RE: what real CBT/ERP looks like and how to do it right

[Guest guest]

T wrote a post about CBT/ERP and intensive outpatient.

I have 4 kids who all experience OCD symptoms - though only 2 have been

diagnosed thus far.

My 8 year old's OCD is most difficult right now. She is trying to resist

doing what OCD tells her to do - but then she says her brain tells her other

ridiculous thoughts.

I'm in the middle of reading March's and Chansky's books on OCD.

I'd love to know what you meant, , by " what real CBT/ERP looks like and

how to do it right " .

Does anyone know of therapists in CT?

Thanks,

Vicki

[Guest guest]

Where in CT?

RE: what real CBT/ERP looks like and how to do it

right

T wrote a post about CBT/ERP and intensive outpatient.

I have 4 kids who all experience OCD symptoms - though only 2 have been

diagnosed thus far.

My 8 year old's OCD is most difficult right now. She is trying to resist

doing what OCD tells her to do - but then she says her brain tells her other

ridiculous thoughts.

I'm in the middle of reading March's and Chansky's books on OCD.

I'd love to know what you meant, , by " what real CBT/ERP looks like and

how to do it right " .

Does anyone know of therapists in CT?

Thanks,

Vicki

[Guest guest]

Fairfield county – easily accessible to these cities: Norwalk, Bridgeport,

Danbury and New Haven is about 45 minutes away.

Vicki

[Guest guest]

Can you get to White Plains? The NY Presbyterian Hospital there has an amazing

pediatric anxiety disorder center. My daughter sees someone who used to work

there.

RE: what real CBT/ERP looks like and how to do it

right

Fairfield county – easily accessible to these cities: Norwalk, Bridgeport,

Danbury and New Haven is about 45 minutes away.

Vicki

[Guest guest]

Can you get to White Plains? The NY Presbyterian Hospital there has an amazing

pediatric anxiety disorder center. My daughter sees someone who used to work

there.

RE: what real CBT/ERP looks like and how to do it

right

Fairfield county – easily accessible to these cities: Norwalk, Bridgeport,

Danbury and New Haven is about 45 minutes away.

Vicki

[Guest guest]

Here is my issue with " real CBT/ERP " vs " non real " :

There are many therapists out there who dont specialize in OCD but may do alot

of work with anxiety and CBT. They THINK that by nature of their training or

that they are an anxiety specialist or something that they are somehow qualified

to treat OCD.They have read some basic stuff about exposures and think they can

do it- they have general concepts but not specifics of how to make it sucessful.

They take you on a s a patient and waste YEARS of your childs life by doing sub

optimal therapy. By the time you figure out that there is better therapy out

there, both you and your child are so frustrated and discouraged, your life is

in turmoil and the child may think the case is hopeless and be less motivated to

try. This is especially true with very young children ( I would personally

classify this as under 5) where almost NO ONE in the world has a lot of

experience.

I wrote the below in response to a specific parent but the concept is

generalizable as to what GOOD CBT/ ERP looks like:

AGHHHH! I have been dying to respond to your post about the shoes and socks

making you homebound but have been too busy. Everyone here knows what you are

going through to one degree or another, and I agree with all that once you start

the exposures and therapy things will get better ( may get worse at first- hard

to imagine I know). However you can start treating the shoes issue right now

either with or without socks ( maybe ask her if she wants to try just shoes or

shoes and socks) The socks are not critical but the shoes are if you are ever

going to leave the house. Ready for a crash course on shoe (clothing) exposure

therapy while you wait for your appointment?

Get her a childs book about OCD -see previous posts or files section for

suggestions

Explain to her that her OCD is keeping you(her) from doing fun things, that you

love her and are not going to let OCD ruin her life

Explain to her that you know it is really hard and scairy to wear shoes( socks)

but that she is going to have to do it while at home for a short period of time

daily to help her body and mind get used to it and that as she wears the

shoes(socks) her body and mind will get used to it and it will become less

uncomfortable ( I used the hot bath analogy when my son was 3- when you get into

a hot bath at first it is too hot , but if you count to 10 it becomes OK because

your body adjusts. explain to her that for her hard work each day she can get a

reward, and at the end when she is able to go places she can get a big reward.

Brainstorm with her what might motivate her ( a treat or sticker or piece of

gum daily and a trip to the toy store to pick something out at the end-

something like that- I dont know what will work for her but find something she

loves and use it to drive the process.

Find a time during the day when you know you have a good one to 2 hours to kill

make an uncomfortableness (fear) chart from 0-10.

Tell her she needs to put on the shoes ( let her pick the shoes she thinks would

be easiest) and leave them on , in the house until they stop feeling so

uncomfortable. Assure her that this will happen and the two of you will make a

chart to watch how she gets used to it

I have a chart which looks like this:

Fear scale

Pre task 1 min 2 min 5 min 10 min 15 min 20 min

list the task ( ie wearing shoes)

make multiple rows so you can use t the chart for a week or so

Chart a pretask fear score

Have her put on the offending item. Let her know that the fear will likely

increase over the first couple minutes, but that she is ok, you are there with

her, this is just her OCD playing tricks on her and the fear will get better

just like the bath ( maybe you could even do a pre exposure demonstration with a

hot bath or eyes getting used to the dark to show how the body accomidates)

Here comes the really hard part- let her sit in the fear, supported by you,

melting down if necessary with you reassuring her that she will be ok and the

fear will get better over time .Continue the exposure, not distracting her but

helping her to focus on the fear until it peaks and then goes down ( this will

usually happen within 20-30 min). You do not want to stop the exposure before

the fear goes down significantly or it will reinforce the fear. Remind her that

she does not have to wear them all day, but this is an exposure and she only

needs to do it for a short time and there is a prize at the end. Do not get

sucked in to reassuring her that her toes are ok, just keep reminding her that

her fear is her OCD playing tricks on her and when she fights back her OCD gets

smaller and smaller until it disapears. The fear should go down from it's peak

to at least half if not down to a 0 or 1 or 2.

When you are done tell her how proud you are and give her the prize. Show her

the chart of how she beat OCD today. tell her you will be doing it again

tomorrow ( or later in the day depending on how many times a day you have time/

energy to do it.)

Repeat until the exercise is no longer difficult (can take several weeks, but

may begin to see results in several days).

Put on some shoes and celebrate by going to the toystore or out to dinner or

whatever big prize you agreed on then move onto the next agenda item that is

difficult and repeat the process

Ideally you start with easier stuff first and work up to the hard stuff, but

some something like shoes she needs to be to wear them to go anywhere and

warrants working on sooner. "

If you substitute out the specific issue, the rest can be used for anything. All

CBT/ ERP follows the same formula.

The main things I see people (me included) doing wrong is:

1. not making a fear heirarchy and doing easier stuff first

2. NOt having a GREAT reward system

3. NOT MAKING A SPECIFIC TIME OF DAY TO SET UP AND DO THE EXPOSURE AS A TIME OUT

OF LIFE- exposures do not occur in real time until later in the course of

treatment.

4. Trying to do realxation work during an exposure- the whole point of the

exposure is to NOT relax and to crank the fear up

5. Stopping the exposure too early ( fear has not decreased)

If the therapist you are seeing waits more then 3--5 visits before starting

therapy, they are wasting their time and likely dont know what they are doing.

If they dont have you as a parent in the room for at least SOME period of time

each session, they are wasting your time ( with young children you should likely

be present for whole session. I was present for ALL of EVERY session with my 13

year old when we had good therapy. If they dont give you DAILY homework, they

are wasting your time.

Hope that is helpful

[Guest guest]

Thank you for the very detailed explanation.

My I ask what kind of treatment is helpful for a visual type behavior, where

I don't see fear being involved.

My son has this thing he does with his eyes. We'll be in the middle of a

conversation and his eyes dart to focus elsewhere and his eyes are moving

slightly. He says he is lining things up. For example, there may be a

picture frame or molding frame around a door and he is shifting his eyes

back and forth to line things up.

Is ERP the right treatment for this?

Thanks,

Vicki

[Guest guest]

Thank you for the very detailed explanation.

My I ask what kind of treatment is helpful for a visual type behavior, where

I don't see fear being involved.

My son has this thing he does with his eyes. We'll be in the middle of a

conversation and his eyes dart to focus elsewhere and his eyes are moving

slightly. He says he is lining things up. For example, there may be a

picture frame or molding frame around a door and he is shifting his eyes

back and forth to line things up.

Is ERP the right treatment for this?

Thanks,

Vicki

[Guest guest]

Is this a tic or a compulsion? It sounds more tic like to me.

I have no experience treating tics at all since we have never had them

However, if it is a compulsion, your can set up the same exposure of either

having him not line things up for a period of time( and see if fear comes up

then) or have him do it at times when he doesnt feel like he needs to, or have

him move the eyes a different direction then he wants to- just undo it.

One other thought- has he seen an ophthalmologist? Are you sure his eyes are

tracking properly? It is possible that he has a tracking problem and is doing

it truely to line things up

[Guest guest]

Thank you for the great information. My son has OCD and he has the constant bad

thoughts and repeats things a lot (asking the same question over and over

again). Do you know how to deal with that through CBT/ERP?

>

> Here is my issue with " real CBT/ERP " vs " non real " :

>

>

[Guest guest]

Thank you for the great information. My son has OCD and he has the constant bad

thoughts and repeats things a lot (asking the same question over and over

again). Do you know how to deal with that through CBT/ERP?

>

> Here is my issue with " real CBT/ERP " vs " non real " :

>

>

[Guest guest]

The bad thoughts are harder since you cant see him doing them but the

reassurance seeking is easy. YOu and he need to decide the number of times per

day he is allowed to seek reassurance. Then, when he asks a question, tell him "

" Is this one of the x number of times you want to know the answer? " If not, then

he will likely get more anxious as he sits with the unanswered question. Focus

on that anxiety, chart it's level and watch it come down as the question goes

unanswered over time ( maybe 20-30 min). The next time he asks do the same. And

the next and the next. Keep track of the number of times you DO answer the

question and if he reaches his max number of answers and asks again, tell him he

has already reached his max number and then do the exposure exercise as

described above. Gradually over time, lower the number of times a day he is

allowed to ask. Again, as with previous posts, you need to do this with a daily

reward system and with a conscious focusing on the level of anxiety rather than

distraction.

With the bad thoughts, if he will express these to you, you can start by having

him write a story of all the WORST possible things that could happen- his worst

fears with lots of gory detail. Then, read the story to him several times a day

and again focus on and chart the anxiety it causes pretask, 1 min, 2 min, 5 min

10 min etc. Do it until the story becomes boring and doesnt raise his anxiety

any more. Tis may take several weeks of reading the story several times daily.

As he becomes more comfortable with it, you can add other horrific nightmarish

details as needed. You need to not be afraid to be graphic and inappropriate

depending on the topics he worries about. You also need to not reassure him

that these thoughts are not likely to happen or everything will be ok or

anything other than that the anxiety will go down because the thoughts are just

OCD trying to bully him. The more you play into reassurance, the more OCD wins

[Guest guest]

The bad thoughts are harder since you cant see him doing them but the

reassurance seeking is easy. YOu and he need to decide the number of times per

day he is allowed to seek reassurance. Then, when he asks a question, tell him "

" Is this one of the x number of times you want to know the answer? " If not, then

he will likely get more anxious as he sits with the unanswered question. Focus

on that anxiety, chart it's level and watch it come down as the question goes

unanswered over time ( maybe 20-30 min). The next time he asks do the same. And

the next and the next. Keep track of the number of times you DO answer the

question and if he reaches his max number of answers and asks again, tell him he

has already reached his max number and then do the exposure exercise as

described above. Gradually over time, lower the number of times a day he is

allowed to ask. Again, as with previous posts, you need to do this with a daily

reward system and with a conscious focusing on the level of anxiety rather than

distraction.

With the bad thoughts, if he will express these to you, you can start by having

him write a story of all the WORST possible things that could happen- his worst

fears with lots of gory detail. Then, read the story to him several times a day

and again focus on and chart the anxiety it causes pretask, 1 min, 2 min, 5 min

10 min etc. Do it until the story becomes boring and doesnt raise his anxiety

any more. Tis may take several weeks of reading the story several times daily.

As he becomes more comfortable with it, you can add other horrific nightmarish

details as needed. You need to not be afraid to be graphic and inappropriate

depending on the topics he worries about. You also need to not reassure him

that these thoughts are not likely to happen or everything will be ok or

anything other than that the anxiety will go down because the thoughts are just

OCD trying to bully him. The more you play into reassurance, the more OCD wins

[Guest guest]

The bad thoughts are harder since you cant see him doing them but the

reassurance seeking is easy. YOu and he need to decide the number of times per

day he is allowed to seek reassurance. Then, when he asks a question, tell him "

" Is this one of the x number of times you want to know the answer? " If not, then

he will likely get more anxious as he sits with the unanswered question. Focus

on that anxiety, chart it's level and watch it come down as the question goes

unanswered over time ( maybe 20-30 min). The next time he asks do the same. And

the next and the next. Keep track of the number of times you DO answer the

question and if he reaches his max number of answers and asks again, tell him he

has already reached his max number and then do the exposure exercise as

described above. Gradually over time, lower the number of times a day he is

allowed to ask. Again, as with previous posts, you need to do this with a daily

reward system and with a conscious focusing on the level of anxiety rather than

distraction.

With the bad thoughts, if he will express these to you, you can start by having

him write a story of all the WORST possible things that could happen- his worst

fears with lots of gory detail. Then, read the story to him several times a day

and again focus on and chart the anxiety it causes pretask, 1 min, 2 min, 5 min

10 min etc. Do it until the story becomes boring and doesnt raise his anxiety

any more. Tis may take several weeks of reading the story several times daily.

As he becomes more comfortable with it, you can add other horrific nightmarish

details as needed. You need to not be afraid to be graphic and inappropriate

depending on the topics he worries about. You also need to not reassure him

that these thoughts are not likely to happen or everything will be ok or

anything other than that the anxiety will go down because the thoughts are just

OCD trying to bully him. The more you play into reassurance, the more OCD wins

[Guest guest]

This topic got my attention. My understanding and experience is that a

combination of anti-anxiety medication and Exposure and Response

Prevention ERP is the most effective PROVEN way to treat OCD.

Our 16 year-old dear son ds has had significant OCD for 3-5 years.

Last summer, after two years with three different (non-ERP) therapists

he went to Hospital in Wisconsin. With the help of the team

there, he got over his worst fear: That he would need to care for and

eventually marry his step sister - who is on the autism spectrum.

taught us that ERP works. Unfortunately, costs $24,000.

per month. After 10 weeks he came home but was still unable to go to

the local HS. He now attends the Montcalm School for Boys -a

theraputic HS in Albion, Michigan. Though it is a wonderful place,

there is no access to ERP there. It costs $7,000 per month.

Our son has not had ERP in 7 months. We now have a large second

mortgage on our home.

Finding getting EPR therapy for our son is now our biggest challenge.

We live in a small town. It is 35 miles to the nearest Behavioral

Health clinic. No one there does ERP. The drive there with DS is,

quite frankly, hell. The closest place to get credible ERP therapy is

about 75 miles. I cannot imagine making that drive.

Our plan is for me to do ERP with our son this summer. I have read

about it and paid close attention to how they did ERP at . I

have my own limitations regarding learning about and using things like

ERP. However I WILL push past my own limitations to help our son.

Wish me luck

Todd

[Guest guest]

Hi Todd, ready to ask if you live near me. Same thing with distance to

treatment providers. Is his school out soon?

Hopefully, with his age and past experience at , he's willing to do some

ERP this summer; without parent nagging, lol, how it worked with me. I know it

was difficult for me to find " planned exposure " time, so we had the 1,2,3 things

picked out to work on and just worked on as they came up each day or so; except

during schoolyear homework time or other times when I needed him de-stressed.

Or, sigh, when I was in the midst of cooking supper...like I said, hard to find

the minutes some days. But from what I've read, having that " set time " that

this is ERP time, we're gonna work on it, is a good idea.

Hope to hear how it's going once you begin!

>

>home.

>

> Finding getting EPR therapy for our son is now our biggest challenge.

> We live in a small town. It is 35 miles to the nearest Behavioral

> Health clinic. No one there does ERP. The drive there with DS is,

> quite frankly, hell. The closest place to get credible ERP therapy is

> about 75 miles. I cannot imagine making that drive.

>

> Our plan is for me to do ERP with our son this summer. I have read

> about it and paid close attention to how they did ERP at . I

> have my own limitations regarding learning about and using things like

> ERP. However I WILL push past my own limitations to help our son.

>

> Wish me luck

>

> Todd

>

[Guest guest]

You might check to see if anyone in the state is doing scype therapy or if

anyone has scype studies going on right now ( ocf website under research

button). We got our best therapy ever over scype

[Guest guest]

Hi Todd,

Definitely wish you luck with the ERP! It is a very big challenge finding

someone with expertise doing ERP. An unfortunate problem coming out of

inpatient treatment, lack of follow up treatment to maintain the gains and keep

momentum going.

Skype is a good option. Many more docs out there offering this.

Here are a couple of links to check out -

www.ocdhope.com (Florida)

Dr. Hyman - author of the OCD Workbook. Heads this centre.

www.ocdonline.com (comprehensive website, with articles, videos)

Dr. on - offers phone consultation/skype

www.gatewayocd.com (California)

Comprehensive treatment centre. Offers a 3-week intensive treatment program

which includes up to 35 hours of treatment per week. Follow up maintenance

treatment via skype.

There is also a self-help website you can sign up to do your own self directed

ERP -

www.ocdchallenge.com (home website - www.peaceofmind.com)

Have to say the other common challenge is the teen part. We found we had to

wait out our son until he was " ready, willing, and able " to truly take on the

OCD. It is a process, still ongoing Our son is now almost 21 and not doing

as well as he has. He is in avoidance mode, rather than address the OCD head on

with ERP, he just opts out and avoids anything that triggers it.

Since it is a lifelong management issue, they have to be the ones to take it on.

I found I expended my energy trying to get the ERP moving to no avail. It self

corrected though, I ran out of energy, so now it's up to our son Seems to be

pretty common. The good news is that once they decide to get moving it can

shift really fast!

Warmly,

Barb

Canada

Son, OCD, LD Plus

>

> This topic got my attention. My understanding and experience is that a

> combination of anti-anxiety medication and Exposure and Response

> Prevention ERP is the most effective PROVEN way to treat OCD.

>

> Our 16 year-old dear son ds has had significant OCD for 3-5 years.

>

> Last summer, after two years with three different (non-ERP) therapists

> he went to Hospital in Wisconsin. With the help of the team

> there, he got over his worst fear: That he would need to care for and

> eventually marry his step sister - who is on the autism spectrum.

> taught us that ERP works. Unfortunately, costs $24,000.

> per month. After 10 weeks he came home but was still unable to go to

> the local HS. He now attends the Montcalm School for Boys -a

> theraputic HS in Albion, Michigan. Though it is a wonderful place,

> there is no access to ERP there. It costs $7,000 per month.

>

> Our son has not had ERP in 7 months. We now have a large second

> mortgage on our home.

>

> Finding getting EPR therapy for our son is now our biggest challenge.

> We live in a small town. It is 35 miles to the nearest Behavioral

> Health clinic. No one there does ERP. The drive there with DS is,

> quite frankly, hell. The closest place to get credible ERP therapy is

> about 75 miles. I cannot imagine making that drive.

>

> Our plan is for me to do ERP with our son this summer. I have read

> about it and paid close attention to how they did ERP at . I

> have my own limitations regarding learning about and using things like

> ERP. However I WILL push past my own limitations to help our son.

>

> Wish me luck

>

> Todd

>

[Guest guest]

Hi Todd,

Definitely wish you luck with the ERP! It is a very big challenge finding

someone with expertise doing ERP. An unfortunate problem coming out of

inpatient treatment, lack of follow up treatment to maintain the gains and keep

momentum going.

Skype is a good option. Many more docs out there offering this.

Here are a couple of links to check out -

www.ocdhope.com (Florida)

Dr. Hyman - author of the OCD Workbook. Heads this centre.

www.ocdonline.com (comprehensive website, with articles, videos)

Dr. on - offers phone consultation/skype

www.gatewayocd.com (California)

Comprehensive treatment centre. Offers a 3-week intensive treatment program

which includes up to 35 hours of treatment per week. Follow up maintenance

treatment via skype.

There is also a self-help website you can sign up to do your own self directed

ERP -

www.ocdchallenge.com (home website - www.peaceofmind.com)

Have to say the other common challenge is the teen part. We found we had to

wait out our son until he was " ready, willing, and able " to truly take on the

OCD. It is a process, still ongoing Our son is now almost 21 and not doing

as well as he has. He is in avoidance mode, rather than address the OCD head on

with ERP, he just opts out and avoids anything that triggers it.

Since it is a lifelong management issue, they have to be the ones to take it on.

I found I expended my energy trying to get the ERP moving to no avail. It self

corrected though, I ran out of energy, so now it's up to our son Seems to be

pretty common. The good news is that once they decide to get moving it can

shift really fast!

Warmly,

Barb

Canada

Son, OCD, LD Plus

>

> This topic got my attention. My understanding and experience is that a

> combination of anti-anxiety medication and Exposure and Response

> Prevention ERP is the most effective PROVEN way to treat OCD.

>

> Our 16 year-old dear son ds has had significant OCD for 3-5 years.

>

> Last summer, after two years with three different (non-ERP) therapists

> he went to Hospital in Wisconsin. With the help of the team

> there, he got over his worst fear: That he would need to care for and

> eventually marry his step sister - who is on the autism spectrum.

> taught us that ERP works. Unfortunately, costs $24,000.

> per month. After 10 weeks he came home but was still unable to go to

> the local HS. He now attends the Montcalm School for Boys -a

> theraputic HS in Albion, Michigan. Though it is a wonderful place,

> there is no access to ERP there. It costs $7,000 per month.

>

> Our son has not had ERP in 7 months. We now have a large second

> mortgage on our home.

>

> Finding getting EPR therapy for our son is now our biggest challenge.

> We live in a small town. It is 35 miles to the nearest Behavioral

> Health clinic. No one there does ERP. The drive there with DS is,

> quite frankly, hell. The closest place to get credible ERP therapy is

> about 75 miles. I cannot imagine making that drive.

>

> Our plan is for me to do ERP with our son this summer. I have read

> about it and paid close attention to how they did ERP at . I

> have my own limitations regarding learning about and using things like

> ERP. However I WILL push past my own limitations to help our son.

>

> Wish me luck

>

> Todd

>

[Guest guest]

,

Just wanted to thank you for describing how to address reassurance questions

and scary thoughts.

Vicki

From:

[mailto: ] On Behalf Of Trabulsy,

Sent: Monday, June 04, 2012 7:19 AM

To:

Subject: Re: what real CBT/ERP looks like and how to do it

right

The bad thoughts are harder since you cant see him doing them but the

reassurance seeking is easy. YOu and he need to decide the number of times

per day he is allowed to seek reassurance. Then, when he asks a question,

tell him " " Is this one of the x number of times you want to know the

answer? " If not, then he will likely get more anxious as he sits with the

unanswered question. Focus on that anxiety, chart it's level and watch it

come down as the question goes unanswered over time ( maybe 20-30 min). The

next time he asks do the same. And the next and the next. Keep track of the

number of times you DO answer the question and if he reaches his max number

of answers and asks again, tell him he has already reached his max number

and then do the exposure exercise as described above. Gradually over time,

lower the number of times a day he is allowed to ask. Again, as with

previous posts, you need to do this with a daily reward system and with a

conscious focusing on the level of anxiety rather than distraction.

With the bad thoughts, if he will express these to you, you can start by

having him write a story of all the WORST possible things that could happen-

his worst fears with lots of gory detail. Then, read the story to him

several times a day and again focus on and chart the anxiety it causes

pretask, 1 min, 2 min, 5 min 10 min etc. Do it until the story becomes

boring and doesnt raise his anxiety any more. Tis may take several weeks of

reading the story several times daily. As he becomes more comfortable with

it, you can add other horrific nightmarish details as needed. You need to

not be afraid to be graphic and inappropriate depending on the topics he

worries about. You also need to not reassure him that these thoughts are not

likely to happen or everything will be ok or anything other than that the

anxiety will go down because the thoughts are just OCD trying to bully him.

The more you play into reassurance, the more OCD wins

[Guest guest]

,

Just wanted to thank you for describing how to address reassurance questions

and scary thoughts.

Vicki

From:

[mailto: ] On Behalf Of Trabulsy,

Sent: Monday, June 04, 2012 7:19 AM

To:

Subject: Re: what real CBT/ERP looks like and how to do it

right

The bad thoughts are harder since you cant see him doing them but the

reassurance seeking is easy. YOu and he need to decide the number of times

per day he is allowed to seek reassurance. Then, when he asks a question,

tell him " " Is this one of the x number of times you want to know the

answer? " If not, then he will likely get more anxious as he sits with the

unanswered question. Focus on that anxiety, chart it's level and watch it

come down as the question goes unanswered over time ( maybe 20-30 min). The

next time he asks do the same. And the next and the next. Keep track of the

number of times you DO answer the question and if he reaches his max number

of answers and asks again, tell him he has already reached his max number

and then do the exposure exercise as described above. Gradually over time,

lower the number of times a day he is allowed to ask. Again, as with

previous posts, you need to do this with a daily reward system and with a

conscious focusing on the level of anxiety rather than distraction.

With the bad thoughts, if he will express these to you, you can start by

having him write a story of all the WORST possible things that could happen-

his worst fears with lots of gory detail. Then, read the story to him

several times a day and again focus on and chart the anxiety it causes

pretask, 1 min, 2 min, 5 min 10 min etc. Do it until the story becomes

boring and doesnt raise his anxiety any more. Tis may take several weeks of

reading the story several times daily. As he becomes more comfortable with

it, you can add other horrific nightmarish details as needed. You need to

not be afraid to be graphic and inappropriate depending on the topics he

worries about. You also need to not reassure him that these thoughts are not

likely to happen or everything will be ok or anything other than that the

anxiety will go down because the thoughts are just OCD trying to bully him.

The more you play into reassurance, the more OCD wins

[Guest guest]

Thank you to all who responded to my post about finding ERP therapists,

especially Barb and who suggested therapy via Skype.

Todd

[Guest guest]

Thank you to all who responded to my post about finding ERP therapists,

especially Barb and who suggested therapy via Skype.

Todd

[Guest guest]

Yes, thank you for explaining that in detail. Can't wait to try and see

how it works with our son.

>

> ,

>

>

>

> Just wanted to thank you for describing how to address reassurance questions

> and scary thoughts.

>

>

>

> Vicki

>

>

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>

[Guest guest]

Yes, thank you for explaining that in detail. Can't wait to try and see

how it works with our son.

>

> ,

>

>

>

> Just wanted to thank you for describing how to address reassurance questions

> and scary thoughts.

>

>

>

> Vicki

>

>

>

>