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The Worry Hill - Page 10

After the RIDE

Parents and children need to be prepared for the reality that OCD "slips" or relapses can happen, particularly at times of stress and transition. When prepared, they're likely to have an organized and productive response, and less likely to become demoralized. Relapse-recovery training involves having realistic expectations about the future, recognizing the early signs of relapse, keeping things in perspective, and intervening immediately. I helped Maria and her parents think about relapse recovery in the context of the Worry Hill metaphor: "When you fall off your bicycle, you pick yourself up. If you made no attempt to get up, you wouldn't get anywhere. If you want to move on, you get up, dust yourself off, survey the damage, attend to it, and get right back on that bicycle."

Therapy sessions were tapered off to once every other week and then to once a month for the next four months. These booster sessions were described as "tune-ups" for the bicycle ride, to make sure everything was still working well. We focused on nipping OCD symptoms in the bud. Maria and her parents discussed any symptoms that were present, and we'd repeat the ERP process for each of them.

Maria maintained treatment gains well for about a year before she experienced a "slip" at the beginning of the school year, when she began to have obsessive thoughts about getting AIDS. But she was back on track within two weeks, because both she and her parents were prepared for it, knew that times of transition or stress might trigger a relapse, and were prepared to ride up the Worry Hill again without getting unduly demoralized. Maria went through ERP exercises similar to those she undertook about hepatitis a year earlier. Her parents were careful not to enable her this time, and instead of giving her mindless reassurances, challenged her to face her fears and ride the Worry Hill, which she did successfully again.

It's been four years, and Maria is now 15 years old. She's successfully transitioned to high school. She reports occasional symptoms and "quirky" rituals, which she's been able to nip in the bud. She's doing well and looking forward to becoming a journalist when she grows up. She says she'd like to write some articles to tell others how she conquered OCD, to bring hope and optimism to the many children who are still struggling.

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