As a mom watching your child struggle with obsessive compulsive disorder (OCD), you may feel helpless seeing them caught in a cycle of intense worry and ritualistic behaviors that seem beyond their control. You might notice them repeatedly checking things, seeking reassurance, or getting stuck in routines just to find a sense of relief from overwhelming fears.

OCD symptoms include both mental and behavioral rituals to reduce feelings associated with anxiety. These symptoms of obsession and compulsion take up a considerable amount of their time (one hour or more) and disrupt their daily functioning in everyday life.

For children and teens, this can mean falling behind in school, struggling to focus, and missing out on meaningful social experiences, making OCD feel isolating and disruptive during critical developmental years.

The Root Cause of OCD: A Dysregulated Nervous System

OCD is often misunderstood as just a behavioral issue when, in reality, it’s deeply rooted in the brain and nervous system. At its core, OCD activates a “fight or flight” response in the brain, causing a person to feel intense fear and anxiety in response to their thoughts. This leads to compulsive behaviors aimed at finding relief from the discomfort.

In my work, I focus on calming the nervous system first because it’s essential to help the brain move out of that reactive, over-alert state. When the nervous system is dysregulated, it constantly signals a sense of threat, making it difficult for anyone, especially a child with OCD, to find calm or focus.

What is Exposure Therapy?

The gold standard treatment for OCD is Exposure and Response Prevention (ERP) therapy. ERP is a specialized form of Cognitive Behavioral Therapy (CBT) that involves gradually exposing individuals to their obsessive fear and feared outcome while helping them resist the urge to perform compulsive behavior.

Exposure therapy is a type of treatment that was developed to help people confront and face their fears. It has been scientifically demonstrated to be a helpful treatment for a variety of issues, including phobias, panic disorder, social anxiety disorder, obsessive thoughts, post-traumatic stress disorder, and generalized anxiety disorder.

How OCD Exposure Therapy Works

Exposure Therapy works by gradually and safely helping a person confront the fears that trigger their anxiety through an exposure exercise. This will allow them to see that they can tolerate the discomfort without needing to perform compulsive behaviors. It’s a step-by-step process, often used in treating OCD, anxiety disorders, and phobias, that reduces fear responses over time.

Here's a breakdown of how it typically works:

1. Gradual Exposure

The person is gradually exposed to their triggers in a controlled and supportive environment, starting with less intense situations. This exposure can be:

• Imaginal: The person imagines the feared situation.
  – In this type of exposure, a person in therapy is asked to imagine and confront the fear or situation mentally. For example, someone with a fear of heights might be asked to imagine standing on the edge of a tall building.
• In Vivo: Real-life exposure to the anxiety-triggering situation.
  – When using this type of exposure, a person is exposed to real-life objects and situations. For example, a person with a fear of germs is asked to pick up a dirty ball.
• Virtual Reality: For some, simulated exposure through technology is used.
  – This type of fabricated exposure combines elements of both imaginal and in vivo exposure so that a person is placed in situations that appear real but aren’t. For example, someone who has a fear of germs might participate in a virtual simulation of touching an object that someone just coughed on.

2. Response Prevention

During exposure, the person is encouraged to resist the usual compulsive behaviors or avoidance tactics they might use to reduce anxiety. This step, known as Response Prevention, is crucial because it breaks the cycle of compulsion and avoidance.

3. Tolerance Building

With repeated exposure exercises, the person learns to tolerate the anxiety associated with their fears. Over time, they see that their anxiety decreases naturally without needing to avoid or perform rituals, weakening the “fear connection” in their brain.

4. Cognitive Restructuring

Often, the person is guided to reframe their thoughts around the feared object or situation, realizing that the danger they anticipate is either exaggerated or unlikely. This reframing helps reduce the power that irrational fears have over them.

Through these steps, exposure therapy enables people to face their fears head-on, reducing anxiety and breaking the compulsive cycles associated with disorders like OCD. It empowers them to live with less fear and more freedom.

Sophie’s Story: A Case Study on ERP Therapy for OCD

Meet Sophie, a sweet 9-year-old with big dreams and a love for reading. But every night, she faced the same worry: bedtime. Sophie had developed a routine of leaving her bedroom door open, needing it to be in a specific position to feel “just right” and safe. If the door didn’t stay exactly as she wanted, she would get out of bed, check the position again, and often start to panic if it wasn’t perfect. This bedtime ritual kept her awake for hours, made her anxious, and left her exhausted during the day.

Sophie’s parents decided to work with me in my BrainBehaviorReset™ Program. Together, we developed a tailored treatment plan to help Sophie feel safe and calm without relying on her rituals.

In the beginning, we suggested imaginal exposures—we practiced imagining the door closed or even slightly off position. I encouraged Sophie to sit with her uncomfortable feelings and realize that, while it felt scary at first, she was actually safe. With time, these mental exercises helped her feel a little braver.

Next, we moved to small in vivo exposures or real-life practices with her parents’ help. Her mom and dad would start by closing the door just a tiny bit—an inch or so—and ask Sophie to stay in bed, even if she felt anxious. They supported her with Calm Brain tools I recommended, such as deep breathing exercises and coping skills, helping her learn that her fears would naturally lessen on their own.

Over a few weeks, her parents worked closely with me to gradually close the door a bit more each night. Every time they moved it slightly closer to being fully closed, Sophie grew more comfortable. She began to feel safe, even if the door wasn’t left open just the way she wanted.

Following through on this therapy at home was key for Sophie’s parents. They learned not to reopen the door on nights when Sophie felt extra nervous, which would only reinforce her OCD. Instead, they reminded her of the progress she was making, helping her build resilience and confidence.

Today, Sophie is able to sleep with her door fully closed. She feels proud of herself for overcoming her worries, and bedtime has become a peaceful time in her day. Her parents’ commitment to following through on her therapy plan made all the difference, showing her that she could handle her obsessions and intrusive thoughts and find calm.

How Do You Stop Obsessive Compulsive Disorder?

With suitable therapies and the right core interventions, like cognitive therapy, exposure therapy, or acceptance and commitment therapy, children can learn to manage better and overcome the obsessions and compulsions. This journey is often taken with the support of a trained therapist or a mental health provider who guides individuals through the process, significantly during times when symptoms might flare up, such as during periods of stress or life changes.

Seeking a therapist's guidance early on can significantly impact the management of OCD. It allows individuals to develop healthy strategies for managing feared stimuli and breaking ingrained OCD patterns. Therapy provides a structured path toward relief, offering practical ways to handle intrusive thoughts and compulsive behaviors effectively. Getting support from a licensed mental health professional is crucial for effective OCD treatment.

Cognitive Behavior Therapy CBT

Over time, through psychoeducation and cognitive behavioral therapy, the person’s response to triggers changes, leading to a decrease in the frequency of compulsions and the intensity of obsessions. OCD treatment and anxiety expert, Kimberly Morrow, LCSW explains “We have to teach clients that they are “feeding the dog” with negative thinking and they have to understand that OCD is a bully that they can overcome”.

Evidence suggests that therapeutic exposures repeated over time decrease associated anxiety and OCD symptoms because the individual learns that nothing bad happens when they stop performing rituals. They can learn to stop OCD from bullying and taking over their thoughts. Cognitive restructuring is part of the process, so they learn to evaluate perceived threats associated with each obsession and then test limits. And when their anxiety does get too high in a session, a therapist is trained to support the client through the exposure.

There is work to be done outside the therapist's office, too, such as practicing managing exposure transfers from the therapy session to the real world. Parents are part of every session with children, and they learn to support exposures at home and get their child or teen to learn how to tolerate the discomfort.

Upon completion of E/RP therapy, OCD intrusive thoughts and symptoms often diminish or disappear. Ultimately, the person with OCD learns to tolerate the discomfort and not be so triggered. Moreover, as part of the E/RP process, they also learn strategies to cope with anxiety cycle.