Enhancing Quality in
School Mental Health

Treatment Techniques for Students

Individuals with OCD often feel embarrassed or guilty about their symptoms of OCD. The first priority as a therapist should be to help the student identify OCD, and not themselves, as the problem. Therapists should also encourage caregivers to not label OCD behavior as bad or inappropriate, as this only continues the cycle of shame.
After the student identifies OCD as the problem, the therapist should clearly define his or her role as a “coach” who helps the student confront OCD. The therapist then explains the rationale behind exposure and response prevention.
In session, the therapist encourages the student to discuss and rate his or her fears. Once the therapist knows the student’s fears, the therapist can guide the student in creating a hierarchy of fears. The student then chooses the targets to which he or she will be exposed during the treatment.
Research recommends using a visual tool, such as a “fear thermometer,” to help students measure their anxiety. A visual tool enables the student to recognize that different fears evoke different responses; this, in turn, encourages the student to develop a more realistic outlook toward each of the fears.
Therapists typically use two forms of exposure during the treatment process: imaginal and in vivo. Imaginal exposure includes images or ideas associated with the student’s known fear, while in vivo exposure includes physically presenting the known fear.
Therapists frequently model the desired response to the student’s fear before beginning the course of exposure. This gives students a repertoire of responses to draw upon when confronted with the fear.
Response prevention constitutes the second half of exposure. For exposure to be successful, the negative reinforcement effect of the behavior or ritual needs to be blocked. For example, a child with fears related to germs must not only touch items that he or she views as filled with germs, but also must refrain from washing or other associated rituals. (continued on reverse)

Exposure and
Response
Prevention are the hallmarks of
effective treatment for OCD

Research suggests that including family members in exposure and response prevention as coaches may enhance student response to treatment for OCD.
Renshaw, K.D., Steketee, G., & Chambless, D. (2005). Involving families members in the treatment of OCD. Cognitive Behavior Therapy, 34(3), 164-175.

Student response to anxiety

Signs of school refusal typically reflect some form of anxiety: separation from a parent; test performance; bullying; lack of peer acceptance; obsessions or compulsions.
The child or adolescent displays a variety of behaviors in order to avoid going to school: temper tantrums, body aches or sickness. A transition may precede the onset of school refusal; the transition can be major (e.g. divorce, new school, death of a loved one) or quite common (e.g. long weekend, vacation, poor subject area).
Students who display symptoms of school refusal have lower levels of academic performance, develop more disruptive behaviors, are more likely to develop depression, and exhibit higher levels of anxiety. The following list provides some ideas for what clinicians can do to help students with school refusal problems:
Learn more about the home environment to see if recent transitions relate to the pattern of school refusal.
Consider other diagnoses that could account for potential barriers to learning, such as dyslexia, ADHD, hearing and vision impairments, anxiety, etc.
Work with caregivers to establish an incentive system for attending school on a regular basis.
The longer the student is out of school, the harder it will be to get them re-engaged.
Wimmer, M.B. (2004). Information for educators. National Association of School Psychologists. Retrieved March 13, 2006 from http://www.childswork.com/default.aspx?M=a&index=1224&cat=17.

Treatment Techniques (Continued)

Before the student begins exposure, though, the therapist teaches the student how to “talk back” to OCD by using constructive self-talk and relaxation techniques.
Modeling and imaginal exposure provides an opportunity for the therapist to show the student how to talk more positively and realistically about a situation in order to successfully confront the fear. In addition, the therapist can teach students progressive muscle relaxation and deep breathing as a way to ward against negative thoughts, which may trigger compulsive behavior.
The therapist not only empowers the student to confront his or her fear, but also equips the student with alternative coping strategies. By drawing on both cognitive and behavioral techniques, the therapist arms students with a variety of tools with which to confront OCD.
This type of therapy has been shown to be the most effective way to treat OCD, far and above any other type of therapy.
References
March, J.S., & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavioral treatment manual . New York: Guilford Press.
March, J.S., Franklin, M.., Nelson, A., & Foa, E.B. (2000). Cognitive-behavioral psychotherapy for pediatric obsessive compulsive disorder. Journal of Clinical Child Psychology, 30 (1), 8-18.