Exposure and Response Prevention: Top 8 things I want every parent to know about OCD Parenting

Once a month, Kairos Wellness Collective runs a parent training course for the families that are supporting their child during Exposure Response Prevention. 

These are the top 8 takeaways that I want to make sure every parent takes to heart:

1. Your child CAN deal with serious anxiety.  They will cope with anxious feelings. Anxious feelings are transient.  Parents don’t need to fix anxiety for their children.  

   We want to teach kids mindfulness towards their anxiety, an acceptance and a gentle allowing, rather than trying to fight against it with compulsions.  When anxiety arises, we teach kids an awareness of the sensations, thoughts, and emotions in the present moment, observing them without getting caught up in them or trying to push them away.

   However, in order to teach kids to have a non-reactive stance towards their anxiety, parents must also have a non-reactive stance towards their child’s anxiety.  

2. The brain knows how to habituate naturally, it is a biological process.  We just need parents and kids not to interfere with the habituation process involved in ERP.  

   If an OCD stimulus is repeatedly presented to a child, the brain gradually reduces its response.

   This reduction occurs through a process called synaptic plasticity, where the connections between neurons in the brain are modified. Specifically, the strength of synaptic connections related to the stimulus weakens, leading to a diminished response.

3. Avoidance will only escalate your child’s fear. 

   Same as above, avoidance blocks the brain from habituating to a fear stimulus. 

   The avoidant child will not be able to have the emotional corrective experience that helps break the cycle of OCD.

4. Enabling avoidance will ultimately create an unwitting alliance between you (parent) and the OCD.  

   At the end of the day, every parent has to decide if they are going to be on the side of the child or on the side of the OCD. 

   Many parents feel that they are protecting their child by supporting them in avoiding their fear triggers, but ironically, they are actually aligning with their child’s OCD.  

5. Exposures cause short-term distress but long-term reduction in fear.  

   Yes, your child will feel fear during Exposure Response Prevention treatment.  They may come out of session rattled or irritable. 

   However, long term, ERP builds your child’s resilience to their fear.  Exposures are necessary for habituation, even if they are unpleasant in the moment and shortly thereafter.  

6. Anticipatory anxiety for an exposure is almost always worse than the actual exposure.

   A child may say “I could never do that” or “that would give me a panic attack” but often they are overestimating the difficulty of an exposure, and almost always feel more confident after completion. 

   As part of ERP work, therapists ask the child to rate an exposure in terms of their SUDS (Standard Units of Distress, 1-10) both before and after an exposure.  Very commonly, children will reflect “I did so much better with that than I thought I would.”  

7. Relapses are part of recovery.  

   I am pretty sure that I have never worked on an OCD case that did not have some relapse at some point in the recovery.  OCD is an incurable, lifelong disorder, and even people with years under their belt of subclinical OCD presentation (like yours truly) will have an uptick in symptomatology. 

   I like to frame OCD relapses as like the system catching the occasional cold despite being overall very healthy.  Like a cold, we simply have to power through the relapse and have faith that it is temporary.   

   Many of the clients at Kairos continue their connection to their therapists on an “as needed” basis after discharge.  

8. Over-exposures will happen, it is a normal part of ERP work.  An over-exposure does not take you back to “zero,” even if it feels that way in the short-term.  

   Over-exposures refer to moments in the OCD work where the nervous system does not habituate to a stressor because the client experienced too acute of a panic response. 

   An example might be if a client is surprised by an exposure that is a 10 on their fear hierarchy, despite not having done the necessary groundwork of exposures 1-9.  Usually over-exposures are accidental, perhaps because a clinician misjudged the severity of a trigger, or the client came in with an already stressed nervous system.  Over-exposures are not a reason for despair, and work is often simply picked up at the last successful exposure.  

Overall, my message to parents is: please trust the process. 

I know as an OCD parent myself how difficult it is to let go and believe in a technique, but it is an incredible help to our children if we can be on the same page with Exposure Response Prevention.   

Check our Events page for details and to sign up for the next ERP for Parents Workshop at Kairos Wellness Collective.