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The Worry Hill - Page 9

I helped Maria through the tougher exposures by reminding her of her previous successes, continually encouraging her efforts and urging her to "stick it out." Frequent Fearmometer ratings helped her acutely experience her anxiety escalate during exposure—cognitively, behaviorally, and physiologically—and then dissipate during habituation, which gave her powerful, tangible feedback about how fears can be extinguished. With repeated practices, these difficult exposures became easier, until she was able to complete them successfully. She and her parents were overjoyed to be able to hug again!

At home, Maria practiced the same exercises she'd completed in session. These exercises were discussed with her parents, so that they could make the time and be encouraging as she tackled her daily practices. She wrote in her diary what she practiced each day and how it went.

Within six sessions, Maria was able to ride the Worry Hill confidently and successfully. Now, it was time for her parents to stop enabling her. With Maria's consent, a "weaning plan" was developed to gradually extricate her mother from her entwinement in her daughter's rituals. In the next two sessions, I coached Maria's parents about how to carry out this plan. They gradually decreased the number of reminders, the physical assistance, and the extra checking they provided for their daughter. When she sought reassurance, they redirected her rather than providing answers reflexively. "Is that you asking, or is it OCD? Do you want us to help you or help the OCD? What do you think you need to do with that OCD thought?" They helped her remember that the uncomfortable feeling would pass if she just waited it out.

When she got distressed, they had to stick it out too, until their own anxiety passed. Maria's parents had to climb their own Worry Hill. It was a good experience for them to be in her shoes briefly and see how hard it can be to withstand anxiety. Although challenging at the beginning, the weaning gradually became easier because it was planned and discussed ahead of time, and Maria had already experienced success with ERP. They celebrated their successes together. After eight weekly sessions of CBT, Maria and her parents reported an 80-percent improvement in her symptoms. OCD worries were now passing thoughts rather than paralyzing fears.

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