Home Management Strategies for OCD

We will be removing this page on Dec 15, 2017.  The material has been replaced by the MAP (My Anxiety Plan) session to session program. If you have any questions or comments please send them to this e-Mail address.

Step 1: Teaching your child about anxiety

  • No matter what type of anxiety problem your child is struggling with, it is important that he or she understands the facts about anxiety

Fact 1: Anxiety is a normal and adaptive system in the body that tells us when we are in danger.
Fact 2: Anxiety becomes a problem when our body tells us that there is danger when there is no real danger

  • As an important first step, help your child to understand that all his or her worries and physical feelings have a name: Anxiety. 
  To learn how to explain this to your child, see How to Talk to Your Child about Anxiety.  

Step 2: Teaching your child or teen about OCD

  • It is important that your child or teen understand that all the upsetting thoughts and rituals that he or she is having is called OCD. 
  • One way to think about OCD is as a “computer virus” or a “hiccup” in the brain.

Talking To Your Child: “OCD as a computer virus”

Parent: “Let’s talk about your OCD today. One way to think about it is as a computer virus. What do viruses do to computers?”
Child: “Well, viruses can mess up the computer. Some programs might not work well, but it could also break the whole computer”
Parent: “That’s right. Well, think of your OCD as a computer virus in your brain. It can mess up certain programs, and sometimes it just shuts the brain right down. For example, sometimes you just keep washing your hands over and over again. That’s your OCD virus messing up the program. Other times, you just don’t want to leave the house because you are so anxious; that’s the OCD virus again. Your OCD virus turns the volume of scary thoughts up really high in your brain. So, together we need to get rid of that OCD computer virus. What do you think?”
  

Talking To Your Child: “OCD as a hiccup”

Parent: “Let’s talk about your OCD today. One way to think about it is as a hiccup in your brain. What happens when we hiccup?”
Child: “We make a hiccup sound, and it keeps happening again and again.”
Parent: “That’s right. It just keeps coming back, and we have no control. Well, OCD is like a hiccup. You have thousands of thoughts in your head every day, but when you have an OCD hiccup, the same thought comes up again and again, and just won’t go away. For example, sometimes when you go to bed at night, your brain has an OCD hiccup. Do you know what it is?
Child: “Yes. I check all the doors and windows to make sure they are locked.”
Parent: “Exactly. The OCD hiccup in your brain tells you that you need to check again and again to make sure that everything is locked. So, together we need to stop your brain from hiccupping. What do you think?”
 

Step 3: Building your child’s toolbox

The best way to help children or teens deal with OCD is to give them tools that can be used instead of the compulsions.  For OCD, tools in the toolbox include: 

Tool #1: Naming the bully

  • OCD can quickly take over your child’s life. A good way for you to start helping your child tackle OCD is to encourage him or her to see the OCD as a separate entity, rather than a mistake on the part of your child. To do this, children and teens are encouraged to see their OCD as a bully that is trying to control them and tell them what to do. 
  • Have your child give a name to the OCD bully, such as “the worry bug,” “the pest,” or “the OCD monster.” 
  • You and your child can then talk about OCD without blaming anyone for it. For example, “It looks like the OCD monster has been bullying you around today!”

TOOL #2: Changing or Delaying the Rituals

This tool is especially useful with younger children. Once you begin helping your child to deal with OCD, you can ask him or her to delay or change a ritual slightly as a first attempt to “boss back” the OCD. For example, “Let’s try bossing back the OCD by having you wait 5 minutes before washing your hands,” or “Let’s try putting the right sock on before the left sock.” Afterward, make sure to praise your child’s accomplishment, and remind him or her that this is how we “boss back the OCD”.  

Helpful Tip:
Delaying or changing an OCD ritual can be very difficult. If your child is very anxious, it is OK to take very small steps. For example, delaying washing hands for 30 seconds.

You might even want to make a fear ladder with your child that has gradually harder exercises for him or her to do, such as, starting with a delay of 30 seconds to not washing hands all day. (See Helping your Child to Face Fears: Exposure for more information.)!

  • It is a good idea to remind your child whenever OCD is being a bully. For example, “I see that you are arranging all your socks in the sock drawer. Is the OCD bully acting up again?”
  • Don’t forget to give lots of rewards and praises to your child for any attempts he or she makes to fight off the OCD rituals.  
Praise, Praise, Praise!!
Because it is hard work to manage OCD, your child needs lots of encouragement. Some helpful rewards can be:

  • Stickers that your child can put on a posterboard every time he or she tries to boss back OCD
  • Verbal praise: “What a great job you are doing!”; “I’m so proud of you!”; “Look how brave you are!”
  • Rewards at home: extra TV time, family time together, playing a fun board game, dinner at a favourite restaurant, or a new toy. Some rewards should be more long-term. For example, “When you are able to boss back the OCD for a whole day and not check any doors, we will go to the toy store and get a new video game for you.”

Tool #3: Addressing Reassurance-Seeking

  • Because children with OCD often want reassurance from their parents, this is an important tool, not only for your child, but also for you. 
  • When your child asks for reassurance, for example, “are you sure the kitchen is clean?”, you can answer in the following ways:
  • “What if it’s not completely clean? What would happen then?”
  • If your child gets very anxious, you can remind him or her that OCD is being a bully, and ask which tool he or she can use from the OCD toolbox.
  • You can give your child reassurance once, and then if he or she asks again, you can reply: “I already answered that question. Why don’t you try using your toolbox?”
  To learn how to explain this to your child, see How to Address Excessive Reassurance Seeking.  

Tool #4: Facing Fears: Exposure and Response Prevention

The majority of the work in helping your child or teen “boss back” the OCD is in helping your child to gradually face his or her fears. This involves developing a list of all of your child’s rituals (e.g., washing hands, checking doors), as well as a list of situations when your child completes the rituals (e.g., when touching the doorknob or when going to bed at night). With OCD, this is sometimes called “Exposure and Response Prevention,” because children or teens need to face their fears (e.g., touching the doorknob), and then deliberately not do their compulsion (e.g., washing hands). Facing fears is the exposure part; not doing the compulsion is called “response prevention.” Gradually, your child can begin reducing these behaviors by not doing the compulsions and then tolerating the anxiety until it subsides. This tool will probably be the most effective of all the OCD tools.

Tool #5: Stopping Parent-Assisted Rituals

Once you start helping your child or teen to battle OCD, you might think that stopping all the rituals that you yourself have become involved in is a good idea. For example, your child might ask you to clean the house or do the laundry in a certain way (such as using bleach everywhere, or cleaning clothes separately). Although one of the goals in managing OCD is to stop all the rituals you are involved in, suddenly stopping them all can be very overwhelming for your child. When your child starts facing his or her fears, these parent-assisted rituals can be another part of OCD to boss back. That is, you can make a fear ladder with your child, to gradually reduce these rituals. 

Tip #1: Your Child or Teen is the Boss!
It is important to ultimately let your child decide when he or she is ready to reduce, change, or eliminate rituals that you assist with. Your child needs to feel “in charge” of bossing back OCD.

Tip #2: Be Patient
Most parents are very frustrated with all the rituals they are involved in. However, it is important to remember not to get angry at your child for unsuccessful attempts at bossing back OCD. Instead, focus on successes! Give your child lots of praise, even if his or her attempt to stop some rituals was unsuccessful. Being positive is extremely motivating.

Tool #6: Coping Cards

One of the most helpful tools will be the things that your child can say to him or herself to help deal with anxiety. Coping cards are very useful for this. (see Developing and Using Cognitive Coping Cards with Your Child). Some helpful coping statements for OCD include:  

  • “There’s my OCD monster! He’s trying to bully me again! I don’t have to listen.”
  • “I feel really anxious right now, but I know that feeling will go away soon.”
  For more detail and a sample of an OCD ladder, see Helping your Child to Face Fears: Exposure.  
Helpful Tip:
Some of the OCD fears that your child has might be based on false information or ignorance. For example, many children with OCD who wash their hands excessively don’t know that washing your hands repeatedly is not good for you. It is important to have some germs; otherwise, we never get to build up our immunity. Your child can put this kind of information onto a coping card. If your child teen is unsure whether this new information is true, make a trip to the library or look up the information on the internet.

Tool #7: STOP plan: Challenging Unhealthy Thoughts

This strategy involves challenging some of the unhealthy beliefs that your child holds about his or her obsessions. For example, your child might think, “If I don’t line up my shoes perfectly, my mom will die!” This thought is obviously unrealistic and inaccurate, but it might be hard for your child to see that when he or she is feeling anxious. The STOP plan can help your child to STOP these unhealthy thoughts, and rethink whether or not they are in fact true. For more information on the STOP plan for younger children, see Healthy Thinking for Young Children. To help teens think more realistically, see Realistic Thinking for Teens

Tool #8: Information about Obsessions

Some children or teens have obsessions that involve very upsetting, scary, or gross thoughts. For example, some children may have unwanted thoughts like “What if I pushed somebody in front of a car?” or “I thought about my mom getting hit by a car today; that must mean that it will happen!” A good way to help your child deal with these types of thoughts it to talk to them about obsessions. Here are some facts about obsessions:  

Fact #1: Everybody has unwanted or unpleasant thoughts sometimes. It is normal.Fact #2: Just thinking about something won’t make it happen. For example, if you think about breaking your leg, it won’t necessarily happen.Fact #3: Thinking a bad thought does not mean you are a bad person. It also does not mean you want to do anything bad. Obsessions are just “garbage of the mind.” Fact #4: The best way to boss back these thoughts is to ignore them. If you don’t pay attention to the thought, it will go away on its own. If you try to fight it or push it out of your head, it will keep coming back! 

One final tip:
Although all of these tools can be very effective in helping you to manage your child’s OCD, sometimes it is not enough. Sometimes children have very severe OCD, and despite all your best efforts, they may still be struggling daily. If this is the case with your child, it is a good idea to obtain some professional help in dealing with OCD, either through a consult with your GP, a psychiatrist, or a child psychologist/mental health worker.

Step 4: Building on Bravery 

Your child's progress comes from hard work. If you are noticing improvements, both you and your child deserve lots of credit!  Learning to overcome anxiety is like exercise – your child needs to "keep in shape" and practice his or her skills regularly, and make them a habit. This is true even after your child is feeling better and has reached his or her goals.    

Don't be discouraged if your child has lapses and returns to old behaviors every once in a while, especially during stressful times or transitions. This is normal, and just means that one or two tools in the toolbox need to be practiced again. Remember, coping with anxiety is a lifelong process.  

  Hint: Occasionally remind your child what he or she was not able to do before learning how to cope with anxiety and face fears. It can be very encouraging for your child too.