Treatment for OCD
Cognitive behavioral therapy
The first step in treatment is helping children understand how OCD works. It often helps to put OCD in a context that children can understand. For example, a clinician might explain that OCD functions like a bully. If a bully asks for your lunch money and you give in because you’re afraid, then the bully will be happy and go away. But the next day the bully will come back for more, because he knows you are afraid. The more you give in to a bully the more he will ask for. OCD functions the same way. The goal of treatment is to help a child learn how to stand up to his bully.
The gold-standard treatment for OCD is a kind of cognitive behavioral therapy called exposure and response prevention, or ERP. ERP works by helping children face the things that trigger their anxiety in structured, incremental steps, and in a safe environment. This allows children to experience anxiety and distress without resorting to compulsions, with the support of the therapist. Through facing their triggers children learn to tolerate their anxiety and, over time, they discover that their anxiety has actually decreased.
For example, a child with fears about germs and contamination would create a “fear hierarchy” with his therapist. They would work together to identify all of the contamination situations he fears, rate them on a scale of 0-10, and then tackle them one at a time until his fear subsides. The child would start with a low-level trigger, such as touching clean towels, and build to more difficult triggers, such as holding something from the trash.
Because children often have symptoms that are specific to settings outside the clinical office, at home or in restaurants, for instance, it is important for treatment to move outside the office as needed. Your clinician should provide ERP in real world locations where your child experiences anxiety, and make sure that caregivers know how to reinforce ERP skills outside of treatment, too.
For most cases of mild to moderate OCD, treatment once a week for 12-15 weeks is usually enough to get strong results.
Working with parents
Parents spend the most time with their children, so it is essential for family to be involved in treatment. You should expect your child’s clinician to work closely with you, explaining how treatment works and giving you and your child homework to practice the skills your child is learning in therapy.
Because children often come to parents looking for reassurance or to help with an obsession or compulsion, it is also important for parents to learn the best way to respond to their child without reinforcing her OCD. When a parent gives reassurance, it makes the child feel better in the moment, but that relief is fleeting and can actually reinforce the child’s anxiety in the long run. It also doesn’t help her learn any coping skills to help herself — only that asking mom or dad will help.
Similarly, if your child has an aversion to a certain word, your family might have learned to avoid saying that word and apologize if someone accidentally uses it. However inadvertent, this also reinforces the OCD because it doesn’t give the child a chance to overcome her anxiety. Your child’s clinician should work with you on finding ways to respond to requests for reassurance that are supportive without reinforcing OCD symptoms.
Intensive CBT and hospitalization
For children with severe symptoms, weekly or even twice-weekly therapy sessions might not be effective enough. If your child’s symptoms are seriously interfering with school performance, family life and friendships, and if typical treatment isn’t helping, you may want to consider a treatment program that is more intensive.
Some institutions that specialize in OCD, like the Child Mind Institute, offer intensive treatment programs that allow children to be seen several times a week, compressing treatment and helping children make more gains faster. These programs can have a transformative effect on children struggling with severe OCD, and can many times prevent hospitalization.
An inpatient hospitalization program is another option for children with severe OCD who are not getting the help they need from traditional outpatient treatment. After an inpatient OCD hospitalization, a child may be recommended to participate in an intensive outpatient program to help ease his transition away from being in a clinical environment and to help him maintain the gains he has made.
Medication treatment for OCD
While the primary treatment for OCD is cognitive behavioral therapy, children with more severe cases are often treated with a combination of CBT and medication. A class of antidepressant medication called SSRIs, or selective serotonin reuptake inhibitors, can be used to help reduce a child’s anxiety, which in turn allows the child to be more responsive to therapy. Medication can be decreased or discontinued as the child learns skills to help her overcome her anxiety on her own.
Sometimes other types of medicines can be prescribed to control excessive irritability or anger that may be complicating treatment.