, and clinicians experienced in PANS and PANDAS generally recommend it as part of a comprehensive approach, not something to set aside while pursuing medical treatment. The complication is timing. During an acute, severe episode, a child may not be able to engage meaningfully with intensive therapy — the brain needs a calmer state to do that work. Most experienced providers work toward parallel treatment: addressing the infection and immune dysfunction medically while keeping behavioral support in place, adjusting the intensity of formal CBT/ERP during acute phases and pursuing it more fully as the episode settles. Medical treatment calms the storm. Therapy helps the child rebuild what the storm damaged. Both are necessary.