Disclaimer [ENGLISH]
Cognitive Behavioral Therapy (CBT)
The first step in the treatment of obsessive-compulsive disorder (OCD) is to better understand how OCD works. For younger children, it often helps to put OCD in a context that they can understand. For example, parents can explain that OCD functions like a bully. If a bully asks for your lunch money and you give in because you are afraid, then the bully will be happy and go away. But the next day the bully will come back because they know you are afraid. The more you give in to a bully, the more they ask for. OCD works the same way. The goal of treatment is to help a child learn how to stand up to the bully.
The gold-standard treatment for OCD is a specific type of cognitive behavioral therapy (CBT) method called Exposure and Response Prevention (ERP). This has been shown to be highly effective for kids struggling with OCD. ERP works by helping patients face the things that activate their anxiety in a safe environment. At each step, with repetition and practice, they see the anxiety subside and are ready to work their way up to bigger and bigger fears. Patients learn that avoiding their anxiety gives it more and more power — and they develop skills to tolerate it without giving into their compulsions. Through facing their fears, patients gradually learn to tolerate their anxiety and, over time, discover that their anxiety has decreased.
For example, a child with fears about germs and contamination would create a “fear hierarchy” with their therapist. They would work together to identify all the contamination situations, rate them on a scale of 0-10, and tackle them one at a time until the fear subsides. The child would start with a low-level fear, such as touching clean towels, and build towards more difficult situations, such as holding something from the trash. The therapist provides ERP in real world locations where your child experiences anxiety, and teaches caregivers how to reinforce ERP skills outside of treatment for continued practice. For most cases of mild to moderate OCD, treatment once a week for 12-15 weeks is usually needed to get strong results.
Intensive CBT
For those with severe symptoms, weekly or even twice-weekly therapy sessions might not be effective enough. If the child’s symptoms are seriously interfering with school performance, family life and friendships, and if typical treatment is not helping, parents may want to consider a treatment program that is more intensive. Thee programs meet for several hours per day for many days per week for 3-6 weeks.
Hospitalization Program
A hospitalization program is another option for children with severe OCD. After an OCD hospitalization, the child may be recommended to participate in an intensive outpatient program to help ease the transition away from being in a structured hospital environment and to help maintain the therapeutic gains made.
When Treatments Don’t Work
If therapy does not seem to be working, consider the following:
- Is the therapist using the correct kind of cognitive behavior therapy aimed at addressing OCD specifically?
- Is the child practicing the skills learned outside of therapy sessions?
- Are all fears being addressed?
- Are families included in the treatment?
Usually the challenge lies in one of issues above and addressing them will result in improved outcomes.
Medication Treatment for OCD
While the primary treatment for OCD is cognitive behavioral therapy, patients with more severe or therapy-resistant symptoms are often treated in combination with medication. A class of medication called selective serotonin reuptake inhibitors (SSRIs), can be used to help reduce their anxiety, which in turn may allow them to be more responsive to therapy. Medication can be decreased or discontinued as patients learn skills to help overcome their anxiety on their own. Sometimes other types of medicines can be prescribed to control excessive irritability or anger that may be also be present. A therapist will not be able to prescribe medications (although they may strongly recommend it) and may refer the patient to a medical doctor experienced in medication management.
This publication was adapted from the Child Mind Institute (https://childmind.org/guide/parents-guide-to-ocd/; https://childmind.org/article/intensive-treatment-for-ocd-and-anxiety/)
Reviewed by: HB M.D., PL M.D. | 04/2024