What Is ERP Therapy and How Does It Help Children With OCD?
Children with Obsessive-Compulsive Disorder (OCD) often struggle with intense anxiety, intrusive thoughts, and the urge to perform compulsive behaviors to feel better. These repetitive behaviours can be misunderstood as habits. However, they’re driven by overwhelming fear and discomfort.
Exposure and Response Prevention (ERP) Therapy is a mode of Cognitive Behaviour Therapy that helps children break the cycle of OCD and learn healthier ways of coping. This blog will discuss the goals of ERP and how it targets the OCD in children.
How OCD Presents in Children
OCD is a mental health condition characterized by obsessive thoughts and compulsive actions. Obsessions are unwanted, distressing, and often irrational thoughts or urges—while compulsions are the repetitive behaviours or rituals performed to try to reduce the discomfort caused by these thoughts.
Common examples in children might include:
Excessive hand washing due to a fear of germs
Repeated checking to prevent harm to loved ones
An overwhelming need for perfectionism or things to be "just right"
Constant reassurance-seeking or rumination over what-if scenarios
The Goal of ERP Therapy
ERP helps kids confront their fears in a safe and structured way, while learning not to engage in compulsive behaviors that temporarily ease their anxiety but ultimately reinforce the OCD cycle.
There are two main components:
Exposure: The child is gradually and repeatedly exposed to situations or thoughts that trigger their OCD. This could include touching a "contaminated" object or imagining a feared scenario.
Response Prevention: The child is supported in resisting the urge to perform their usual compulsions or ritualistic response. Instead, they learn to sit with the anxiety and allow it to pass naturally, building resilience over time.
Through this process, children learn healthy coping skills and discover that their fears are often exaggerated or unfounded. The goal isn’t to eliminate anxiety altogether but to empower kids to live with uncertainty without being controlled by it.
Examples of How ERP Targets Different Types of OCD
ERP is not a one-size-fits-all therapy—it can be tailored to address the unique manifestations of OCD in each child. Below are some common subtypes and how ERP helps:
1. Contamination
Fear: Germs, dirt, illness
Compulsions: Excessive washing, avoidance of certain objects or places
ERP Approach: Gradual exposure to “contaminated” objects, like touching doorknobs without washing hands, and preventing the excessive hand washing routine.
2. Checking
Fear: Causing harm, making a mistake
Compulsions: Checking locks, appliances, or repeatedly seeking reassurance
ERP Approach: Encouraging the child to avoid checking and learning to tolerate uncertainty about safety or mistakes.
3. Symmetry and Perfectionism
Fear: Things being out of order or not feeling “just right”
Compulsions: Rearranging objects, repeating actions until they feel right
ERP Approach: Deliberately disrupting symmetry or accepting imperfections without fixing them.
4. Harm
Fear: Hurting others or oneself, even unintentionally
Compulsions: Mental checking, avoidance, rumination
ERP Approach: Imaginal exposures to feared scenarios and resisting the urge to mentally review or seek reassurance.
5. Religious or Moral (Scrupulosity)
Fear: Being sinful or morally wrong
Compulsions: Excessive praying, confessing, or moral rumination
ERP Approach: Facing feared thoughts without engaging in unhealthy response or seeking moral certainty.
6. Sexual or Violent Intrusive Thoughts
Fear: Having inappropriate or dangerous urges
Compulsions: Avoidance, reassurance seeking, mental rituals
ERP Approach: Learning to sit with the discomfort of intrusive thoughts without reacting to them.
Considering ERP?
ERP therapy offers a proven path to freedom from the distressing grip of obsessions, compulsions, and anxiety. With patience, practice, and professional guidance, kids can learn to face their fears, resist compulsive behaviors, and develop lifelong coping strategies.
If your child is struggling with OCD, don’t wait—reaching out for therapy could be the first step toward lasting change and emotional wellbeing. To learn more, visit this page or book a free consultation with one of our child therapists today.
