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Can my son’s multiple obsessions be treated quickly?

Posted on Monday, December 15, 2008

Question: My child has this problem with OCD interfering with writing and reading as well as in many other important arenas. We just started CBT therapy. We’ve had to start small because he blows even small concerns into large ones. My question is, with so many issues that affect his functioning, is there a way we can quickly address multiple obsessions?

Boston

Answer: First, you are already doing a great job helping your child out by getting him started in some exposure with response prevention therapy.  One reason that your child is so irritable and likely to blow up is because of the anxiety that his OCD causes, which in turn results in being really irritable and easily frustrated.  This is probably in addition to the frustration caused by the actual obsessions and compulsions.  The quickest way to help your child to start being less irritable is to dive into the appropriate therapy that gets rid of the things that are causing the irritability and low frustration tolerance in the first place. 

Second, if you are not already doing an intensive exposure protocol that has daily therapy sessions that last longer than the typical 45 minutes that an insurance plan allows, then I would suggest that you consider this option.  Having daily lengthy sessions offers lots of support and encouragement for both you and your child.  It allows your therapist and your child to tackle multiple problems in a systematic progressive fashion without becoming scattered.  Good intensive exposure therapy is systematic and sequential and can allow your child to rapidly overcome their rituals.  You would be surprised how much progress can be made when your child is spending 10-20 hours per week in daily exposure therapy!  Research on treatment outcome shows that intensive exposure protocols are often the most effective option for those whose OCD is moderate to severe because their OCD is extensive and overwhelming and one or two 45 minute sessions a week is just not enough to be helpful. 

Last, I would recommend that you and your child’s therapist review ways to manage oppositional behaviors during the exposure therapy so that you feel confident about ways to manage tantrums should they occur.  It also helps to realize that tantrums are a symptom of anxiety and not a permanent personality change in your child.  They tend to disappear when your child’s anxiety is well managed by effective treatment.