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The Worry Hill - Page 4

"Of course, you can only coast down the hill if you first get to the top. Likewise, you can only get past your fears if you face them. You have to stick it out without doing your rituals until the bad feeling goes away. Then you'll see that your fears don't come true. But if you give in to the rituals, it's like rolling backwards down the hill. You don't give yourself a chance to find out that your fears won't come true, even when you don't do rituals."

Maria listened and nodded. She liked riding her bicycle, she said, and it made sense to her.

The key to CBT for contamination fears is learning to accept the difference between unpleasant and dangerous. Maria needed to learn that although she didn't like the "dirty" feeling involved, not washing her hands wasn't calamitous or life-threatening. In any case, she'd never be able to completely avoid the possibility of contamination—germs are everywhere. In short, she needed to learn to live with the discomfort of possible contamination.

"Maria, you may not like the dirty feeling," I explained, "but by touching things and not washing your hands, you'll get used to the feeling. It's just like the cold water in a swimming pool—you don't like it at first, but you get used to it when you stay in it for a while. You'll also learn that your fear of getting hepatitis won't come true." Maria listened thoughtfully, cringing at the mention of not washing her hands, but then nodded to indicate she understood.

Persuasion involves helping children see the necessity for change, the possibility for change, and their innate power to change. Understanding both the costs of OCD to themselves and the benefits of overcoming it convinces children that change is necessary. When I tell stories of other youngsters who've ridden up the Worry Hill, successfully overcoming OCD, children begin to believe that they have the power to do the same thing.

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