Cognitive Behavior Therapy

In order to help your child, it’s very important that you be aware of a special kind of therapy called Cognitive Behavior Therapy (CBT) – the treatment of choice for all forms of OCD.  CBT makes use of two evidence-based techniques: Exposure and Response Prevention therapy (ERP) and Cognitive Therapy (CT).  

Exposure and response prevention involves controlled, gradual exposures to the situations that trigger a person’s obsessions and compulsions.  Over time, the person learns to respond differently to these triggers, leading to a decrease in the frequency of compulsions and the intensity of obsessions.  OCD symptoms often become so mild that they’re easily ignored; sometimes they disappear.

How It Works

The first step in ERP is for your child to provide the therapist with a detailed description of his or her obsessions and compulsions, which are then ranked from the least bothersome to the most difficult.  Beginning with easier symptoms on this hierarchy, the therapist will design “exposures,” or challenges, that put your son or daughter in situations that trigger obsessions.  During these exposures, your child will avoid performing compulsive behaviors (“response prevention”) for increasingly longer periods of time.

Through repeated exposures, your child will come to realize that anxiety increases temporarily, peaks and then decreases when he or she avoids performing compulsions.  In fact, the anxiety experienced when first confronted with this challenge will shrink until it is barely noticeable or actually fades away.  Your son or daughter will then be able to take on more challenging exposures until they, too, became manageable.  Effective ERP leads to “habituation,” which means that your child will learn that nothing bad happens when he or she stops performing compulsive rituals.

For example, if your child has an obsessive fear of germs, a therapist conducting ERP therapy might encourage your child to touch a doorknob that he or she believes is contaminated (the task, or challenge, would be based upon the child’s hierarchy list). Your son daughter will be coached to wait longer and longer to wash his or her hands.  This gradual exposure and delayed response helps him or her learn to control the response.  Over time, he or she will learn to respond differently to the fear or thoughts about germs, which would actually lead to a decrease in the frequency and intensity of the obsession.

Cognitive Therapy, the second technique involved in CBT, helps your child identify and modify patterns of thought that cause anxiety, distress or negative behavior.  In other words, CT helps him or her understand that the brain is sending “error” messages (e.g., the brain is “playing a trick” on him or her).  Through Cognitive Therapy, your child will learn to recognize these errors and confront the obsessions by responding to them in new ways.  For example, a child who says “I’ll get germs and get a disease from touching clay” may be taught to reframe his or her thinking by saying, “Lots of kids touch clay, and they’re perfectly fine!”

There is no way to predict exactly how long it will take for your child to gain control over his or her OCD symptoms.  Because every child is different, the therapist will design a program that fits the needs and circumstances of your child and family.  Most CBT treatment is conducted on an outpatient basis once a week with “homework” consisting of daily exposures to be completed between therapy sessions.  In severe cases, people may require more frequent sessions or even residential treatment.  Rarely, and only in special circumstances, is hospitalization needed (e.g., in extremely severe cases of OCD; if a child may be trying to harm himself or others; when multiple disorders are present, requiring extended observation and treatment; if reaction to medication needs to be closely monitored; or if a suicide attempt has been made).

CBT is the only form of behavior therapy strongly supported by research for the treatment of OCD.  Therefore, it’s extremely important to find a trained cognitive behavior therapist experienced in treating children and adolescents with OCD – usually a psychologist with a Ph.D., Psy.D., M.A. or M.S. degree, or a specially trained social worker.  Beyond OCD can help you find a treatment provider.

This treatment may seem unusual; you may even think it wouldn’t work.  Or perhaps your son or daughter has already tried to resist compulsions, without much success.  But with the right therapist and sufficient time and support, Cognitive Behavior Therapy has helped many thousands of children gain control over their OCD.