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The Worry Hill - Page 3


I let Maria and her parents know that there are about one million children in America who have OCD. Maria was surprised and pleased to hear that she wasn't the only one with OCD. She was curious to hear about other children like her. "Everyone's OCD can be a little different—people can have obsessions about getting hurt or having bad luck," I explained. "Sometimes, they may even have thoughts that they've said or done something really bad when they actually haven't. Rituals can also be of many types, like checking things, counting, cleaning, or saying 'I'm sorry' all the time."

To alleviate blame and shame and build an alliance with the family, I then discussed the current understanding of OCD as a neurobehavioral disorder. "Having OCD isn't your fault. It's not your parents' fault either. It's like having allergies or asthma—it happens to you because you're more sensitive to it. Sometimes there are other people in your family who are also sensitive and have OCD. OCD isn't something you do on purpose to get attention or because you're lazy. Sometimes your parents or your teachers or friends may think that you're just being stubborn or annoying. It's hard for them to understand that you don't want to do it, but you don't know how to stop." Maria glanced at her parents with a "See, I told you!" look, as her mother tearfully acknowledged having had such reactions.

Communication is key. Most children and families aren't aware that the body is designed to habituate naturally to anxiety. I developed the Worry Hill metaphor to make CBT more child-friendly and prepare children for treatment, by helping them understand how exposure leads to habituation. It's a drawing of a bell-shaped curve that graphically illustrates how anxiety rises with exposure until it reaches a peak, and then, if the child persists in resisting the urge to employ the usual anxiety-avoidance tactics, automatically begins to decline.

In our second session the next week, I explained to Maria and her parents, "Learning how to stop OCD is like riding your bicycle up and down a hill. At first, facing your fears and not doing your rituals feels like riding up a big Worry Hill, because it's tough. You have to work hard to huff and puff up a hill, but if you keep going, you can get to the top. Once you get to the top, it's easy and fun to coast down the hill.

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