How Exposure and Response Prevention Helps OCD
When I first meet a child with OCD, they often tell me they feel hopeless. Kids with OCD are usually aware something is wrong: the worries that bother them feel foreign, and they wish they could just make the thoughts go away. When a child isn’t able to control his thoughts on his own, it can be a powerless and scary feeling.
The compulsive behaviors and rituals that come along with OCD can quickly become all-consuming, taking kids away from fun activities they love and leaving them feeling frustrated and embarrassed. Even though OCD can feel hopeless, the truth is that there’s a therapy approach out there that is really effective for treating obsessions and compulsions. ERP therapy for children can help kids deal with the overwhelming worries of OCD, and the way that it works might surprise you.
What is ERP Therapy?
ERP stands for Exposure and Response Prevention. It is a form of therapy that has been specifically designed and studied to treat OCD symptoms in adults, teens, and children, and it is often considered a “gold standard” for OCD treatment. ERP is a form of cognitive behavioral therapy, meaning that it’s based on the belief that changing a person’s thinking patterns and actions can also affect their emotions. Although some kids with OCD might also benefit from medication, ERP therapy does not involve medication. You can find ERP being practiced in big mental health centers as well as in private practice by psychologists, counselors, social workers, and other mental health professionals.
The main goal of ERP is to help children gradually face the frightening or difficult situations that set off their OCD worries (called exposure) without having to do their OCD behavior or ritual (response prevention). This is done in a safe, controlled way, usually in the therapy office, to keep children from feeling too overwhelmed. Children are taught about how OCD thoughts work to make them less mysterious and scary, and are given tools to fight back when their OCD thoughts arise.
Can Young Children Have OCD?
OCD can start at any age. Although most people with OCD aren’t correctly diagnosed until adulthood, two thirds of adults with OCD say their symptoms began before the age of 18. OCD can be diagnosed in children as early as age 6, and the time frame between 6 and 15 years of age is a common time for children to develop symptoms.
Here are some possible signs of childhood OCD to look out for:
Recurring fears, worries, or thoughts that the child doesn’t want to have, but can’t stop thinking about
Fears about hygiene (like handwashing), morality (like telling the truth), illness (like vomiting), or violent or upsetting thoughts
Needing to sort, count, or perform an action an excessive number of times, or in a certain sequence
The repeated worries and tasks are getting in the way of your child’s day-to-day life
How Does ERP Therapy Work with Children?
ERP therapy for children is based on the same tools and ideas as ERP for adults, but adapted to be more kid-friendly. OCD can feel disorienting and even embarrassing to children, who are often aware something is wrong but feel powerless to stop it. The first step in ERP with kids is to help children understand what OCD is, how it works, and that they are not alone. Explaining OCD using metaphors, reading age-appropriate books about ODC, and art and play therapy techniques can all help demystify OCD and help children understand that they’re experiencing something common and manageable.
Once kids have a better understanding of OCD, we can start teaching children tools to stop the cycle of OCD worries, and get control over their compulsive behavior.
“Bossing Back” OCD Thoughts with ERP
ERP therapy for children is a cognitive-behavioral approach, meaning that it focuses on a child’s thoughts and behavior to help shift their mood. Usually, ERP starts by helping a child learn to manage the repeated worries and unwanted thoughts that arise over and over with OCD. Sometimes these are described as “intrusive thoughts” because the thoughts can be upsetting ones that a child would never choose to have, but they pop into the child’s brain anyway.
In ERP a child learns that, like a glitch or a hiccup, these intrusive thoughts can be bothersome, but they’re not dangerous or a sign that something is seriously wrong. Kids learn how these OCD thoughts are different and less realistic than everyday thoughts, and practice spotting them when they pop up. Once a child can identify her OCD thoughts, she can learn tools to be the boss of them, instead of getting bossed around by the unhelpful worries.
Children might learn ways to use logic to prove that worries aren’t accurate, which can help take some of their power away. Children can also learn how to talk back to their fears, coming up with more helpful and empowering statements to say to themselves when an OCD thought is bothering them. Rather than being bossed around by OCD worries, children learn how to “boss back” and challenge their thoughts to regain control over them.
Doing the Opposite
The behavior-based part of ERP therapy for children is the one that might surprise you. After children tackle the thoughts and worries of OCD, they are asked to do the exact thing their OCD tells them not to do. For example, a child with a fear of getting germs on their hands might be encouraged to play in the mud…without washing her hands right away. A kid who worries about throwing up might be asked to talk about vomiting and make barf jokes in therapy sessions.
This might seem counterintuitive: if a child is feeling really anxious about a certain activity, won’t doing it make him feel worse? When a person is anxious, it’s really tempting to avoid anything that triggers anxiety. Each time we do this, however, we are “feeding” the anxiety and making it stronger in the long run. Although our anxiety might go away when we avoid a scary thing, the next time we encounter the same situation it will come back even stronger.
Kids are never asked to face their fears all at once—this would be way too scary and overwhelming! Instead, a therapist helps a child to work up to the scariest situations, bit by bit, usually over the course of many weeks. This is done in a safe setting like a therapy office, where the therapist can control the situation and make sure the child is not feeling too overwhelmed. Each time the child faces a part of their fear, they re-train the brain that this situation is not something worth getting so anxious over. Children are also encouraged not to practice their OCD behavior during this time, even if it feels like it would help them to reduce their anxiety. By ignoring the urge to complete a compulsive behavior, we can diminish its strength over time, and eventually children may not feel the need to do it at all.
More Resources on ERP Therapy for Children
If you suspect a child in your life has OCD, and wonder if ERP therapy for children could be helpful, there are a few next steps you can take. My blog post on child OCD symptoms can help you learn more about how OCD can manifest in kids, or you can check out my homepage on childhood anxiety to get advice about how to help kids soothe anxiety at home. You can also visit the International OCD Foundation’s website, which has excellent resources for families and can help you find a therapist who specializes in OCD in your area.
If you’re in the Lake Norman or Charlotte, NC areas, I’m always happy to talk about local resources and how I might be able to help support your child with OCD. You can reach out to me here.
