Let's learn about cognitive behavioural therapy

 Cognitive behavioural therapy is also called CBT. 

 The word cognitive means thinking. The word behavioural means the way someone behaves or responds to their thoughts and feelings. The word therapy means a therapist helps you change how you think about your unwanted thoughts. 

When you do CBT your thoughts change for the better. When your thoughts change for the better your feelings change for the better too. Thinking and feeling better makes you feel confident. Confidence helps you resist compulsions and instead you do the behaviours you want to do and not what OCD wants, so this is a positive response. 

CBT also includes exposure response prevention. 

Let's see what this means in the section below.

Exposure Response Prevention

When you start to resist compulsions you learn to challenge your OCD fears by first making a list of what these are. The list is called a fear ladder or hierarchy. You then use your ladder to do exposure response prevention, or ERP for short. The word exposure means  agreeing to face the fears on your list one by one. This takes a lot of COURAGE and you would usually do this with a therapist. The words response prevention means you make a big effort not to respond as you normally would which is doing a compulsion, but to resist this instead, like you learned in the 3-step challenge in lesson 3. I believe you have the courage to do this... so let's go ahead and learn more...

Dulling your fear

Doing ERP begins to dull your fear. Dulling your fear means becoming habituated to the triggers and obsessions that cause you the fear. Let's say touching the bin makes Johhny feel dirty or fearful of catching germs. When doing ERP in small steps, his fears and doubts about feeling dirty or catching germs weaken. This helps him to take risks, which helps him to live with uncertainty. 

Johnny's compulsion is to wash his hands. Usually he washes them 5 times after touching the bin. He is learning a new response which is to wash them 4 times, then 3 times and so on until the urge to wash them gets less. The compulsion to repeat the handwashing behaviour will eventually lose its strength and Johnny will start to wash appropriately again, meaning once only. 

Becoming habituated

This is like getting into a cold swimming pool. When you've been in the pool for a few minutes it doesn't feel so cold anymore. The same happens with anxiety. The more you resist compulsions you become habituated to your fear-related obsession. 
Can you remember the word cognitive and that this means thinking? Well, when you think differently about your unwanted thoughts, your feelings and responses change for the better. So if Johnny touches a bin, he could think "I can either accept there is a very small risk of catching germs and becoming ill; or worry about my fear forever." This is the uncertainty part and feeling more comfortable about coping with that. So next, Johnny would do his ERP by using the handwashing steps above. One tip is for Johnny to also delay asking for reassurance about whether everything will be okay, because the more he asks, the more he'll need to ask. This is because reassurance seeking is a compulsion and makes the obsession worse. Delaying asking shows he can learn to cope without reassurance which will weaken his obsession. 

You can learn to do the same with my 3-minute ERP egg timer technique
Caring Carol's 3-minute ERP egg timer technique
When Johnny did his ERP he used my 3-minute egg timer technique. This was to help him time and monitor his ERP sessions. His first exposure time was for 6 minutes, so he turned this over twice, meaning once the sand reached the bottom of the timer he would do the same again. So if your first exposure time is for 6 minutes and say you are resisting the compulsion to check, make something straight, pray, or something else, you would turn the timer over twice, like Johnny, and then note the time down on a progress sheet or in a diary. A progress sheet can also be called a ERP log because it logs information. The aim is to reach 1 hour or longer without doing any compulsions. You can get bigger sand timers with more sand when you are ready for longer exposures, and they come in lovely colours too, like red, blue and purple. Sandtimers are not only a clever way to note down your exposure times, they can also make you feel calm when you watch the sand fall to the bottom. The other children you've met at OCD Kids Web are doing very well with ERP with my 3-minute sandtimer technique, and I'm pretty sure that you will too!

Let's look below to find out how to manage anxiety when you do ERP

Distress levels

When your distress becomes manageable, which is around 3/10 or less, you don't usually need to do ERP for your feared situation any longer. However, each day you are still encouraged to resist the compulsion while working on other fears on your ladder. The good thing is this all gets easier the more you practice! Basically, as soon as you feel ready to go onto your next fear on the ladder get your sandtimer or other timer to help you keep track of time and then note down your distress levels on a separate progress sheet - remember to keep up with the exposure until your fear is down to 3/10 or less. 

Anxiety thermometer 

To measure your anxiety level you can draw a thermometer, like the one above. 

Each day, you put a tick beside the number that indicates your distress level. You can then log this to help you monitor your progress. Don't worry if things don't go to plan straight away, just keep trying like Johnny and the other children, and you'll get there eventually!

 Question Section 

Let's see how well you can remember what you've just learned!

 Caring Carol says please ask your grown-up to help you find the answers! 

  1. What does cognitive mean?
  2. If you think better about your unwanted thoughts, what else changes for the better?
  3. What do you list on a hierarchy?
  4. How can Caring Carol's 3-minute egg timer technique help you do ERP?
  5. What does habituation mean?
Caring Carol says WELL DONE on coming to the end of your fourth lesson!

 Thumbs Up!

Now it's time for your final lesson. Click on the link when you're ready and Caring Carol will help you know what to do if you have other problems too, like feeling sad or something else.


ERP logs and a diary can be effective because it helps children monitor their weekly progress and working on setbacks. 
WHAT TO DO WHEN YOUR CHILD IS FACED WITH DOUBTS - encourage them to continue to hold on to their choice. They can break this down by resisting doing a compulsion first for 15 minutes, even 10 or five minutes. Then have them build on the time they started with. When you do this and practice it with them they learn to recognise that anxiety usually goes away all by itself, usually after about 15-30 minutes, and no longer than an hour. If it's a little bit longer, don't worry, it will come down eventually. This is when your child starts to realise that OCD threats do not come true if a compulsion is not given into. This is also when they start to learn to cope with uncertainty. What happens next is that their fears start to weaken. When this happens, OCD doesn't bother them so much anymore, and so making their own choices become easier and easier!