It is important to know right from the start of your child's treatment that the specific type of cognitive behavioral therapy for the treatment of OCD is not the same as traditional psychotherapy or what is sometimes called “talk therapy.” Cognitive behavioral therapy was first employed in the treatment of OCD in 1996. The cognitive in cognitive behavioral therapy refers to the thought process behind a person's behavior. In cognitive approaches to therapy, a therapist works to change his client's belief system so that unproductive behaviors will be dropped. The process by which a cognitive therapist tries to change the patient's thoughts in order to change her behavior is sometimes called “reframing.” The word behavioral addresses the actions that result directly from someone's thoughts. If, for example, your child washes her hands six times before dinner, the belief behind her behavior is the mistaken idea that only by excessively washing will she avoid depositing dangerous germs she picked up in the course of her day on her meal.

CBT therapy for OCD goes one step further than simply aiming to change a client's thoughts in order to influence her behavior; using Exposure Response Prevention techniques (ERP), it exposes the OCD sufferer to the things he fears in order to gradually reduce his levels of anxiety.

In this process, OCD sufferers are given exercises where they agree to touch or focus on the things that trigger their anxiety in the form of an obsession. By gradually increasing time and contact with a feared thing or situation, they become habituated to their fear to the point where it no longer causes them the level of discomfort it once did. These structured exposure exercises are the foundation of the type of therapy adults and children with OCD use in order to manage their disorder for life.

For example, many children with OCD experience anxiety when they use public toilets. As a result of this anxiety, a contamination obsession takes over the child's mind whenever she's faced with the possibility of using a toilet outside of the family home. To deal with this particular obsession, CBT treatment involves the child in gradually increased exposures to public toilets. She might first go near a public restroom without actually using it. Next, she might stand next to it for longer periods. Then she might go inside and touch the toilet. Finally, she would use the toilet and do so without compensating with a compulsive prayer or ritual. This process is also called habituation. The goal of a CBT exposure is to give your child both the tools and practice to help her fight back against her OCD by confronting the anxiety behind her OCD in whatever manifestation it may take.

Unlike other forms of therapy, CBT for the treatment of childhood OCD should involve homework in the form of exposure exercises done outside of the therapist's office. With childhood OCD, this homework will necessarily involve one or both of the child's parents. Given the importance of ERP homework, the therapist you choose should be available between weekly appointments to take your phone calls or e-mails in order to answer any questions that may arise in the course of home ERP therapy.