Areas of Specialization - Children and Adolescents
Exposure and Response Prevention for Obsessive Compulsive Disorder
Similar to adult treatment, obsessive
compulsive disorder in children
and adolescents requires exposure
and response prevention and cognitive-behavioral
therapy. However, it is necessary
to adapt the treatment to the appropriate
developmental level, and especially
with younger children, parental
involvement becomes a crucial component.
The first step of the treatment
is education about obsessive compulsive
disorder within a medical model.
The use of analogies to other medical
illness and metaphors to explain
their distressing thoughts and behaviors
are employed. As a result, the child
and family understand that this
disorder is not the child's fault
and is a neurological problem. Children
and adolescents are also taught
about the nature and function of
anxiety and they learn anxiety management
skills, such as deep muscle relaxation
and diaphragmatic breathing. The
next step involves training in cognitive
techniques for resisting the obsessions
and compulsions. These include reinforcing
accurate information regarding obsessive
compulsive disorder and cognitive
behavioral treatment. "Resistance"
to the symptoms is also reinforced
through cognitive restructuring
of the meaning of the obsessive
thoughts and compulsive behaviors
and challenging the belief that
unpleasant physiological arousal
is a sign that "something bad
is going to happen." An example
of this "talking back"
to OCD is having the child respond
to the obsession with statements
such as "I am the boss OCD…
This will be hard, but I can do
it, I've beaten OCD before."
Cognitive restructuring also focuses
on teaching the child to shift between
what OCD states and what the child
estimates as a realistic probability
of danger or risk. Thus, the overall
objective of cognitive training
is increasing the child's sense
of competence, predictability and
controllability of the obsessions
and compulsions. The next phase
begins with delineating the areas
in which the child is free of OCD,
the child can sometimes resist the
OCD, and when the child is powerless
to control the OCD. This information
is then placed into an anxiety hierarchy
that is ranked from least difficult
to control to most difficult or
impossible to resist the OCD. Next
gradual exposure and response prevention
guides the child through the process
of confronting their fears (e.g.,
Jake petting his dog) without having
to perform the routine anxiety reducing
behavior (e.g., excessively washing
his hands or showering). For more
information regarding exposure and
response prevention treatment and
intensive treatment options, please
refer to the Adult
Obsessive Compulsive Disorder.
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