Experience using CBT for OCD in Children

[RachelT]

Hi Everybody

 

My 13 year old daughter has a severe form of OCD. She has been having the traditional type of talking therapy for the last couple of years. It works fairly well. She only used medication in the early days. CBT us something that has been suggested to us a couple of times. I have researched it and I am not sure how she would cope.

 

Can anybody tell me their experiences with their child and CBT. I would really appreciate some feedback so I can weigh up the possibilities of trying CBT.

 

Thanks
Rachel

[Chemar]

Hi Rachel

my son has had CBT periodically for the OCD that is associated with his TS and it has been immensely beneficial.

 

It is very important to find a therapist that your child and you feel comfortable with, and one who does not have a domineering approach. Sadly there are some therapists that want to change kids into their own image, or into something that THEY feel the child should be....rather than just helping the child be better at being themself!

We had a brief experience with one of those and it was more detrimental than good!

I suggest you interview the therapist first before allowing your child to start with them.

[MomWithOCDSon]

Rachel --

 

I truly think the right CBT with the right therapist is key to getting our kids functional, but "talk therapy" alone isn't likely to produce the best results. A specific branch of CBT known as Exposure Response Prevention, or ERP, therapy, has been demonstrated to be the most effective against OCD. ERP can be tricky, though, and really requires the right mix of "tough love" and compassion. A good therapist will be able to guide your DD and your whole family through ERP exercises in therapy sessions, at home, and out in the world that will improve your DD's ability to function and lessen her anxiety and OCD response to various triggers.

 

Just know that, especially at 13, your DD is unlikely to "enjoy" therapy and will quite possibly even do whatever she can to avoid it. That's where some of the tough love comes in, because you have to hold onto the big picture, the knowledge that allowing her to avoid working through it is likely to only give the OCD more of a safe haven, and deeper roots from which it can spread and consume more and more of her daily life. Therapy, on the other hand, will give her the tools and techniques for keeping the OCD "pruned back."

 

Hang in there!

[RachelT]

Thank you Chemar and Nancy for your feedback. I can see that if we choose to help Sam by using CBT we will have to find a very understanding therapist and one who has a lot of patience lol. My son who is 19 has Aspergers and I thought dealing with that was difficult but Samanthas for of OCD has made that memory seem like a walk in the park. I will keep you both posted on how the CBT works out for her. Thank you both again.

Take care,
Rachel

[mommybee]

CBT the gold standard treatment for mild to moderate OCD, with or without medication. As Nancy indicated, it's hard work to force yourself to face your fears. But if you can do this, little by little you will extinguish them. Chemar is also right that finding a good therapist who won't be domineering is also important.

 

The one thing I would caution about is to take it slowly. If the child experiences too much anxiety as part of the exposures, his or her fears will be reinforced rather than extinguished. Not all therapists understand that for some children, anxiety can spike from very quickly resulting in a panic reaction that is destructive, if not abusive.

[lulu648]

Hi Rachel, we are just starting the same treatment with our almost-13-year-old daughter. She fought tooth and nail the day O took her to meet the therapist, but I think she's on board now. We're scheduling apts. around school so she doesn't have to tell her friends what she's doing if she doesn't want to. Our second apt. is coming up, where I'm hoping we will get to work on her OCD. Please check back in to comment on your daughter's progression, would love to hear how it goes for you. Best of luck.

 

[Ladymavs]

We just had a session with a therapist who has worked with many PANDAS kids/teens and my son (14) walked out of the session with much more anxiety than he went in with. His main issue has always been the intrusive thoughts and they have recently become more non-stop and the last several days have been really heightened. He has been parked on the scrupulosity based OCD (religious based) and it is very distressing for him as he values his Christian faith. They say the OCD hits hardest in those areas that are valued by the person. Anyway, I can see how pushing through and contunuing on with CBT/ERP can be helpful in getting through the worst ....but I have also read that doing therapy in a heightened state of anxiety (as mentioned above) can also be more damaging than beneficial. Just trying to decide on best course going forward. Also hoping new antibiotic/supplement protocol will help with underlying causes.

[Wombat140]

Hi, sorry I can't really answer this, I know the stuff about treating PANDAS and the stuff about treating OCD, separately, but don't know much about how they fit together - I've not had much luck with either so far myself, so can't tell you anything from my own experience. But I just wanted to say good luck and how is it going on at the moment? Is your son still worse, or back to where he was, or better?

[MomWithOCDSon]

Ladymavs and Wombat --

 

Just a note that, as our DS got older, though we and his therapist still implemented many of the CBT/ERP strategies, these obsessive thoughts were the hardest to eradicate.

 

In the end, we decided to try a different kind of cognitive therapy called Acceptance and Commitment Therapy (ACT) which appealed to DS because it is based upon mindfulness and gave his brain something else to work with rather than those annoying "bad" thoughts. It might be worth exploring:

 

https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy

 

All the best!

[Ladymavs]

The ACT therapy is very interesting. I have recently read and heard more about mindfulness practices. In a heightened state of OCD, his last session with a therapist (one we had seen months earlier) was way to upsetting for him. I don't know that a once a week session is going to be as effective as a weekly visit and am researching some of the recognized programs to consider once he comes out of this exacerbation like Rothman, Rogers, or possibly Houston OCD Center as we are in Dallas. Anyone have personal experience with these clinics or others to consider. We are not liking for the thoughts to totally disappear but for him to be able to disregard and move forward quickly.

[Mommby123]

My DD did CBT at Rothman as part of a study. Hard work and took time but totally worth it in the end. I will say when she was in a full flare therapy did nothing, only meds worked. Now that PANDAS is controlled she uses the techniques she learned to manage her long standing anxiety and OCD residuals. Your right that the thoughts never completely go away, goal is to manage them.

[Louisa]

My DD did CBT at Rothman as part of a study. Hard work and took time but totally worth it in the end. I will say when she was in a full flare therapy did nothing, only meds worked. Now that PANDAS is controlled she uses the techniques she learned to manage her long standing anxiety and OCD residuals. Your right that the thoughts never completely go away, goal is to manage them.

My son has had more than 15 session in CBT treatment which mainly involves talking, and the effect was none to minimal. I am looking for a therapist who can do ERP. I live in northern new Jersey. Does anyone know of good therapists with ERP specialty in new york and new Jersey.

 

My son's OCD is severe and he does not seem serious about fighting his OCD. I am not sure if he is a good candidate for ERP treatment then

 

Your information and advice is appreciated.

 

Louisa

[MomWithOCDSon]

Louisa --

 

You don't say, I don't think, how old your son is, but it wouldn't be at all unusual that he's not necessarily a willing participant in CBT or ERP therapy. Depending on his age, you may find him more compliant after a couple of weeks of successful, effective immunotherapy, whatever that ultimately turns out to be. But if he's a bit older (12+), especially, the potential for his compulsive "routines" to become entrenched grows exponentially the longer he's allowed to engage in them, so, willing or not, I would try to find a good therapist for him and start the work.

 

Finding a good fit between your DS and the therapist is important, so, if after a few sessions, neither you nor your DS feel there's any ground being gained, I would consider moving on to another option. And I would really encourage you to work with a therapist who will invite you into at least a portion of the sessions, as well, because family assistance/compliance/coaching is key in supporting the ERP and gains that come from it. That's one reason, I think, that the Rothman program is so successful; it gives the whole family tools and a skill set for "shrinking" the kid's OCD.

 

I don't know any therapists specifically in your area, but I would start with the IOCDF (International Obsessive Compulsive Disorder Foundation) and its "Find Help" web page. Here's a link:

 

https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist/

 

Here you can search by not only location, but also age (of patient), specific issues, etc. And all of these therapists are members of the IOCDF, so you know they have good training. Still, there can be a "dud" in every bunch, and even a good therapist may not be effective if their rapport with your DS is not good. So just remember that you're the customer, and if you're not satisfied, you may have to try more than one.

 

Most importantly . . . don't give up. It can be trying, frustrating, demoralizing and difficult. But it WILL pay off in the end!

 

All the best!

[Louisa]

My son is 18 years old and has Aspergers.

 

here is the problem for his OCD using ERP treatment

 

During ERP session, the therapist will have the patients exposed in a situation where they feel anxious and show OCD. I can understand how the exposure will help those patients with OCD, like washing hands, touching things, or just intrusive thoughts.

 

But my son’s OCD is displayed when he is getting changed (to repeatedly make sure his certain body parts are covered and endlessly thinking about that). So if he is in ERP, that means the therapist will see him getting changed while working with him???

 

I just do not know how ERP would work that way. Does any one has the experience with working with a therapist using ERP for such “private” OCD?

[MomWithOCDSon]

Louisa --

 

In our experience, by its very nature, much of OCD can be a pretty "private" issue, whether it's manifesting as intrusive thoughts about sex, body exposure, hygiene after toileting, etc. Therapists are very familiar with all of these manifestations because, for whatever bizarre reason (the brain is crazy mysterious), they're very common among OCD sufferers. The overall sense of taboo, maybe?

 

Our son had some of the same issues, and the therapist was able to work with him without making him feel violated in any way. But for compulsions of this type, it is a longer process, I think, because that relationship has to be built, and the therapist is not going to dive in and ask him to unbutton the top three buttons of his shirt at Appointment One; he's going to build up to that in some meaningful, guided way. And, hopefully, he's going to give him some meaningful at-home exercises, too, that you can be supportive and coach him along in, in small steps, as he builds that tolerance and builds that "muscle" to push back at the OCD and take back control over that part of his life.

 

Also, there ARE therapists out there that have experience with both OCD and Asperger's (we found one in our market), so that would likely be your best bet. These folks "get" the kind of very perseverative thinking patterns and tendency to "parse" language and reasoning and thus can have greater success in breaking through to a patient like this.