What is ERP with Children
Exposure with response prevention (ERP) is a well-researched treatment that has been shown to help kids with Obsessive Compulsive Disorder (OCD) or severe anxiety. It is not unusual for kids with OCD to avoid situations that trigger their obsessive thoughts or to get stuck in rituals or routines (i.e., compulsions) that are meant to bring down their anxiety. While anxiety naturally brings on an urge to avoid, ERP approaches avoidance and compulsions as short-term solutions that may temporarily bring down anxiety, but keep fears around longer and eventually cause long-term problems at home, at school, and with friends. ERP helps fix this pattern by encouraging kids to approach rather than avoid their anxiety so that they can build resilience to their anxiety, learn that they can cope with difficult situations, and regain a sense of control over their lives.
ERP has three primary components.
- Learning about OCD and anxiety: the therapist helps kids and families identify what triggers the anxiety, what the anxiety feels like, and how kids cope with or avoid their anxiety.
- Exposure: kids are geared up with skillful ways to slowly but surely approach situations that trigger obsessive thoughts or bring on the urge to engage in rituals or routines.
- Response prevention: kids are taught alternative strategies for responding to their obsessive thoughts and anxiety so that they can get unstuck from their routines or rituals.
The goal of ERP is to help kids learn how to cope with their anxiety effectively, rather than living a life controlled by their anxious thoughts.
Therapeutic Components:
- Structure: ERP is a structured type of talk therapy that requires a commitment to practicing skills and meeting weekly or bi-weekly. Sessions are structured around learning and practicing new skills and trying out new exposure tasks.
- Theory: ERP is anchored in the theory of exposure. Exposure theory believes that our anxiety gets strengthened and sticks around for longer when we avoid the things we fear. By learning skills to approach their fears, kids can decrease how intense their fears are, how long their fears last, and the impact of their fears on their lives.
- Intervention: ERP interventions involve identifying feared situations, learning skills to approach them, and approaching the feared situations gradually over time.
- Modalities: the TAP clinic currently offers ERP with an individual therapist. For parent support, we recommend our Supportive Parenting for Anxious Childhood Emotions (SPACE) program
How are parents included in treatment?
We know from research and experience that ERP treatment with kids is most effective when parents are involved! Especially with younger children, the therapist will likely include parents in sessions to learn about their child’s anxiety, learn about how the OCD cycle plays out in families, incorporate parents into exposures practiced during sessions, and brainstorm ways to reward kids for practicing skills at home. The goal is for parents to be like coaches and cheerleaders at home!
Oftentimes, families can also get stuck in the anxiety and OCD cycle because it can feel like there are no other choices than to help kids avoid feared situations or participate in their routines or rituals. We typically recommend that parents also receive parenting support through our Supportive Parenting for Anxious Childhood Emotions program (SPACE). SPACE helps parents make changes at home that will help support and strengthen the work that their children are doing in ERP therapy.
It’s also not uncommon for children to refuse or to not be ready to engage in ERP treatment due to a number of factors (e.g., motivation, developmental readiness, time). When children are not willing or ready to be involved in treatment, we recommend that parents become involved in our SPACE program, which has been shown to be effective on its own to improve and treat childhood OCD.