Changing or Delaying OCD Rituals
As the work towards helping your child or teen fight back against obsessive compulsie disorder (OCD) gets underway, many families start to feel hopeful that exposure and prevention response (ERP) can actually work and that their lives might feel a little bit normal once again. However, feelings of hope are also shared with a sense of being overwhelmed by just how many areas of your child’s life are ruled by the OCD. While ERP can be very effective, your child may only want to do 1-2 exposures a day but you know there are far more than just 2 situations, or about 1 hour, when OCD dominates. We wrote this section to provide you with ideas about how to manage the other 23 hours in the day.
The most important and effective tool in your child or teen’s M.A.P. is learning to do ERP as part of his/her Facing my Fears program. For the rest of the time the following 5 tools are also highly useful. These tools can be used alone or in a combination that makes sense for your child’s needs. See the examples below for ideas.
- Change the ritual: This tool is exactly how it sounds. Just because the OCD demands that your child engage in a ritual doesn’t mean your child has to do it the way OCD says. Having your child decide how the ritual gets done can send a powerful message to the OCD that your child will not be bossed about. For example, OCD wants your teen to wash his hands after touching “dirty” items. Your teen isn’t ready to stop washing his hands yet, but he doesn’t have to wash his hands with 3 pumps of soap, 3 rinses and 3 paper towels as OCD says. Instead he can try for 2 pumps, 3 rinses, and 2 paper towels. Or 2, 2, and 2. OR 1 pump, 2 rinses, and 3 towels. Have your teen decide or mix up the number pattern every time. Keep OCD guessing.
- Shorten the ritual: This tool is similar to changing the ritual as above. However, instead of changing the ritual, in this option your child can shorten it. For example, your child’s dressing ritual involves a series of dressing and undressing steps that can last up to 20 minutes to get dressed for the day. You can begin my timing your child to determine the exact time, and then encourage him or her to shorten the dressing time by a set amount each day or week. It’s up to your child by how many minutes and when s/he is ready to shorten further, but it is s/he who is deciding how long it will take and not the OCD.
- Delay the ritual: OCD makes demands and wants it done NOW. However, it can send another powerful message when the child’s actions communication is “yeah, I’ll do it, but I’m doin’ it on my timeline not yours.” Encourage your child to wait a few seconds to as much as a few hours before doing the ritual. The neat thing that happens the longer your child delays, is that the urge to ritualize goes down and sometimes your child may not even feel the need to do the ritual at all! That's a huge success.
- Slow down the ritual: Some children have many rituals spaced closely in time so they feel forced to have to rush through them to get them all done. Unfortunately, this pressure to rush sometimes backfires. This can cause your child to have to go back and re-do the ritual because OCD doubt wiggles it’s way into their brain making them wonder “Did I really get all the soap off?” or “Did I accidentally touch the dirty spot then I left the room?” This slow-down tool allows the child to be more in control with his/her actions by doing rituals in a slower or more deliberate way to prevent the need to go back and re-do rituals. For example, rather than rushing through the house checking the window locks at high speed but then worrying a particular lock was not checked properly and having to return to check not only that lock but to check all the locks, your child does this ritual slowly. And as your child checks, your child might say, “I’m seeing and feeling that this lock is secure.”
- No AIR: This final tool allows for a combination of other tools. It stands for No Avoidance Interaction or Reassurance seeking. Helping your child face his/her fears rather than avoid is critical. Avoidance only serves to increase the power of OCD. In addition, teaching your child not to interact or engage with OCD will help him/her begin to regain some power over what s/he wants to spend his/her time doing. Although it is hard to ignore OCD, given it is such a bully, you can help your child focus on other more fun aspects of his/her life instead. For example, your child might say, “OCD I know you are there trying to make me worry I got poo on my shoe, but my shoes are fine by the door and right now I am playing a game with my sister so I am going to talk and play with her, and not listen to you.” Finally, reducing and eventually eliminating reassurance seeking is another critical tool in managing OCD. Giving your child less and less reassurance allows her to become stronger in managing OCD, thus reducing the power of OCD.
Note: Using these tools can even be fun. Try encouraging your child to pick and choose a tool to try for the day or week and then report back to you on how it went. Or make it a self-competition game so your child tries to use 1 tool as many times as possible in a day, or a particular combination for each day of the week. Various combinations can be created to meet the specific needs of your child. For example, changing and delaying with hand washing, or shortening and changing a touching ritual, or delaying and slowing down an order and symmetry ritual.