Common OCD Treatments and Therapies

OCD, or obsessive-compulsive disorder, is a mental health condition in which children experience persistent, unwanted thoughts and fears that trigger intense anxiety — and feel driven to perform specific rituals or routines in an attempt to relieve it. As parents, we play a crucial role in that process: learning how to support our kids through treatment without accidentally reinforcing the very behaviors we're trying to help them overcome.

For more information on which treatments and therapies have proven most effective — including approaches tailored to children who need additional layers of support — we spoke to Ogechi “Cynthia” Onyeka, PhD, assistant professor in Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine; Madelaine Davidson, LMFT, a licensed marriage and family therapist at The Center for Anxiety and OCD; and Harper Word, a college student at the University of Missouri who also has OCD.

The gold-standard treatment for OCD is a type of CBT specifically known as Exposure and Response Prevention (ERP), “which is the first-line treatment for pediatric OCD,” Dr. Onyeka says.

ERP is considered the most effective first-line therapy for OCD in children, teens, and adults. ERP helps people gradually face the fears, thoughts, or situations that trigger their OCD (exposure) — while “making a choice not to do a compulsive behavior once the anxiety or obsessions have been ‘triggered’” (response prevention). With support from a trained therapist, children practice tolerating uncertainty and discomfort in a structured, gradual, and supportive way. Over time, this helps reduce the power OCD has over their daily life and teaches the brain that anxiety can decrease without them needing to complete rituals or compulsions.

“One of the things that the research has demonstrated is that with the exposure component of CBT, you’re essentially facing your fears,” Dr. Onyeka says. “The earlier that’s introduced in treatment, the quicker we see gains in terms of reduction of obsessive-compulsive symptoms or anxiety symptoms, and improvements in functional impairment, so the ability to do the things you want and need to do. And then, the more time we wait and introduce exposure, we may see helpful outcomes. Since we know that exposure works really well, it’s good to emphasize exposure early and often.”

Some studies also suggest that involving the family in treatment (family-based ERP) can be even more effective than working with the child alone, especially because parents play such an important role in the OCD cycle at home. “One of the main things that we want to emphasize with exposure and response for treatment is to have parents involved, like family-based Exposure and Response Prevention, or family-based CBT,” Dr. Onyeka explains.

What does ERP actually look like?

When a family is meeting with a provider in treatment, one of the first things that will happen is understanding what OCD is, Dr. Onyeka explains. A big part of that is helping the child understand that OCD is not a part of them. To support engagement, therapists may even use creative or developmentally appropriate strategies — like turning exposures into games — and help children “externalize” OCD by giving it a name so the family can work as a team against it rather than feeling overwhelmed by it.

“A lot of times, OCD will attach itself to the things that you value and the things that you like to do, so that you start to internalize the OCD. We externalize it. And for younger kids, a lot of times we frame OCD as a monster, or we give it a name. For example, I had a kiddo that I worked with and the name of their OCD was Doug. Like, ‘That’s Doug, and we don’t like Doug.’ So we externalize Doug and say that Doug is telling you to do these things, but you can be brave, you can boss back Doug, or boss back OCD. So providing psychoeducation about what OCD is and externalizing it is the first step.”

Treatment is always collaborative and begins with a careful understanding of a child’s obsessions and compulsions, daily impact, and how the family may be unintentionally accommodating OCD. Together, the therapist, child, and parent build an exposure hierarchy, which is a list of feared situations ranked from least to most distressing.

Treatment may move through this list in order, but it is also flexible so children can work at a pace that fits their readiness. During exposures, children intentionally face triggers while tracking their anxiety to notice how distress rises and falls over time and how feared outcomes usually don’t happen. Afterward, the therapist helps the child reflect on what they learned, reinforcing that anxiety is tolerable and that they can do difficult things without relying on compulsions.

In this clip, Dr. Onyeka explains more in depth what the process of ERP therapy for childhood OCD can actually look like, including work on exposure hierarchies and the role parents play in reducing family accommodation at home.

What does ERP feel like?

Word describes exposure therapy as one of the most challenging but ultimately effective parts of her treatment for OCD. She shares that while it helped her significantly, it was also emotionally and mentally difficult in the moment. “Exposure therapy definitely helped me, and it was really difficult. It took a lot out of me. It freaked me out, it made me nervous,” she explains.

However, she notes that over time, as she continued the work with her therapist and practiced resisting rituals, she began to notice real change. As she puts it, a key part of progress was learning not to let OCD dictate her daily behaviors. “But as I did it more and more, and I worked with my therapist to avoid doing certain rituals and just not letting it control my every move, I noticed immediate improvement,” she says.

She shares that one of the most difficult compulsions for her to reduce involved repeated checking behaviors at night. “I would have to go and lock my back door maybe like five or six times before I went to bed every night,” she explains. Through exposure work, she gradually reduced this within a few weeks from multiple checks down to a single check, which she describes as a major milestone. Word emphasizes that while exposure work can feel uncomfortable and even distressing at first, staying with that discomfort is what leads to meaningful change over time.

While ERP is the gold-standard, sometimes children may need additional supports alongside their primary OCD treatment to help support progress and symptom management. ERP is under the umbrella of CBT, but CBT can include many other modalities of therapy. CT (cognitive therapy) is another similar modality; however, CT primarily uses a cognitive-based framework that focuses on the present, while CBT (cognitive behavioral therapy) also emphasizes behavior and the actions a client can take to change unhelpful patterns.

Cognitive therapy helps children and teens with OCD notice, understand, and gently challenge unhelpful beliefs that can drive obsessions and compulsions — such as feeling overly responsible for preventing harm or needing things to be perfect. Research shows that combining CT or CBT with ERP can improve outcomes, especially for children who have a harder time recognizing how strongly OCD is influencing their thoughts and behaviors.

Davidson shares a tool she uses specifically with children — metaphors or stories. “One that I really love to do with kids in the cognitive restructuring area is I’m not a fortune teller. So much of our obsessions sound like what-ifs or this is going to happen, and then this is going to happen, and then this is going to happen. We get so stuck in our brain like that, even as adults, but for kids, reminding them that we aren’t magic [is helpful]. I don’t know the future. I can’t tell the future. I’m not a fortune teller. I don’t have that superpower. You don’t have that superpower.”

What does CBT feel like?

Word shares that CBT has been one of the most helpful tools in managing her OCD, especially in learning how to identify and separate intrusive thoughts from her own thinking. “I’ve done a lot of work with my therapist about recognizing what is coming from my brain and what’s coming from OCD brain,” she explains.

She describes how CBT helped her recognize that many of her most distressing thoughts were not reflective of reality, but instead part of OCD patterns. “If I’m thinking that one of my relatives is in danger or somebody’s angry at me, a lot of the time, that’s not actually rational thought. That’s OCD trying to override me. And I think having the tools to recognize when that’s happening has been super helpful because it’s easier to disarm it,” she says.

She also emphasizes that progress is not immediate and that time is a critical part of the healing process. “It’s really, really hard to rush yourself when dealing with OCD, because therapy doesn’t make it go away. It’s kind of always going to be there,” she explains. She adds that meaningful progress often involves setbacks, adjustment, and learning through experience, rather than expecting constant forward movement.

She also reflects on how important it has been to give herself patience during the process, especially as therapy can be emotionally demanding. Rather than pushing for rapid improvement, she learned that allowing space for change actually supports long-term growth.

If you’re wondering how you can help, SPACE is a parent-focused treatment for childhood OCD, anxiety, and related conditions. Unlike traditional therapy where the child is the main participant, SPACE works directly with parents and caregivers.

In this approach, parents learn how to shift the way they respond to their child’s anxiety and OCD symptoms — especially by reducing accommodation. Family accommodation happens when family members unintentionally change routines, participate in rituals, provide repeated reassurance, or help a child avoid anxiety triggers in order to reduce distress in the moment. While these responses usually come from a place of love and wanting to help, they can accidentally keep the OCD cycle going over time. Part of treatment, Dr. Onyeka explains, involves “teaching [the family] about what family accommodation looks like and how it can show up in their family, and slowly but surely reducing those areas where accommodation is happening while you’re engaging in exposure response prevention.”

This is helpful because helping individuals with OCD can sometimes feel like we have to do the polar opposite of what our hearts are telling us, especially as parents. As Davidson tells us, “We love our children. We love our kids. We want them to feel safe, we want them to feel happy, we want them to feel secure. And so we’re going to do a type of accommodation where, ultimately, we don’t know that what we’re doing is actually feeding into that [OCD] cycle and maybe even making us more symptomatic and making it worse in our family. So what SPACE is going to tackle is how to be a support person for your loved one and do that in a way that maybe we’re pulling back on those accommodations. . . . We’re just going to pull back on our behaviors that are feeding into this cycle, and teaching you how to do that in an effective way.”

In this clip, Davidson breaks down what CBT, ERP, and parent-based OCD supports can actually look like for kids and families, including how therapists help children challenge anxious thoughts, tolerate uncertainty, and reduce compulsions over time.

Can therapy be adapted for kids with developmental disabilities or limited communication?

Dr. Onyeka explains that when OCD occurs alongside a developmental disability — or when a child has limited communication — treatment needs to be thoughtfully adapted to match the child’s strengths and abilities. “That’s where we want to use clinical judgment and tailor the approach a little bit more to leverage the strengths of the child and the strength of the family.”

So for children who are very young or nonspeaking, “We won’t emphasize exposures that are more . . . verbally based, or that have a more cognitive load.” Instead, treatment tends to focus more directly on observable behaviors and working with the parents a lot more to help them reduce their accommodating behaviors, which will also help with addressing the OCD and the child. For example, if a child is experiencing contamination OCD but can’t speak about it, the parent can reduce the availability of a certain soap the child uses to wash their hands or put a limit on the amount of time that the child is washing their hands. Or, if the child has to wash their hands right after school or use a certain bathroom and the parent always allows it, they can instead direct the child somewhere else.

Even when a child is able and willing to participate in OCD treatment, Davidson explains that parent involvement is still incredibly important — especially for children with developmental disabilities, limited communication skills, or more complex support needs. In many cases, clinicians may combine direct therapy for the child with parent-focused approaches like SPACE to help families respond to OCD more effectively at home.

“Sometimes, even when there is willingness, we’ll suggest doing something like a SPACE program too,” Davidson explains. “Because if I’m working with your child, and they really want to work on this and get better, but then they’re going back to a home where the parents aren’t sure exactly how to support them, some of that work is getting erased when they go back home and are able to do whatever we were working on in a regular way.”

She explains that one of the biggest goals is helping everyone in the child’s environment respond consistently to OCD. “This is a great way to have an introduction and psychoeducation period for parents,” she says. “So even if your child is doing this work, they’re going back home into an environment where everybody’s on the same team and everybody’s getting the same information.”

Even if a family is not formally participating in a SPACE program, Davidson recommends that parents stay actively involved in treatment whenever possible. “If you have a child with OCD, [it’s important] to have a bit of engagement in the work,” she explains. “Or at least do what we call a parent support session of, ‘Here’s what this looks like, here’s what I am working on, and here’s how you can continue that in your home,’ because that environment is going to be such a critical place for continued learning and continued success.”

Is treatment neurodiversity-affirming?

As you move into the treatment, it can be difficult to work out what is and isn’t neurodiversity-affirming, especially when your child has co-occurring disabilities, such as autism or ADHD. Davidson explains that OCD treatment is not about changing who a child is, what they value, or what they care about, but about helping them separate fear from values so they can live with more freedom and less distress.

“It is absolutely affirming because we gain our freedom back from only living in fear and only making decisions based on what my brain tells me I can and cannot do. . . . We want to have a relationship with our OCD where we’re not at war with it all the time,” she explains. “The nature of OCD is to make our life smaller and smaller and smaller because we want to be safe.” She emphasizes that treatment is not about altering identity or beliefs, including in sensitive areas like religion or personal values. “We’re affirming you, and we don’t want to change you,” she says.

For example, a child may have religious/moral/scrupulosity-themed OCD and a compulsion is praying excessively before they go to sleep at night. “That’s a big one where this conversation comes up,” she says. The individual might feel, “‘This is what I believe in. This is my faith. This is something that is important to me, and I don’t want to challenge it or be okay with doing things that are outside of what I believe in.’”

To that, she says: “Our goal is never, ever, ever to change you. It’s to bring you even closer to your values — the things that you care about and love and believe in — and not decisions that are based on fear. Fear robs us of the ability to make values-based decisions and values-based moves.”

So during exposure work, as in ERP, even though it can feel super scary and uncomfortable, “The whole goal of that is to get us to a point where now I am able to do the things that I love based on a brain that is not just consistently in fight or flight,” she explains. “We actually create such a healthier relationship with ourselves and with our interests and with our values when we understand, ‘This is what I love and what I care about, and this is what I’m scared of.’ Those are two different things, and learning the difference between those things is part of the goal of these types of treatment.”

Dr. Onyeka emphasizes that exposure work can be very challenging for children and families, and it is normal for it to bring up distress, resistance, or even emotional outbursts at times. However, she notes that it’s important not to let OCD “sneak back in” by shifting away from exposure when things feel hard.

She explains that coping skills like breathing or grounding can be helpful, but only when they are used to support exposure, not to replace it. “We want to use those skills to help facilitate exposure and not replace exposure practice,” she explains. In other words, the goal is not to use these tools to avoid anxiety, but to help a child get ready to face it.

Sometimes this might look like briefly using a coping strategy before beginning an exposure, and then continuing with the planned practice rather than stopping altogether. As Dr. Onyeka notes, “We’re giving ourselves some training wheels or scaffolding to still do the approach-oriented behavior.”

She also highlights the risk of safety behaviors, which can feel helpful in the moment but ultimately reinforce anxiety over time. “A safety behavior is literally something that we do to help manage the anxiety in the moment, but we inadvertently learn that we weren’t able to handle the anxiety,” she explains.

For example, if a child feels unable to order at a restaurant unless a parent is holding their hand, they may begin to believe that support is what makes the task possible rather than their own ability to tolerate discomfort. While these behaviors may reduce distress in the short term, Dr. Onyeka emphasizes that the long-term goal is for children to learn, “The way I’m able to do this is because I was able to handle it,” rather than relying on avoidance or external supports. Davidson emphasizes that even when self-care strategies are used during OCD treatment, the goal is not to avoid anxiety, but to support children in staying with it. “The common thread is not, ‘I’m going to do this so aggressively and so much to escape my anxiety,’ she says. “The point of tools is to help us sit with the discomfort. So it’s to aid us in that. We’re not trying to put out the fire as fast as we possibly can. We’re trying to sit in the feeling, and these are going to be aids in allowing us to do that in a way that feels more manageable.”

Sensory and movement strategies

Some children benefit from sensory or body-based strategies during OCD treatment because anxiety doesn’t just show up in thoughts, it shows up in the body.

Sensory and body-based strategies can be helpful supports for children with OCD because they help regulate the nervous system when anxiety is high and bring the body out of a fight-or-flight state. Davidson explains that these tools work because they reconnect a child to their senses and create a sense of safety in the body during moments of distress.

“Something that’s really great with a sensory experience is we’re using our body and our five senses to remind our brain that I am okay. So if I am actually in danger, I’m not going to be able to see, smell, taste, touch, all those things, right? And so when we are doing these sensory experiences, it’s really a great way to remind our brain that I am safe, because truly, our brain feels like it isn’t,” she explains.

These strategies can include sensory input (from things such as textures; temperature changes, like hot or cold things; or comforting objects that feel soft), intense flavors or smells, fidgets, movement and exercise, and breathing practices. Davidson notes that movement can be especially regulating because “if our body can run, we’re not in danger. . . . If our body can walk, we’re not in danger,” and breathing exercises — particularly those that lengthen the exhale — can help activate the body’s calming response system.

Medication can be an important part of OCD treatment for some children, particularly when symptoms are more severe. Davidson explains that medication is not always the first step, but it can play a key role depending on symptom intensity and how much OCD is interfering with daily life.

“Medication for OCD specifically is usually for kiddos with moderate to severe OCD starting off. If the kiddo has mild to moderate OCD, the first-line response would be psychosocial interventions like ERP. For moderate to severe [OCD], a combination of an SSRI [selective serotonin reuptake inhibitor] and ERP is usually the gold standard of treatment there.”

Although commonly referred to as “antidepressants,” serotonin reuptake inhibitors (SRIs) are also considered “anti-OCD” medications because they increase activity of serotonin in brain regions involved in OCD. Response varies from child to child, making individualized care essential.

If your child also has ADHD, clinicians may first focus on treating OCD to better understand how attention and behavioral symptoms change once obsessive thoughts and compulsions are reduced. In some cases, what looks like inattention can improve when OCD symptoms are effectively addressed. When OCD co-occurs with ADHD, additional medications may be considered to support overall functioning.

It’s important to consult with your therapist or OCD specialist as you work with your child on these therapies and strategies, because they could also become compulsive. For example, if a child begins relying on a sensory tool in a rigid or repetitive way to escape discomfort, it can start reinforcing the OCD cycle instead of easing it.

Suppose your child has health OCD: Davidson tells us, “All of a sudden, now we’re using our essential oils to make sure that we can still smell, right? We don’t want to do that. But using them as a tool in our home is really great.”

Learn more tips on supporting children with OCD at home and at school in our article here.