We were pleased to see the results of a recent study on the effectiveness of treatments for children with obsessive-compulsive disorder. Pleased in part because there are so few studies involving children, but also because researchers were testing not just medication for OCD, but cognitive behavioral therapy.
The study involved 7- to 17-year-olds with OCD who were divided into three groups. The first group was treated with medication. The second got medication with some instruction in cognitive techniques for managing anxiety. The third got medication with a course of behavioral therapy. After 12 weeks, the children were evaluated to see how many had at least a 30% reduction in their symptoms, measured by the severity of their anxiety, the kinds of rituals they were performing to manage that anxiety, and the amount of time they were spending on those rituals.
The result: just 30% of the children in the medication-only group hit the benchmark for improvement. Of those who also got instructions in how to modify their behavior, 34% got better. But twice as many of the children who got both meds and 14 sessions of behavioral therapy—68%—got better.
This dovetails with our clinical experience, and highlights a couple of things we’ve seen in our patients. We find that medication for OCD will decrease the frequency of obsessions, and lower the level of the anxiety for the remaining ones. But kids know that it’s a pill making them feel better, and that gives them the attendant fear that when they stop taking the pill, the obsessions will return. In fact, if they haven’t learned the CBT skills that give them control and power over their obsessions, they can find themselves right back where they started; sometimes the obsessions are even more frequent.
The behavioral therapy that’s very effective with kids who have OCD is called exposure and response prevention, or ERP. In a safe, controlled setting, we expose kids to the things that stimulate their anxiety in very gradual doses. They learn to tolerate the anxiety without performing the ritual. The need to perform the ritual diminishes as their ability to tolerate the anxiety gets stronger. When we treat kids we have them name their OCD, and talk back to it. They are encouraged to see themselves as facing down a bully—the bully that’s in their own heads, that is. And the bully gets smaller as they get stronger.
What we are teaching children (and their parents, who are essential allies in fighting their OCD) is skills to counter and master the fears that have come to dominate them. It takes a great deal of practice and repetition—real work on their part, and on the part of their families, to wrestle their obsessions down to a manageable size. ERP involves a lot more work than taking a pill to reduce anxiety, but it trains kids in skills they can use for the rest of their lives when they find themselves in danger of slipping into obsessive-compulsive patterns.