by Sarah Hunter, LCSW

In the past few months, I have had the privilege to attend two OCD conferences. For me, conferences are a time for me to learn about new advances in the treatment of OCD and other anxiety disorders. They are also a time to learn and be inspired by others as I learn new ways to implement basic components of evidence-based treatment for anxiety disorders.

This year, trainings highlighted one of the key findings from neurological research involving the way our mind processes fear and assesses for safety. This new research has implications for how clinicians can use exposure therapy to treat anxiety disorders. Exposure therapy is an evidenced-based treatment for anxiety. Its close cousin, ERP or exposure and response prevention, is the preferred treatment for OCD. Exposure therapy and ERP involve identifying a feared stimulus (for example driving a car) and creating situations for a person to experience the fear without avoiding or doing other actions (known as compulsions in OCD) to try to get the fear to go away.

Researchers used to believe that through exposure, a person’s fears were becoming extinct. Meaning the more a person was exposed to the feared situation (driving a car) the less the brain comes to fear it. Years ago, therapists would even train clients to have a relaxed response to a feared stimulus. For example, looking at a picture of a car while taking deep breaths and relaxing the muscles. The thought was that the mind needs to learn to be relaxed in the presence of something previously associated with fear.

While this treatment was effective, research eventually showed that the effective part of the treatment was not the relaxation at all. It was the exposure. Thanks to research developments, we now know a bit more about why this is.

Around the area of the amygdala, there is part of the brain responsible for assessing fear. Psychologists used to think this area of the brain was changing through exposure—meaning it was learning to not fear. However, research has shown that this area does not change over a person’s lifetime. It is fixed; once your brain has assessed something as dangerous, that assessment never changes. This is the bad news for people with anxiety disorders. This means that there will never come a day when public speaking or germs or driving a car or any other multitude of things people feel anxious about will not trigger a fear signal.

However, there is also good news. The good news is that there is another part of the brain that assesses for general safety. This part of the brain has the ability to send a signal that says, “it’s reasonably safe to do this scary thing” even though there is fear present. Thankfully, this part of the brain is plastic meaning it can grow and change over time. Just like a muscle, the more this area of the brain is worked through doing things that feel fearful, the stronger it becomes. Eventually, the “it’s relatively safe” signal can become loud enough that the danger alert seems relatively quiet.

So, with practice, a person who is fearful of driving can have learning experiences that teach the brain that driving is a relatively safe activity. Even though the brain will continue to interpret driving a car as dangerous and send a danger signal to the body resulting in an anxious feeling, over time, the safety assessment part of the brain will override or inhibit that fear signal. The system will learn that even though there may be some risk to driving a car, it is generally safe enough to go ahead and get behind the wheel.

This type of new learning happens every time we exercise courage and do something we want to do even though it feels scary. Researchers have used the term “inhibitory learning” to describe this phenomenon. This term is used because it is describing how the safety signal inhibits the danger signal. Instead of the body and mind responding as if there was real and present danger, a person’s system learns to respond in a more adaptive way recognizing they are in fact relatively safe.

The bottom line is that living with anxiety and OCD can be discouraging at times, but effective treatments are available. Even with limited understanding of the complexity of the brain, highly effective treatments exist. Hopefully, as we come to learn even more about the way the brain works, treatment effectiveness will continue to improve which will lead to reduced suffering and improved treatment outcomes for people with anxiety disorders.

by Sarah Hunter, LCSW

This article is part of a series that will help readers understand the purpose of twelve basic human emotions: guilt/shame, pride, compassion, gratitude, disgust, joy, fear, curiosity, anger, love, sadness, and connection.

Feeling Proud

Humans are born with the instinct to feel good about learning and doing good things. The good feeling we get when we accomplish a goal, learn something new, or act in line with our values is called proud. Because human behavior is shaped by internal and external rewards and punishments, it is essential to make room for proud feelings.

For most young children, feeling proud comes quite naturally. Imagine a baby taking her first steps into the welcoming arms of a parent. The joy and excitement from that monumental accomplishment is felt on a visceral level by everyone watching. Similarly, the sense of accomplishment that comes from successfully completing a task such as using the bathroom, although quite unremarkable for adults, is exciting for children. In the early years, bathroom success is celebrated with cheers, high fives, treats and privileges. Of course, when mastery occurs, the fanfare ends. It is then reserved for a time when the child accomplishes something that is more challenging such as learning to talk, read, write, tell the truth, be a good friend, play a sport, and the list goes on.

When Feeling Proud Feels Risky

Human life is meant to be full of continued challenges, growth and progression. This means that the opportunity to feel proud never really ends.

Yet, as we move out of childhood, many of us start to disconnect from the joy of accomplishment. This is easy to do when our self-talk changes from things resembling what we tell young children “That’s so awesome!” “You did it!” “Look at you!” “I’m so proud of you!” to things like “I was just doing what is expected of me.” “Anyone can do that.” “It wasn’t perfect.” or “Others do it better.”

Feeling proud is a surprisingly vulnerable feeling. Our internal system knows the pain that comes from being criticized and rejected and so it creates protective barriers that get in the way of feeling proud. The fear sounds like “the higher I climb, or the more effort I invest, the more it will hurt when I fall or fail.” When there has been painful past learning, our system warns us not to climb too high. Getting too happy or excited about our accomplishments feels as unsafe as standing on the ledge of a cliff. To prevent the pain of the fall, our mind creates rules about what we can and cannot feel proud about.

For example, consider a teenager who struggles with math prepares and studies and earns a B+ on his math test. This is the best score he’s ever received. He reacts with an initial surge of pride but quickly tells himself “This is nothing to be proud about.” He thinks of his friend who gets A’s every time and tells himself “I’m not smart like her. She didn’t even have to study.” As a result, the surge of pride is gone, and the teen might even feel ashamed of himself.

Proud and Motivation

There is a consequence for not allowing yourself to feel proud. The biggest consequence is a loss of motivation. Proud feelings are motivating. They are designed to light up the reward center of our brain which makes us want to do more things that make us proud.

However, in the example of the teen above, he did a good thing (worked hard to study for a math test) and instead of feeling good is feeling ashamed of himself. If this pattern continues, it will be difficult for him to keep up the good study habits because he will start to believe “It doesn’t matter what I do. I always feel bad inside.” Why go to the extra work to study if working hard to earn a good grade feels the same as not trying and getting a failing grade? 

Nurturing Proud Feelings

If you think that you or your child/teen is struggling with the inability to feel proud here are some ideas to help:

1. Take some time to think about your inner dialogue when it comes to feeling proud. When you do something good, what do you tell yourself? When answering this question, many people discover they have developed “rules” for feeling proud that they did not even realize they had.

   For example, when someone outperforms you, a common reaction is to feel second best even if you beat your own personal record. You could frame this as a rule for feeling proud such as “I’m not allowed to feel proud about something I do well if there is someone who can do it better.” Some other common rules include “If the thing I did is easy for someone else, I shouldn’t be proud even if it was hard for me,” or “I can’t be proud because I didn’t do it perfectly” and “I’m not allowed to feel proud because I’ll get a big head and stop trying. I need to degrade myself in order to keep myself in check.”

2. After identifying the rules your mind has created to interfere with proud feelings, take a look and decide what you want to do with the rules. Stating the rules explicitly like this makes them easier to scrutinize. You can ask yourself “Do these rules sound fair?” or “If I keep these rules am I ever going to be able to feel proud?” For most of us, there will always be someone who is better than us, there will always be things that are hard for us and easy for others, our efforts will always be imperfect and degrading ourselves actually makes it harder to stay motivated. This means our “rules” are not helpful in determining if we should feel proud.

3. If you realize your rules are not working, it’s time to create some new rules. What would be a better setup for feeling proud? Maybe a new rule like “I can feel proud of myself any time I try my best.” Or “I can be proud of myself whenever I do something brave or take a risk.”  Remember, your mind comes up with thoughts and ideas all day long, but you get to choose which ones you believe and which ones you dismiss.

4. After you have decided to adopt some new rules that allow you to feel proud, it’s time to begin to find ways to intentionally nurture this feeling. One way to do this is to take time to write down your successes on a daily or weekly basis. Include things on the list that are big and small but that fit within your new rules for feeling proud. To really capture the energizing spirit of feeling proud try ending each statement with an exclamation point. A typical weekly summary for me might include: Took the dog for a walk! Weeded the garden! Talked to someone at church! Went to the meeting I wanted to avoid! Cooked! Had a moment of connection with my teen! Took a breath instead of yelling! As you write, slow down and pay attention to how you are feeling. What is going through your mind? How is your body responding?

For me, this was a difficult practice to begin because I felt silly for writing down things that seemed so insignificant. But, over time, this practice has increased my motivation to do those “insignificant” things because I have learned to love the good feeling that comes when I do them.

Remember, feeling proud feels good! Clear the way to enjoy the satisfaction of feeling proud about all the good things you do in a day, and watch for an increase in energy, motivation and enjoyment in life.

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DISCLAIMER: The blog posts shared on www.childpsychologistutahcounty.com contain opinions of the specific mental health specialist who authored the post, and do not reflect the opinions of any organizations or affiliates.  While the therapists in this clinic are all trained professionals, all blog posts on this site are for informational purposes only, and are never a substitute for professional advice catered to your individual needs.  Neither Child & Adolescent Treatment Specialist, nor any of the contributing therapists are liable for any diagnosis, treatment plans, or decisions made based on the information presented on this website.  This blog post in no way constitutes a therapeutic relationship.

by Sarah Hunter, LCSW

This article is part of a series that will help readers understand the purpose of twelve basic human emotions: guilt/shame, pride, compassion, gratitude, disgust, joy, fear, curiosity, anger, love, sadness, and connection.

Understanding Guilt

Human beings come wired to experience the emotion of guilt. It is appropriate to feel guilty when we cause harm to someone or something. This uncomfortable feeling is the body’s way of saying “I did something bad.” Appropriate guilt motivates repair. It creates the thought “I need to make this right.” When felt fully, guilt is also a deterrent for causing future harm. The emotion is uncomfortable and just like pain prevents people from touching a hot stove more than once, guilt makes people want to stop doing the behavior that caused it.

Pause for a moment to imagine a world where humans feel no guilt over wrong doing. Most people would not want to live in such a world because they can see that a guilt-free world is a world where people harm each other and destroy things and show no remorse for their actions. Guilt is an essential emotion that is meant to be felt, acted on and then released. At its core, it is a functional emotion.

Guilt vs. Shame

Yet, when guilt is not understood or when it is misdirected, it can become problematic. Guilt that grows too big turns into shame. Dr. Brené Brown has spent decades researching shame and its consequences. A thorough discussion on shame is beyond the scope of this article. For further reading on the topic, try any of her published books. Her first book, I Thought It Was Just Me (but it isn’t): Telling the Truth About Perfectionism, Inadequacy, and Power (Penguin/Gotham, 2007) is a good choice for women wanting to understand more about shame.  Her second book, The Gifts of Imperfection: Letting Go of Who We Think We Should Be and Embracing Who We Are (Hazelden, 2010) is a short read that gives a good overview on shame and how to combat it in order to live wholeheartedly.

For the sake of simplicity, shame can be defined as what happens when the belief switches from “I did something bad” (guilt) to “I am bad” (shame). Rather than motivate repair, the voice of shame motivates people to hide from others and isolate. Shame takes away hope of repair and improvement. It leads to feelings of being unworthy and unlovable. This makes it difficult to keep enough motivation to keep striving.

When shame rears its ugly head, the most helpful thing to do is to recognize it for what it is with a thought like “I’m in shame” ride the wave of emotions that sweep over you and then reach out to a trusted friend or relative and tell the story of what happened. This is an example using a skill called opposite action. Shame says “hide, stay in the dark, you’re not worthy of love.” Rather than giving in and obeying the voice of shame, doing the opposite action of reaching out to someone who cares about you will help you move through shame and back into connection.

Inappropriate Guilt

Another potential downfall when learning to allow guilt to become a healthy part of your emotional experience is the existence of inappropriate guilt. Inappropriate guilt is when a person feels bad about something that is not his fault. This is a common problem; children are especially prone to responsibility for things that were beyond their control. One example is a child feeling guilty for her parent’s divorce. The child may be under the false impression that if she would have not picked so many fights with her brother her parents would still be together.

Another example of inappropriate guilt is when an adult feels guilty for having cancer. Self-talk in this situation may sound like “This is my fault. I should have eaten more salads and exercised more.” Inappropriate guilt is not helpful because it leaves the person experiencing the guilt unable to correct the perceived wrong. For example, the child cannot make her parents get back together. The man with cancer cannot cure himself. In these instances, the appropriate emotional response is self-compassion which will be discussed in a future post.

Practicing Appropriate Guilt

There are many ways to help yourself or your child learn to let appropriate guilt do its job. Here are a few suggestions:

Identify the behavior. Get clear about what you did that was wrong. Journaling about the situation may help with this. Come from a place of seeing yourself as a good person who acted outside of your values rather than as a bad person (shame) who can never change. It can actually be empowering to admit “I was not my best self in that moment.”

Offer a sincere apology. A sincere apology can go a long way toward correcting a problem. Sincere apologies are not done in anger or resentment. They do not contain “buts.” For example, stay away from saying things like “I’m sorry I yelled at you, but you make me so mad I can’t control my temper.” Acknowledging that what you did was wrong regardless of the circumstance is important. Sometimes simply stating “I shouldn’t have done that” helps with this.

Practice empathy. If it’s difficult for you to be sincere in your apologies, try putting yourself in the other person’s shoes. Can you see how what you said affected her? Can you see why he was upset with what you did? Taking the time to see the situation from another person’s viewpoint will reduce defensiveness.

Take appropriate action. Rather than becoming stuck by ruminating on what you did wrong or what you wish would have happened, ask yourself “What can I do about it now?” Take whatever corrective action you can. Sometimes you do not know how to make it right. Sometimes asking the person you hurt “What can I do to make it right?” will give you a forward direction.  Do the things that are within your power to correct the problem.

Let it go. Once you have examined your behavior, identified what you did that was wrong, taken accountability for it and done what you could to repair, guilt has done its job and its time to let it go. Holding on to guilt for long periods of time in the spirit of wanting to punish yourself enough that you will never make another mistake will actually make it harder for you to feel appropriate guilt. You want your internal system to know that you can recover from mistakes and that making a mistake does not mean you have to punish yourself excessively for long periods of time. When your system can trust that guilt is a safe emotion to feel, you will increase your ability to acknowledge wrong doing.

Once you understand the purpose of guilt and you have had some successes in letting it do its job, it’s time to help your children do the same. Adults need to help children navigate guilt by focusing on the behavior that was wrong rather than focusing on defining a child’s character. Telling a child “It’s not ok to hit” is more helpful than saying “You are so mean.”

Remember, children will learn to handle guilt not just from what you say, but also (more importantly) by watching what you do when you feel guilty. Set a good example by admitting when you do something wrong, taking appropriate action to correct the problem, then letting the guilty feeling go.

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The blog posts shared on www.childpsychologistutahcounty.com contain opinions of the specific mental health specialist who authored the post, and do not reflect the opinions of any organizations or affiliates.  While the therapists in this clinic are all trained professionals, all blog posts on this site are for informational purposes only, and are never a substitute for professional advice catered to your individual needs.  Neither Child & Adolescent Treatment Specialist, nor any of the contributing therapists are liable for any diagnosis, treatment plans, or decisions made based on the information presented on this website.  This blog post in no way constitutes a therapeutic relationship.

by Sarah Hunter, LCSW

A significant portion of the work of a therapist involves helping clients understand emotion. Human beings initially learn about emotion from experiences in their first family. Most of these lessons are not explicitly taught but were learned implicitly through observing parents or siblings navigating their emotional experiences.

People who grow up in families that model healthy ways of coping with emotion tend to develop healthy ways of coping as adults. People who grow up in families who demonstrated maladaptive ways of responding to emotion often struggle with emotion as adults. They find themselves responding to emotion in ways that make it difficult to function at an optimal level. These unhelpful responses tend to land on the more extreme ends of a spectrum where avoidance of emotion is on one end and becoming completely swept away by emotion is on the other end.

Because of this, many people struggle to find the sweet spot in the middle where one can be present with emotion, allowing herself to feel it fully without becoming fused to the emotion letting it take over and overwhelm the system.

When emotions are not understood, they can feel scary and complex. When people lack the skills to navigate the inner experience of emotion, they come to see certain feelings as bad. In fact, some people come to therapy so they can get rid of the “bad” feelings they are experiencing. They want the pain and distress to stop. They have tried everything they know how to do including using avoidance and numbing to escape upsetting thoughts and feelings. But, instead of helping, these strategies cause more problems.

People who numb find themselves unable to experience life as fulling and joyful. They often get stuck engaging in problematic behaviors such as over eating, spending hours scrolling online, shopping for things they don’t need and can’t afford, spending extra hours at the office, and the list goes on.

People who avoid find themselves structuring their lives around avoiding all things unpleasant. When this happens, their world quickly gets small and it can become difficult to do meaningful things because fear gets in the way.

Research has shown that these ways of dealing with emotion are problematic because avoidance behaviors maintain and enhance anxiety and numbing can never be selective. When you choose to numb difficult emotions you also chose to numb the emotions that are the most fulfilling such as love and joy.

If you are one who struggles with experiencing emotion, or you have a child who struggles, consider learning all you can about emotions. Here are a few suggestions you can try for yourself or practice with a child who is struggling.

1. Practice naming feelings. If naming feelings is hard, try using a list of emotions (I like emotion wheels which can be found online) and choose what fits. Remember, it is common to feel more that one feeling at a time so continue to look for words to describe what you’re feeling until it feels like you’ve fully captured the emotional experience.
2. Practice noticing the felt body sensation of different emotions. After you name a feeling you are experiencing, ask yourself “Where am I feeling this in my body?” See if you can locate areas of the body where the emotion is most intense. See if you can find words to describe the sensation. Words like light, heavy, hot, cold, knots, butterflies, tight, loose, tingling, open, caged are some of the ways people describe sensations.
3. Practice noticing thoughts that are connected with emotion. Ask yourself “What is going through my head right now?” You may find one thought that is on repeat running through your head over and over again. You may find thoughts racing through you mind so quickly that it is hard to slow them down enough to notice them. You may notice yourself having thoughts about your thoughts. Don’t worry about doing anything with the thoughts, simply notice that they are there.
4. To tie it all together, practice approaching experiences with a curious observer attitude. Use phrases like “I’m feeling ________.” “I’m noticing a sensation in my ________that feels _______.” “I’m having the thought that ________.”

If you practice navigating emotions in this way, you will notice that emotions become less frightening, mysterious and overwhelming. This is an important step forward in improving your emotional literacy which will help you create a more rich and meaningful life.

by Sarah Hunter, LCSW

Introduction

All parents and caregivers have had the frustrating experience of witnessing a childhood meltdown. When meltdowns happen, many parents and caregivers experience a feeling of helplessness and they are left wondering if what they are doing is helping or making things worse. Having a basic understanding of how meltdowns work in a child’s developing brain can help parents increase feelings of competency and improve their ability to help their child learn to regulate emotion.

Left Brain, Right Brain

Most people are familiar with the terms left-brain and right-brain. They have some understanding of the right brain as being the emotional, creative part of the brain and the left brain as being the logical, reasoning part.

One of the goals of parenting is to help children learn to use both sides of their brain in daily life. Children need to be able to use information from their sensing, feeling, creative brain centers. Children also need to be able to use logic, reasoning and story-telling to make sense of their world. Both right and left-brain functions are needed for optimal functioning.

Brain integration does not stop with left and right. As their brains develop, children also need opportunities to help their brain integrate from top to bottom. To explain this concept to parents, in their book called The Whole-Brain Child, neuropsychiatrist Daniel Siegel and parenting expert Tina Payne Bryson introduce the terms “upstairs” and “downstairs” brain.

Upstairs Brain, Downstairs Brain

The upstairs part of the brain (cerebral cortex) is undeveloped at birth and is under construction for the first twenty plus years of life. It is responsible for thinking, planning and imagining. It can predict consequences and it allows humans to guide behaviors based on desired future outcomes.

The downstairs part of the brain (brain stem and limbic region) is more primitive and almost fully developed from birth. The downstairs brain controls basic functions like breathing and blinking. It is responsible for our fight or flight response. It is also the place where strong emotions like anger originate.

So how does this information help parents navigate melt downs?

First, parents can learn to tell the difference between upstairs and downstairs meltdowns.

Upstairs meltdowns

An upstairs meltdown is what most people think of when they think of a childhood temper tantrum. The upstairs melt down is a strategic attempt for the brain to get something it wants.

Picture a young child at the grocery store who sees a fun looking toy or a favorite treat. They may ask for the toy or grab for the treat and their parent or caregiver tells them no. Their brain does not like this answer and so they start to use behaviors to get what they want.

At first, the behaviors may look like polite asking, begging or pleading. If the answer remains no, it may turn to yelling, crying, thrashing about or any number of intense behaviors designed to change their parent or caregiver’s mind. One of the tell-tale signs of an upstairs meltdown is that the parent or caregiver has the sense that if they give the child exactly what she wants the meltdown will stop because the objective has been achieved.

The main thing parent and caregivers need to remember when dealing with upstairs meltdowns is to not reward the behavior. In the words of Siegel and Bryson “never negotiate with a terrorist.” If a child escalates behaviors and parents or caregivers respond by giving them what they want, they are teaching the child that throwing a tantrum is an effective way to get their needs met. This prevents children from learning to use appropriate behaviors (for example polite requests) to get what they want. It also prevents them from learning how to handle disappointment.

Instead, a parent can quickly and firmly set boundaries and enforce the limits they are setting. An example of this would be stating “I know you want that candy bar but this is not the way to get what you want. If you don’t stop now, our trip to the store is over.” After a boundary is set, parents and caregivers need to make sure they follow through with what they have said will happen. Over time, this consistency will teach the child that tantrums are not an effective way to get their wants and needs met.

Downstairs Meltdown

A downstairs meltdown is different from an upstairs meltdown. When a downstairs meltdown occurs, the upstairs part of the brain that is responsible for thinking, reasoning and regulating behavior is offline. The child feels out of control and no matter what rewards the parent or caregiver offers or what consequences the parent or caregiver threatens, the meltdown continues.

Rather than viewing this as an act of defiance, parents and caregivers can think of this as a child’s version of a panic attack. The child is overwhelmed by emotion and is unable to calm herself down. In fact, many children with anxiety or sensory processing issues experience frequent, intense downstairs meltdowns. These are often mistaken for behavioral problems or opposition when in fact they are anxiety driven.

When a child is experiencing a downstairs meltdown, the best thing a parent or caregiver can do is to regulate themselves, connect with their child and help him calm down.

Parent Regulation

Sometimes melt downs are so intense and even scary for parents or caregivers to witness, they become dysregulated themselves. This can be highly distressing to a child who is already feeling out of control. In order to regulate themselves, parents can tell themselves things like “It will be over soon.” “I can handle this.”

Sometimes just knowing what is going on and recognizing that this type of meltdown is a normal part of childhood and is an opportunity to help a child’s brain development is enough to help parents and caregivers regulate themselves enough to be helpful to their child.

However, if none of these strategies are working, it is usually better for a parent or caregiver to put themselves in “time out” and give themselves time to regulate before interacting with their child.

Child Regulation

Once regulated, a parent or caregiver can connect with the emotion the child is expressing and help her calm down. Each child is unique, and parents and caregivers can experiment with what works best for their child.

Generally speaking, giving a name to the emotion the child is feeling, speaking in a calm, nurturing voice and using soothing touch will be most effective. For example, (using a soothing voice, and/or loving touch) “You look very angry now. I’m right here with you. We can talk about this as soon as you are ready.”

At this point, trying to give consequences will not be effective because the child does not have access to the part of his brain that can use that information. Once the child is regulated enough that he is receptive to taking in information, it is appropriate to talk about behavior expectations. For example, “Did you not like it when I put mustard on your sandwich? I understand you didn’t like that, but it’s not ok to hit when you’re mad. Use your words and tell me ‘I don’t like mustard.’”

Depending on how intense the melt downs are, this type of conversation may need to happen hours after the melt down or even the next day.

Remember it is not only toddlers that have downstairs meltdowns—older children, teenagers and even adults can lose access to the thinking part of the brain when they are overwhelmed with intense emotion.

If your child’s meltdowns become dangerous, seem excessive or are more intense than others his or her age, you may consider bringing them to be evaluated by a therapist or other medical provider.

Information for this article was taken from: The Whole-Brain Child by Daniel J. Siege and Tina Payne Bryson, 2011, New York.

“Discomfort is a wise teacher” —Caroline Myss

“And sometimes you meet yourself back where you started, but stronger” —Yrsa Daley-Ward

I just got back from Oconomowoc Wisconsin where I was able to attend the International Obsessive Compulsive Disorder Foundation (IOCDF) Pediatric Behavior Therapy Training Institute (BTTI). The IOCDF’s Pediatric BTTI is an intensive three-day training course providing in-depth education on the diagnosis and treatment of OCD in children and adolescents. I was able to learn the best evidenced based practices from leaders in the field, such as Eric Storch PHD, Aureen Pinto Wagner PHD, Stephani Eken MD, FAAP, and Martin Franklin PHD. and bring back the information to all our therapists here at the Child and Adolescent Treatment Specialists (CHATS).

Some of the topics included in the training were: 1. Cognitive Behavioral Treatment of Pediatric OCD, 2.Cultivating Readiness: Dismantling reluctance in Pediatric OCD, 3. Psychopharmacology in OCD, 4. Trichotillomania and Tourette Syndrome, 5. Pediatric Body Dysmorphic Disorder, 6. Comorbidity in Pediatric OCD.

I was able to bring the most recent research and training regarding pediatric anxiety and OCD back to all our therapists here at the Child and Adolescent Treatment Specialists (CHATS).We are strongly committed to providing good and effective treatment to children and adolescents who come to our clinic.

One in 200 children in the United States suffer from OCD. That is nearly half a million children. However, many children with OCD go undiagnosed and/or receive ineffective treatment. It is thought that 80 percent of adults with OCD actually began having it in childhood.

Please see the following helpful videos:

International OCD Foundation-What is OCD?
Anxiety and OCD Quick Guide 14: What’s Normal, What’s OCD?
What’s normal, what’s OCD?
Anxiety and OCD Quick Guide 16: What makes OCD Worse?

Not all children and/or adolescents with OCD will need medication. If medication is recommended it will usually be an SSRI that is prescribed through a medical doctor. For information on how medications are used in pediatric OCD please see the American Academy of Child and Adolescent Psychiatry links (AACAP).

Obsessive Compulsive Disorder Resource Center
Psychiatric Medication For Children And Adolescents Part I – How Medications Are Used
Psychiatric Medication For Children And Adolescents: Part II – Types Of Medications

According to Eric Storch PHD, “If you don’t do anything it (OCD) won’t get better”.

Dr. Storch espouses that Cognitive Behavioral Therapy (CBT) including exposure based treatments are necessary to address symptoms of OCD. Treatment consists of Psycho-education, Exposure Response Prevention (ERP) (going toward fears in a slow step-wise fashion), Developmentally appropriate Cognitive Therapy, Family Therapy, Contingency Management (rewards, etc.), and Relapse prevention.

Eric Storch, PHD, discussed that 53 % of kids with OCD also have difficulties with “rage attacks” when parents tried to set limits around OCD triggers. He suggested that the rage is important to address in the treatment of OCD. Family involvement is key in this effort. OCD effects the family and is a family issue.

A treatment professional can help establish what Dr. Storch calls the “parents’ as therapists’ model”. This model involves parents in the therapy sessions (where appropriate) and helps parents and children learn skills to address the OCD. Parents learn about anxiety and OCD, learn how to address accommodation that may be intensifying OCD, and how to help their children practice skills between treatment sessions. The therapist takes the lead role and then eventually transfers that role to the parent(s).

As part of the pediatric OCD training, Dr. Storch told a story about his own young daughter. One day she asked her dad why he was gone so much. To this he replied that he was both helping other professionals learn how to help kids with worries and OCD and also helping children with anxiety and OCD. His daughter replied, “Don’t you just face your fears and do it over and over and over again.” Storch stated, his young daughter summarized his whole career in this one statement. OCD treatment and recovery focuses on a “general approach to life in which you face your fears no matter what”. Skills are taught and utilized in treatment to help children and adolescents be able to utilize this general approach.

Avoidance tends to be at the core of many difficulties with anxiety. Avoidance increases anxiety. With anxiety we see children and adolescents avoiding the things they are fearful of. These may include germs, new foods, movies or TV, class and school, etc. Exposure to fears and/or disgust, rather than avoidance, and response prevention can be done with creativity, engagement and fun by a therapist trained in CBT (cognitive behavior therapy) and ERP (exposure response prevention).  As a learning vehicle, exposure and response prevention (preventing the typically feared response) generally teaches that:

(1). Feared thing doesn’t happen. Or

(2). It does happen but it is not so bad.  And

(3). I can cope if given the chance. And

(4). Practice is helpful.

There are many other skills children/adolescents and parents learn over the course of cognitive behavioral treatment and treatment for anxiety and OCD. Dr. Storch emphasized that treatment can change brain functioning over time, especially in children and teens. Pediatric OCD is a treatable condition in which children and families can receive support and treatment.

Over my 25 year career I have had the privilege of treating many individuals with anxiety and OCD. In addition to being so grateful to learn about evidenced based practices for anxiety and OCD, I am also grateful for what I have learned from each person who bravely came into therapy and worked together with me towards healthy change.

For more information on pediatric OCD and/or OCD please see IOCDF.org.

Also see:

Understanding OCD: A guide for parents and professionals, Edited by Adam B. Lewin and Eric A. Storch

Up and Down the Worry Hill: A children’s book about Obsessive-Compulsive Disorder and its Treatment by Aureen Pinto Wagner, PHD

What to do when your Child has Obsessive-Compulsive Disorder: Strategies and Solutions by Aureen Pinto Wagner, PHD

(The information in this blog should not be used as a replacement for guidance, consultation, assessment or treatment by a qualified healthcare professional).