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The Worry Hill - Page 8

Maria agreed that she'd practice this exercise three times daily at home with her parents until she no longer felt any anxiety from reading about hepatitis. She'd end the exercise when her feeling temperature was down to 2 or 3. I reminded Maria and her parents to stay with the assigned task, and not get ahead of themselves—all else should remain the same until we'd collaboratively agreed to proceed.

I then discussed with Maria's parents how they could RALLY (Recognize OCD episodes; Ally with their child; Lead their child to the RIDE; Let go so their child could RIDE on her own; and reward and praise—say Yes, you did it!) for their child. I also set realistic expectations for recovery. Given the urgency for relief, there's often palpable disappointment when parents hear that it may take three to six weeks before their child is appreciably better. Once they understand how treatment works, however, most families realize that recovery is a journey, not a single event. Parents need to know that each child is unique and progress can occur in fits and starts, ups and downs.

In the next session, Maria was ready for the next ERP exercise on the hierarchy. We reviewed her previous ERP experience to prime her for the upcoming one. She then went to the next item on her Fear Ladder: describing the symptoms and causes of hepatitis to her parents. They were surprised at how calmly she could talk about hepatitis, which previously had been a taboo word.

During the next four sessions, Maria slowly but surely tackled each ERP step on her Fear Ladder. The tasks got harder. Using only a limited amount of toilet paper in the bathroom, sitting on the chairs in my office after using the toilet, and hugging her parents after that were the hardest. Although she struggled at times, she was determined and always made it to the top of the Worry Hill and down again.

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