Mild cases of OCD are often treated with cognitive behavior therapy alone, or medication alone; research shows them to be equally effective. But as symptoms intensify or impairment reaches the moderate to severe range, the best approach is the combination of CBT and medication.
Psychotherapeutic: OCD is best treated with cognitive behavior therapy, specifically a technique called exposure and response prevention. This technique introduces a child to the objects of his obsession in incremental doses in a controlled environment, in which he can experience his anxiety and distress without resorting to compulsions. Over time, the child will become habituated, the anxiety response will diminish, and the child will be able to give up the compulsion. The professional will work with your child to develop a “fear hierarchy,” and work on exposure from the easiest, least stressful trigger of OCD behavior up to the most dreaded. Much of the work and improvement is done at home, as the whole family is trained by the clinician to work on exposure tasks.
Many experts caution that traditional talk therapy does not help children with OCD, as talking about the disorder can increase anxiety about obsessions.
Pharmacological: More severe cases of OCD are often treated with a combination of CBT and medication, including SSRIs, or selective serotonin reuptake inhibitors. The medication reduces anxiety and allows the child to be more responsive to the exposure therapy. Once he has acquired skills to overcome the anxiety, medication can be decreased or discontinued.
Whether the treatment is behavioral or pharmacological or both, OCD patients will often return to their clinician in the years following their initial treatment for “booster sessions” to freshen up the skills they learned to control their anxiety levels.