(847) 579- 9317 support@copingpartners.com

Dr. Leigh Weisz 15:34

Right. And I And that’s interesting, because going back to your burglar example, or you didn’t say burglar, but

Dr. Aryn Froum 15:41

yeah, that’s, that’s the idea. The intruder, someone’s

Dr. Leigh Weisz 15:44

gonna break it about safety is like, you know, if you checked one time, I’d be fine. It’s that to me. It seems reasonable, you know, but the person who can’t go to sleep because they’re checking 15 times and then wondering, did they checked and when they checked was it really was it really locked, you know, in doubting themselves? I I never heard that before. I like the disorder.

Dr. Aryn Froum 16:04

This self doubt. And I think I had read that somewhere. Way, way, way back. I tried to cite my sources, as best I can, you know, but that this is something that again, they can’t ever feel sure. Yeah. You know, and something that I also want parents to know, because they they feel guilt, like is this something we did? Or we didn’t do? Right? That I heard this as well, many, many years ago, in relation to bipolar disorder, but it applies here too, for sure. It is not your fault or your child’s fault, right? It is not a choice. Again, they wouldn’t be doing this if they didn’t feel like they had to it is your challenge to overcome together. Right. Right. To work as a family to work with the team with the therapist, a possible psychiatrist, the school if necessary, right? Oh, yeah. So it’s, yeah, it’s a challenge, but no one is to be blamed for it.

Dr. Leigh Weisz 17:09

No, absolutely. Um, so when kids are younger, I’m thinking about toddlers, right? There are a lot of things they do that look a little bit yes, of, you know, neatness and lining things up. I’m curious kind of how do you know when it is more typical rigidity, versus again, a true blown disorder?

Dr. Aryn Froum 17:32

Okay, so thank you for that question. At ages three, or four or so what you just described is pretty typical. And so they especially have kind of rituals, or rigid behaviors, around bedtime, bath time eating, right, like, they don’t want the food to touch on the plate, you know, or they want all of their stuffed animals to be lined up, or their trucks or whatever it is, before they go to bed. Right? Or, you know, I remember this little girl that I saw were ultimately, I did make the diagnosis of OCD, and I’ll get into what else we look for. But where she, you know, at school, and at home, when people were done eating, she had to push all the chairs in at the table, right? That if one was pushed back a little bit or off to the side, that was very anxiety provoking for her. But again, it three and four, you know, it gives a kid a sense of order a sense of control, it’s not necessarily problematic. Right? Right. Okay. So where, you know, the concern arises, and I talk about this for all disorders, as I’m sure you do, too. But the frequency, the intensity, the duration, right? So hot, you know, how many hours are they spending on this? How often is it happening? And then the big piece is distress and impairment.

Dr. Leigh Weisz 19:06

Right? Well with the chairs if it stopped there, right. Oh, so she she likes to tidy up the kitchen. Big deal.

Dr. Aryn Froum 19:12

Yeah. That could actually be a good thing to my house now.

Dr. Leigh Weisz 19:18

But, you know, once it starts to take more of a toll dividual around the family. It sounds like it’s more concerning,

Dr. Aryn Froum 19:26

right. And so the specifics that I give to parents are, you know, as far as the interference with the three R’s, that relationships, responsibilities, like going to school, maybe doing some things around the house and recreational activities. And do the parents feel like it has hijacked the household, like OCD is driving that bus? Do they feel like they’re walking on eggshells? That their child could erupt like a volcano at any moment

Dr. Leigh Weisz 19:59

or Eat. Actually though, that’s interesting Aaron the, the idea that the child that the children can erupt like a volcano or having an outburst. Oftentimes parents will call and distress and say my child has a behavioral disorder, we need help. I’m like, okay, that’s your word. And often it’s not truly a behavioral disorder, but it looks like that when you just for you that tantrum, but like you said, it kind of stems from some of this discomfort internally,

Dr. Aryn Froum 20:27

so much more underneath the surface. Yeah. And you know, that it really is kind of neuro, biological, behavioral, it’s, it’s all of these components, again, nobody’s fault. But it can manifest as, you know, dysregulated sorts of behavior, especially in some younger kids, who can’t find the right words, to explain what’s going on with them. And they feel like they have to do whatever OCD is telling them to do, right. You know, no word about that, to that, you know, as with any disorder, there is a spectrum, like there’s mild, there’s moderate, or severe, you know, and, you know, sometimes, you know, by the time somebody gets to our offices, right, it could be pretty far advanced, right? But other times you catch it early, and you can treat it more quickly.

Dr. Leigh Weisz 21:20

Right? Absolutely. And I’m thinking about how many of these, you know, kind of OCD tendencies that someone has, they have one versus, you know, take hours to do their morning routine, their bedtime routine, you know, all kinds of things getting in the way of function, that that sounds more severe than if I just had one or two,

Dr. Aryn Froum 21:41

or it can more from one thing to another, too. So as soon as we nip something in the bud, it’s a whack a mole. It pops up somewhere else. It doesn’t necessarily have to, there’s just the potential for that. Yeah. Yeah. You know, the other piece that I wanted to talk about, that we sort of touched on briefly, but this is so important, in terms of, okay, when to do something about this professionally, death is when the family is being sucked in to the child’s rituals. So we call this family accommodation. And I’ll just wait until well, I was gonna wait till the end, but I’ll just say it now, in terms of directing people to Le lead, which is work at Yale, I know you have the visual, this book, yes. And his website, space treatment dotnet. And, you know, he has some videos, there some articles. And that’s a good place for parents to start, in terms of okay, is this sort of full fledged OCD? And what do we do about it? So, he has conducted this research now over several years. That’s, that’s actually quite promising. And shows that by reducing the parents accommodation, you know, in the child’s rituals, or you know, that they actually the child can make significant progress. So the whole premise is about parents focusing on changing their own behavior and doing things differently, rather than trying to force the child to do something, right, because they may or may not be willing, right. And so all sorts of ideas popping into my head right now. So I’ll try to keep them straight for you and your listeners. So, you know, he defined support as acceptance of the child’s feelings, and confidence and their ability to handle it. And, you know, you’ll hear me say all the time around here, you know, it’s hard, but I can handle it. Right. It’s tough, but I’m tougher. So bad offer, it’s

Dr. Leigh Weisz 23:58

hard is sort of the supportive part. Yeah, validating, validating, and then, but I can handle it or and I can handle it is, you know, giving them confidence, as opposed to just you know, making it easier in the short term.

Dr. Aryn Froum 24:11

Right, right. And so, Tamar Chansky who wrote Freeing Your Child From Anxiety, and another one Freeing Your Child From OCD, as well as some other books, talks about our role as parents is to spot versus rescue, if you think of gymnastics, you know, to be there to support but not protect, to not swoop in and rescue. Right. So, you know, in terms of some examples of accommodation, yeah. So, all sorts of things. So, I’m thinking of families I’ve worked with over the years, and in one family with a teenager, the mom was doing load after load of laundry because the teenager was insisting that that none of the clothes were acceptable or clean enough, right? And so decreasing cleanliness or germ kind of OCD, right. So you can sort of guess what the parents and I worked on there. Right. And there are so many nuances here, you don’t just rip the rug, right, you know, under, underneath a child, you know. So this

Dr. Leigh Weisz 25:24

mother was doing, you know, a ridiculous amount of laundry, because I’m guessing in the short term, it was easier for her to just do tons of laundry then deal with sort of the emotional consequences for her or her child of not having the clean clothes.

Dr. Aryn Froum 25:40

Yeah, the blow ups, the freak outs. But cheers,

Dr. Leigh Weisz 25:43

ultimately, not really doing her her child a favor.

Dr. Aryn Froum 25:47

Oh, not at all helping with the

Dr. Leigh Weisz 25:48

laundry.

Dr. Aryn Froum 25:49

So and I’ll say I’m gonna give some more examples, because they are interesting, and probably pretty irrelevant, and probably easy.

Dr. Leigh Weisz 25:55

As a parent, I could see getting sucked in pretty quickly and not realizing what you’re doing your extra laundry picked. Yeah. But once it becomes sort of so far gone, then you’re going like, Oh, this isn’t normal that I have to do 12, loads of laundry a day,

Dr. Aryn Froum 26:09

right. And Eli Lebowitz interviews parents about this, and I think some of that’s available on the website, you know, and right, so So something before I give more examples, just to, you know, give people an understanding of why this is problematic, is that when we accommodate, which can be like the example I just gave, where you’re participating in the rituals, or it could be modifying a routine, allowing your child to be late to school or skipping a family get together that’s causing significant anxiety, or the biggie, again, providing reassurance that we’ll talk more about, every time we do those things, we inadvertently send the message to our kids, that you’re right, this is too hard, too scary, too much for you, it validates the worry. So

Dr. Leigh Weisz 27:08

instead of sort of explaining that this is a brain spam or brain track thing, yeah, that is available, you should listen to it more.

Dr. Aryn Froum 27:16

Right? It is. So it’s in this case, you know, it’s the OCD and the child are completely intertwined. Rather than seeing the OCD as externalized is over here is a common enemy to fight against, you’re just giving into it right. And, and it’s kind of like, you know, a band aid, it provides this very temporary, that gets more and more temporary as it goes along, you know, this this relief. And then, you know, OCD comes back even bigger and louder and stronger. Because the more accommodation or reassurance you get, the more you think you need, we talk about reassurance junkies, that they can become addicted to this.

Dr. Leigh Weisz 28:03

Right, right. And again, like you’re feeding the OCD instead of really shrinking it. But But again, in the short term, it’s I’m sure so easy for parents to have no idea they’re doing that. And then until it becomes obvious, in which case, it may be almost, you know, late enough that they’re seeking counseling. Right, right.

Dr. Aryn Froum 28:23

So we could spend like three hours talking about, you know, reducing family accommodation, which is one of those things that parents can do, even before they start more formal treatment. And it’s

Dr. Leigh Weisz 28:37

actually empowering because they don’t really need the child to buy in. At that point. They can do some of the work themselves.

Dr. Aryn Froum 28:44

And they don’t have to reinvent the wheel. Again to reference, you know, Dr. Lebowitz his book, he has, you know, this chart at the back of it, where they can start to identify Whoa, like, where am I getting wrapped up in this? Yeah, yeah. Okay. So some other examples. A family with a teenager, were here was the crossover with sensor with food and OCD, that there was a particular vegetable, that was a huge trigger for him. And so for years, the parents gave up having salad, it family meals, even though they

Dr. Leigh Weisz 29:26

liked it, like even even in his presence, you’re saying yes, like having

Dr. Aryn Froum 29:31

it on the table, having it where it could be seen? would, you know, this kid would just go through the roof, you know, and so you could you could imagine that part of the treatment was gradually reintroducing and I guess we haven’t talked about exposure Response Prevention yet getting a little bit ahead of myself, but I get really excited. This topic.

Dr. Leigh Weisz 29:54

Yeah, no, it sounds like in a way it sounds so basic, which is kind of what’s interesting. But as a parent, right, until you’re sort of explicitly taught my feelings, it’s probably counter intuitive. Surely Can you put the salad on the table? You know, child freaks out? Yeah. I’m just gonna we don’t eat salad tonight no baby, you know, right. So it feels more natural as a parent just to like, we don’t need salad. I’m

Dr. Aryn Froum 30:18

not going to pick my right. It’s not worth it. But But if that

Dr. Leigh Weisz 30:21

happens time after time after time, and she leaves the salad, you know that, then we’re doing him a disservice.

Dr. Aryn Froum 30:28

That’s exactly right. Get another example. And these are somewhat extreme this, this can happen in much subtler forms are. But where I don’t think I referenced this one yet. With again, another teenager, where she believed one of her parents was content, you know, had some sort of contaminant inherently, essentially, and would not allow the parent in her bedroom. Oh, and so this was going on for years. So besides not wanting to have physical contact with the parent, her bedroom was off limits. Wow. Why Harper came on. Yeah. And you know, the bedroom, too. It’s kind of interesting, you know, that sometimes even with just right. OCD, not wanting a parent to come in to straighten up, or anything like that, you know, I mean, that that, again, can be really upsetting for somebody. And so then, okay, so the parent stays out. Yeah, yeah. Oh, oh, my goodness. So I could regale you with examples. But go ahead.

Dr. Leigh Weisz 31:41

No, I mean, I was gonna say, and then there’s a fear, you know, one of them is the fear of like something bad happening. And so I have to do X, Y, or Z chant or ritual to make sure it doesn’t happen. So there’s the safety, I guess, the safety family to

Dr. Aryn Froum 31:55

Yes, yes. You know, right. So, and not know, I mean, that the kids can be very convincing about the bad thing that they think will happen, right? You know, and even if parents know, intellectually, that that is not the case, right? their child’s distress is enough to cause them, you know, to do what the child is, is demanding or insisting, wow, why, but when

Dr. Leigh Weisz 32:23

you’re working with families, you asking them

to sort of track some of these behaviors. Because again, I feel like parents do this automatically, just to kind of like, yes, solve the system and calm the child and probably aren’t aware. But once they become

aware, it probably is easier to address.

Dr. Aryn Froum 32:42

Oh, for sure. I mean, we spend a good deal of time talking about it, because it is one of those things, where, again, we don’t need to even involve the child in that part of it. Because parents can make those decisions on their own. And again, they’re not doing it suddenly or without warning. Right, you know. So referring you back to the book, you know, where he spells out this plan for how to inform your child really writing a letter about what, why the parents are making this new plan because the old way wasn’t working. It was making things worse. They were following OCD use rules, right, right, rather than empowering their child.

Dr. Leigh Weisz 33:28

And it’s a gentler approach than just like starting all the sudden with no warning.

Dr. Aryn Froum 33:33

Right, right. Right. And again, you go gradual, so Okay, the other important part of this, not to belabor the point, but is the reassurance seeking because it is so common, and it can be really sneaky. And so, you know, some examples of that, right? I’m sure you’ve heard this too, with the child asking, am I okay? Will it be okay? Will I get sick or throw up? You? Will something bad happen? Am I dehydrated? You know, that it was my

Dr. Leigh Weisz 34:09

will I be late for a child who hates me? Even though every single day they seem to be firing and turning?

Dr. Aryn Froum 34:15

Yeah. So and, you know, it is something wrong with my breathing. Right? Like, well, I fall on my face and dance. I mean, it could be all sorts of things, you know, or even with the kind of just write it perfectionistic form of OCD, you know, can I stop doing my math homework now? Two hours into it? Oh, no. Right. So, so endless examples and when it comes to, again, one of the, you know, I think easiest things for parents to recognize once we introduced this idea and to do something about is to change or decrease the The reassurance seeking,

Dr. Leigh Weisz 35:02

right or the reassurance giving I guess, I’m sorry, sorry,

Dr. Aryn Froum 35:05

yes. The Giving is a kid seeking. Thank you for catching that.

Dr. Leigh Weisz 35:09

So for sure, yeah. And is there is there I guess the ability to give one one time, really.

Dr. Aryn Froum 35:18

So here’s what I coach parents on, right? Where, again, they’re not going to spring this on the kid, they’re going, I’ll chat about it with the kid, or if I’m just seeing the parents during COVID. Right, and trying to see very young new clients through zoom with OCD was a challenge. So I did a lot of work with the parents who are, you know, when we were all telehealth? And so, having them say, you know, that’s it. And again, some of this comes from other books that are out there. And that it sounds like that’s OCD target, or OCD really wants to know, right, I’m on your side, I want to make you stronger, right and better able to cope with this. Yeah. And this idea of, again, disorder of self doubt. So this is really tough. What I’m about to say, is to listen to your own voice, right? trust what you know, you know the answer,

Dr. Leigh Weisz 36:19

right, but not having the parent give the answer directly,

Dr. Aryn Froum 36:22

right. And there is, you know, I will do one and done, where if a child is totally frantic, right? We can answer the question once, or you can even jot it down, like on a piece of paper or in a notebook, so the child can reference it. Because you’re getting to the ultimate goal of the child not seeking it constantly from the parents. But its babies enough together. Exactly incremental.

Dr. Leigh Weisz 36:51

I’ll sometimes in general with kids, they up, that’s a worry question. You know why it’s asking a question, I believe they really do know the answer to, and or, like you said, just kind of seeking reassurance. And so I’ll say to parents, same thing, like, you know, answer at once? Or if you answer everyday, for the last week, just be like, What do you think, you know, right?

Do you know the answer? It’s just they want that immediate relief? Here? Oh, sure. The parents and feeling more

Dr. Aryn Froum 37:21

secure? Well, and there’s interesting parts of that too, in terms of going gradual, you can abbreviate it, or, you know, if they’re looking for a certain answer, or you can give one word, it doesn’t just have to be one full, you know,

Dr. Leigh Weisz 37:37

reassurance given changing up how your response. So it’s

Dr. Aryn Froum 37:41

all about shortening, delaying, changing, slowing it down being silly when it comes to dealing with the, you know, exposures, right. I was going to

Dr. Leigh Weisz 37:53

ask, so again, parents should not try this at home. But in terms of the exposure and the response prevention, if a parent kind of identifies that they see these behaviors in their kid, and they feel like they’re ready for therapy? Yes, you kind of give a couple examples of what you do in the room, what kinds of work you do not again, that so that they can replicate it. Right? Right? Right. They understand what the child’s work is.

Dr. Aryn Froum 38:19

Yes. And so I always as I’m guessing you do to sit down with one or both or multiple parents first, before meeting with the child. And I even do this with teenagers up to a point and I don’t keep it from that teenager, when I meet with him or her. But to gather background information to set the stage. There’s also this questionnaire that many of us who treat OCD use the CY-BOCS, you know, the Child’s Yale-Brown Obsessive Compulsive Scale, and actually, sometimes that, you know, helps ease the parents distress because they see some of these really extreme or bizarre obsessions or compulsions that they’re not dealing with. Yeah, you know, right. But other times, it’s validating, you know, that’s

Dr. Leigh Weisz 39:11

either way it sounds like that’s a win. Because, again, I’m sure some of the ones that are a little bizarre, they’re even the parents have shame around reporting it, you know, it’s hard,

Dr. Aryn Froum 39:21

right? Or don’t want to really know what this is because they fear the worst, right? We all tend to catastrophize a bit when it comes to our kids. Totally. Okay, so, you know, so I have that session with the parents, and we talk about accommodation, and I explained my treatment approach. And so, when a kid comes in, often times, they do want to be there because they’ve been suffering so much as I alluded to earlier.

Dr. Leigh Weisz 39:49

No, it’s no fun to be having to do what they’re what they feel they have to do.

Dr. Aryn Froum 39:53

Right They are somewhat motivated and willing, versus more of the resistance or stonewalling that you see in other situations. Now you can get some of that the further you go along with exposures, right. So, okay, so I explained to them now we’ll back up a little bit. Oftentimes, the younger kids have not heard the term OCD. And they don’t know what it is. And the parents, even if they’ve suspected it, don’t use that language. And I am generally a proponent of sharing the name of the diagnosis, for normalization for validation for relief that there is a name and a treatment for this, but it depends, right? So there are other words that I’ve used as well. I have said HST habits and sticky thoughts, you know, so, and it also, as far as rhyming, and we’ll get into that a little bit too, for some of the monitors and things they can tell themselves. It’s similar to OCD, you can rhyme a lot with it. But that with teenagers also, that if they’re going to jump on Dr. Google, I want to make sure that they’re going to reputable sites, but more often than not, and earlier on in the treatment than not, I do tend to use that term. For sure. Okay. And so we talk about what it is, is you and I were speaking about, right, the brain trick, the false alarm, the brainstem, the bully, a hiccup, right. So there’s a another well known therapists who treat OCD, who talked about the the scare or the the nonsense message and scary packaging. You know, I mean, that’s kind of what it is that we’re believing what OCD is telling us, but it’s just a glitch. Right. Right. Right. So it’s I say that too, or blip or all sorts of things, right. And helping them see that this is not something that they want to be thinking or doing. Right, OCD is running the show. So again, it’s not me, it’s OCD. And I’m going to talk you through kind of a couple different approaches. Again, feel free to cut me off because I could talk all day about this is great. Okay. So there is this four step process, Aureen Pinto Wagner, who wrote out What To Do When Your Child Has OCD. It was written quite a while ago, and it’s dense, but there’s a lot of good information in there. She she came up with ride our IDE. So you rename what’s going on? You know, we label it, this is OCD. Right? So and then the eye is insist I’m in charge, right? OCD, You’re not the boss of me. And that’s when you can get into the bully, right?

Dr. Leigh Weisz 42:54

I was gonna say that sounds like when I say, you know, this thought is bullying you and you know, what would you say to a bully, right? You wouldn’t just let him or her run the show. So that that’s right.

Dr. Aryn Froum 43:03

And it even more than saying that we draw, we name it, we act it out? We practice it? Right. So, again, for older kids, sometimes I’ll use bully for little little ones. I might use bug. Yeah, like a really annoying bug that’s pestering you. So okay, and then the D. So here is what is key to the treatment of OCD and any anxiety disorder, to quote Patrick McGrath, who is a treat anxiety and OCD in this area and has written a book even about OCD. You know, he says, You can’t think or talk your way out of OCD, you need to be pave your way out of it. And the way you behave your way out of OCD is that the D and ride, do the opposite of what OCD is telling you. That’s the exposure and response prevention, which I guess we haven’t quite named is like the gold standard for training. But you

Dr. Leigh Weisz 44:05

see that once you do x, y, or z or you don’t do right, verzi like the standard doesn’t fall out. Nothing crazy terrible happen, though.

Dr. Aryn Froum 44:14

So hopefully, weaker. Right? And so the ERP is about intentionally doing what OCD is telling you not to do right like, like eat the dirty grape, leave the mess of toys on the floor, say to yourself a write down mom is going to get cancer. I mean, all these things that sounds horrible, but

Dr. Leigh Weisz 44:37

But yeah, I mean, if it’s keeping you in, in the scared place,

Dr. Aryn Froum 44:43

and then you can’t do the ritual that brings you comfort, you are supposed to sit with the anxiety. And there’s been this shift in the understanding of how exposure Response Prevention works in the last several years from kind of this habituation model at all, where we get used to it, and our anxiety subsides, you know, to the inhibitory learning model, where our fear response is inhibited, and we lay down a new neural pathway over it. And we learn that what we expected would happen, actually didn’t happen. And how cool is that? Yeah, right. This was not as bad as scary, as awful as I thought it would be. So it’s a similar process that we’re doing. But there’s a shift in the underlying mechanism as to why or how this works.

Dr. Leigh Weisz 45:39

Right? That’s really interesting.

Dr. Aryn Froum 45:40

Really, yeah. Wow. So and then the E. So otherwise, you just have read, and I guess you want to get rid of OCD, but you can also take it for a ride. The E is when you do these things, when you’re able to stand up to it to boss it back to not engage in the ritual you can eat enjoy your life. Right, because you’re free from OCD. Yeah. Okay, there’s another kind of four step with it. And I integrate both of them, they’re compatible. So and we won’t in this pod cat podcast get into cognitive restructuring, either up, but there is more of a cognitive approach, which is okay, again, you there’s there’s no cute acronym for this one. Where you we label it? Right. So where you step back from it, you know, and see, okay, now let me OCD. And then, you know, use okay, it’s just my brain tricking me again. So I don’t need to listen to what it’s telling me. Right? Then the third step is, which is really true. If you did, you know, if you did nothing with the obsessions, like with, you know, the thought, or the anxiety eventually would pass. So that’s the third step. Right? So the discomfort will pass on its own. Right, if I don’t engage with it, if I don’t feed it, if I don’t fight it, if I just like, let it be, right. So just

Dr. Leigh Weisz 47:06

to get make it go away with such urgency.

Dr. Aryn Froum 47:09

Right, right. So oftentimes, younger kids really like to do the bossing back. Yeah, you know, but there can be more of like this, you know, stepping back sitting back approach, it’s gonna pass on its own, so I don’t need to do the ritual. Right. So thinking of it that way. And then the final step is well, as long as I’m like, hanging out, waiting for the discomfort to pass, I might as well refocus on something I enjoy doing something that’s productive, something that’s fun, that sort of thing. Right, right. So Oh,

Dr. Leigh Weisz 47:46

no, that’s amazing. So, so in your office, maybe one example of a presenting problem a kiddo came in with and some of you know, again, like some of the work that you did with him or her? Sure. So, boy, what to choose,

Dr. Aryn Froum 48:04

there are a whole lot. Well, there are a whole lot of examples. So I can give you I guess, just a few. The other piece I didn’t mention, we didn’t get into the nitty gritty of the treatment. But in meeting with a child in the initial sessions after explaining what OCD is, you talk about how it shows up for them. And so, you know, what’s called a fear hierarchy for adults where you start to list okay, what is it telling you from the, you know, most anxiety provoking thing to the least in terms of what if you, okay, if you, you know, ate your snack after school without washing your hands, right? You know, so that, you know, wherever that would fall for a child, I use a fear thermometer, so they can rate where that would be, you know, and how distressing it would be for them. And once they’ve done all those ratings, and together with the parents, you’ve identified all of the places that OCD is pushing them around you so you can do a fear ladder or bravery ladder from least to most anxiety provoking and then start to intervene with what is less distressing, right,

Dr. Leigh Weisz 49:21

so you’re pushing down but you’re not starting at the you’re not like asking a kid who’s scared to swim just jump in the water. You’re like, right, you’re

Dr. Aryn Froum 49:27

following their lead, because if you start with something that is way too anxiety provoking, they’re gonna balk. No way I’m not doing this right like this, grazie. I rather just live with this, right? No, but also what they’ve learned recently is you don’t necessarily need the ladder, or Lisa was you can do a menu, right? So where you just jot down a whole bunch of these things, and you can you know, rate the distress or not, but that they can they have kind of the power shorter issues. And if you think that they will be in over their heads, you can guide them. But I’ve been doing some more of like the menu approach recently. Wow. So and, you know, examples that come to mind. So many. What one girl in particular, when she was probably at the end of elementary school, had this more interesting contamination fear. She was reading a book, it may have been Little Women, and one of the characters had scarlet fever. And she developed this fear that it was going to kind of how did she sit, like, suck out of the book and into her? Oh, my goodness, yeah, it would keep her up at night. And she would have to wash her hands after reading. And she was supposed to just read for 20 minutes and then turn off the light. But that wasn’t possible. And then even having the book in her room, it was, you know, it was too scary for her at that time. So we did our ladder. Right. And I like to frame it, you know, bravery versus fear. You know, let’s be encouraging and optimistic. And yeah. So, you know, starting out with, Okay, have you looked, she would put the book in a different room, like a wit. So it was nowhere near her. And somehow that was protective. So starting out with the book in the room, and so maybe there was something on top of it, so she couldn’t see it. Right. And once she could feel more comfortable with that, because it’s not getting to know anxiety, we all need some anxiety keeps us safe, it motivates us, right, the goal is never zero. But once it was more tolerable for her, and she learned, okay, like, I don’t have scarlet fever. Right, you know, she could uncover the book. Right? And that it’s also about okay, Can I skip the hand washing part of it? Right. So, you know, something like that. Right. And, you know, humor, by the way, is important here, too, as upsetting as it is for somebody. I mean, especially with any form of OCD, and particularly with the bad thoughts. Yeah, you know, we gotta laugh sometimes. And there are some of the bizarreness of their thoughts and rituals, like, what else can you do? Right, and there was a little girl that I had seen, and she had many manifestations of OCD, you know, and spoiler alert, like, you know, she learned how to manage them and was doing much better, right. But one in particular, was, she developed these fears of being poisoned. And this started to spread to all sorts of things. But I think started, she was out with her family, maybe they were downtown, and they walked by somebody who’s smoking. And all of a sudden, there was some misfiring in her brain, that she could no longer wear the clothes that she had worn that day, because they were contaminated. We’re now poisoned. And actually, she had come home in those clothes and sat on the couch. So now she can’t sit on the couch, because the poison spread to the couch, her shoes. And so in terms of the humor and bossing it back back, you know, and there’s so many ways to boss it back. And you know, so but with OCD, you are I win, you lose, there’s no such thing as haunted shoes. You know, like, that’s what she was able to learn over time.

Dr. Leigh Weisz 53:49

And I can see, by the way, that’s a good example, I could see the parents of that child and it’s causing as much just trust being like, you know what, right, we’ve tried washing it those clothes, clearly your stall, you know, anxious about this, this shirt, let’s just say that you know what, it was $5 or it was a heavy and we’re just gonna talk Yes, yes. Maybe totally just see how easy it would be to think you’re just you’re just being a good parents and like, right,

Dr. Aryn Froum 54:15

I would assume, and I hear you my

Dr. Leigh Weisz 54:19

contract. Yeah. And how it can really take, you know, take a toll if you continue to accommodate, right isn’t that word, but how easy it is. I just have so much empathy for the just like,

Dr. Aryn Froum 54:32

we don’t need that shirt. Thank you for saying that. Yeah, I mean, the compassion for everyone who is going through this

Dr. Leigh Weisz 54:41

is such a painful experience to just imagine, right? How how they’re able to deal with it again, especially without the psychoeducation that you’re providing. Right? So if a parent has never heard of this, the reason or, you know or the accommodation behaviors, they just they wouldn’t know Although it’s not a natural thing to know, in my opinion,

Dr. Aryn Froum 55:02

right, and I also say to parents to try to let go of the guilt they have for not seeing or understanding this sooner and for feeling frustrated with your kid, because sometimes they can really be a pain in the butt. You know, OCD is demand is shouting in their ears, that they need to do this certain thing a certain way

Dr. Leigh Weisz 55:23

makes you late for work, it makes it you know, it sure it takes a toll for sure.

Dr. Aryn Froum 55:28

Right. So, you know, and then just, again, it could go on with the examples. But you know, another one, so this middle schooler with the food triggers, right, where we would just start out saying the name of the particular vegetable, I mean, like with Ellen, you’re just saying salad, and then looking at cartoony pictures of it, right, and then writing it. And then, you know, so before you even get to be anywhere near an actual salad, right, learning to tolerate the discomfort, I mean, you know, treating anxiety is all about getting comfortable with discomfort, getting used to it, and seeing that you can move through it, and it doesn’t have to dominate your life. Right?

Dr. Leigh Weisz 56:15

And even so that you got the cartoon, I’m picturing a cartoon version of like lettuce or whatever. Yeah. So he’s just closing your eyes and imagining that you’re at a table and their salad in front of you, even though

Dr. Aryn Froum 56:24

there’s imaginal. There’s in vivo, you can do scripts, scenarios

Dr. Leigh Weisz 56:31

out in front of that client. And you’re

Dr. Aryn Froum 56:32

right, right. You know, what, we actually didn’t need to get that far. Yeah. So but yeah, I mean, doing things like that. Right. Right, you know, or there was a teenager that I also saw years ago. And she had, again, the whole smorgasbord of kind of OCD manifestations. And one of them was about cancer. And you know, it’s B, can you write the word can you say the word like, hers also had that bizarre quality that made her think she was not, like, if she had the thought that if she points her elbow at someone a certain way they’re gonna get cancer, or that if she exhales, if she does not hold her breath in, when she’s leaving the house to go to school in the morning, she’s going to release all of this negative energy on to the people in the home. So it was really driving her crazy, you know, and so getting more comfortable, you know, who’s sick, like saying the word right, you know, putting her elbow up on purpose, exhaling, breathing 10 times as she’s getting ready to leave the house. And seeing that that terrible, horrible thing doesn’t happen just because you think it doesn’t mean it’s true, or that will happen? I say that,

Dr. Leigh Weisz 58:01

boy, if I could just be a thought, right? That’s the goal. Would everybody

Dr. Aryn Froum 58:05

see a thought as a thought? Not as a warning, a message a prediction, not as truth not as fact not even deserving of your attention,

Dr. Leigh Weisz 58:16

right? For sure. For sure. And it sounds like, you know, the, both the client and the parent really has to be more comfortable allowing the client to face right, these discomfort instead of the void and sort of damage and accommodate, you know, to get around it.

Dr. Aryn Froum 58:36

One of my other favorite quotes by Tamara Chansky remembering is parents. I have to tell myself this. It’s uncomfortable. Not unbearable,

Dr. Leigh Weisz 58:45

right? I see. It’s uncomfortable. not dangerous, but I love it. Yes.

Dr. Aryn Froum 58:49

Anxiety versus danger like that. Yeah, anxiety can feel like danger, right? We’re not going to talk about panic attacks today. But where people truly think they’re having a heart attack, right. But it’s anxiety.

Dr. Leigh Weisz 59:00

Right. And it’s again, it’s also staying calm, right, as a parent when when the child is getting more and more dysregulated as opposed to getting into it with them. Like, we have to do it. Yeah, you know, and kind of get

Dr. Aryn Froum 59:11

eight. All right, so being that calm container. Yeah. Right. So when I think about what can parents do specifically? Yes. So okay, T tolerate their distress, right? Be at least a demore just spoke around here. She talks about in general, let’s be that steady presence. For our teenagers. Our little kids need that too. They need us to be the non anxious presence. Even if we’re freaking out inside. It fuels their fire. If so, that’s okay. And then again, the empathizing, the encouraging the cheering them on. You’re kind of like a cheerleader. Right. You can do these exposures. I believe in you. You’re brave. Right, right. educating yourself about OCD. All right. Don’t forget to give some resources.

Dr. Leigh Weisz 1:00:02

Right. Oh, that that. That was really that was my final question. This has been but yeah, and

Dr. Aryn Froum 1:00:07

let me say something else. So the, because I, there’s a couple of things I don’t want to forget, I’ll do everything myself afterwards if we’re good. Okay. So, you know, like I said, educating, decreasing the accommodations, as we spent a while talking about, and there is a place that you will determine what the therapist for rewards for the exposures, you know, so it’s

Dr. Leigh Weisz 1:00:35

really hard to motivate them to do something, you know, on their on their lap. Yes, it’s okay, to sort of have an incentive, you’re saying

Dr. Aryn Froum 1:00:43

exactly, you know, to sweeten it a little bit to have something to work towards? Because this is hard work? I mean, I’m sort of oversimplifying everything, of course, no, but

Dr. Leigh Weisz 1:00:54

in addition sounds incredibly hard.

Dr. Aryn Froum 1:00:56

Right? You know, and for parents to like, what we would do in our sessions, is you don’t ever ask someone to do an exposure that you’re not willing to do yourself. And so you’re doing these things with them? Right? Like, if it’s touching the bathroom floor, and then eating, like, do we really want to do that? No, but it shows them look, I can do this, too. I’m not asking you to do something that is actually harmful or dangerous. Right? So if the parents part of their work with the therapist, is to do these exposures at home with so that that they need to join in they need to model you No, no, that’s a really good point. So there’s not always a need for that. It just depends on the child or the

Dr. Leigh Weisz 1:01:45

person that you ask someone to do something. Right, that is just clearly by a dangerous, right. There’s not really OCD, it’s just being smart and safe. And you know, again, good anxiety.

Dr. Aryn Froum 1:01:56

Yes, yes. And something that parents need to know about with treating any form of anxiety and OCD is the extinction burst, right? That with anxiety or OCD, that these things can get worse before they get better? Once you start the treatment? Because the kids in it, we’re looking at them like, Well, how could this possibly get worse? What is going on? They’re clinging to what’s familiar, even if it is utterly distressing, and self defeating? Right, right. And so that’s actually usually a sign that they’re about to make some significant progress, right? But you need to ride that storm out and keep cheering and keep encouraging, right? And they will get to the other side,

Dr. Leigh Weisz 1:02:51

right? So the idea that it gets worse before it gets better, or it can’t work,

Dr. Aryn Froum 1:02:55

right, short term pain, for long term gain kind of thing, I think. And again, people say Can you cure OCD? No, right. But you can learn to tame it, you can manage it. And there is sometimes a place for medication, but that’s

Dr. Leigh Weisz 1:03:12

what I was gonna ask you is how many I mean, I don’t need like statistics. But how common is it for you to say at some point in the treatment, I think you should have a consultation with a psychiatrist about medication versus, you know, where it just kind of seems that this by itself

Dr. Aryn Froum 1:03:30

does the trick. It kind of depends how much impairment and distress there is by the time they get to me. So I can be fairly conservative when it comes to medication. But it can also be an incredibly helpful resource that everybody deserves to have access to. Right. So if you know, so generally, you know, we start with doing the exposure and the response prevention, right in decreasing the family accommodations. And if we’re not seeing progress, right, a month, and this would be kind of like meeting weekly, which is ideal, right? Right. But a couple months in and the child is still suffering greatly, or now it’s shown up somewhere else, and is really getting in the way like at school. Then I encourage them to at least have a consultation with a psychiatrist. And the medication nowadays is generally an SSRI, selective serotonin reuptake inhibitor, like what you would take for other forms of anxiety or depression, Prozac, Zoloft, Lexapro, and there’s there’s a whole bunch of them. Hmm,

Dr. Leigh Weisz 1:04:43

no, it sounds like if it’s not, you know, in certain cases, it’s necessary to allow them to do the work right, exactly. Like they it’s not that my thumb will make it

Dr. Aryn Froum 1:04:53

go away. No, it kills in skills, right, but it makes their brain more receptive and more will owing to what you were trying to teach them, right? And so if there is tremendous difficulty, even in those first few weeks, maybe I’ll suggest it, but right like that, it can just kind of take the edge off, and make them more able to use the tools that you’re providing and follow through on the exposures.

Dr. Leigh Weisz 1:05:22

Right? Absolutely. I mean, this is beyond, it’s so helpful, just to hear, I hope, so I feel like it was all over the place. I was gonna say, before we move on to resources, if there’s anything else that I didn’t ask about that you feel like parents should know, again, and sort of intro intro to treatment of OCD and kids. Very interesting.

Dr. Aryn Froum 1:05:45

Okay. You know, I guess this is sort of like a public service announcement. But I’m sure that you have heard people say, I’m so OCD. And as somebody who works with people who truly have it, and have heard from them, how much that upsets them. I encourage people to pause and be mindful of the language that they use, right? So just because you like things neat and clean and organized, does not mean you have OCD, it dismisses the distress the people who truly do have it experience.

Dr. Leigh Weisz 1:06:21

No, that makes so much sense that it’s minimizing the pain that someone actually feels who’s actually, you know, legitimately going through going through so good, it’s good for everyone to be mindful of the words they use for sure. And that it takes a team? Yes, yes, you’re like, so powerful. You can’t, you can’t just on your own, sort of treat this. And you can certainly read books, and this helps. But it’s gotten to a point where you really feel like your child actually has OCD as opposed to like, you know, one time that Z or something, that it’s time to really consult a professional.

Dr. Aryn Froum 1:06:58

Right. And so, you know, just to clarify to a person might simply just have just right OCD, without the other types. And there are many more types that we didn’t get into today, like hoarding, and but among kids, at least in my practice, and the practice of my colleagues around here, it’s often germs contamination, just write symmetry. evenness are the bad thoughts. Yeah. Yeah, absolutely.

Dr. Leigh Weisz 1:07:29

Absolutely. So I was gonna show, so the monster that I really love and actually, so this is Don Huebner is What To Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCD. And I love this because of the metaphors you use is kind of like what we were alluding to. It just seems so much easier to comprehend. Even if you’re a five year old, six year old, you know, like you really get what’s happening in your brain in a way that’s really concrete and understandable. And also how to help it. It’s also kind of an uplifting with pictures. And

Dr. Aryn Froum 1:08:03

yes, and all her books are good. By the way. One thing I encourage parents to do with their kids, especially during the telehealth days, yeah, that that was something concrete that they could do together and really joined forces who know against OCD,

Dr. Leigh Weisz 1:08:19

totally. And then, as you refer to Eli Lebowitz his books, he’s got many but breaking free of child and child anxiety and OCD is one. And then I was going to ask you for other resources, whether they’re websites or podcast that parents can can looking

Dr. Aryn Froum 1:08:35

at. Okay, so there is the iocdf.org, the International OCD Foundation, wonderful resources, adaa.org, Anxiety and Depression Association of America. And there is a podcast, I think there are multiple podcasts, but there’s one that really has more of adult stories of parents just kind of wanting to educate themselves, or if they wonder if they’re struggling with this, there is a strong genetic component so it is possible or maybe a subclinical milder form. It’s called the OCD stories. Okay. And so, I also as I had mentioned, tomorrow, chance skis work, bring your child from anxiety, and then there’s one about OCD but in her general anxiety one, there is a section on OCD. That’s been a very helpful resource to me for many, many years. And Aureen Pinto Wagner’s book that What To Do When Your Child Has OCD that I had mentioned before. And there’s also one for teenagers and again, there are many books out there. Like it’s even in the last 10 or 15 years, which is exciting. This is called Stuff That’s Loud: A Teen’s Guide to Unspiraling When OCD Gets Noisy bye Ben Sedley and Lisa Coyne. That’s great.

Dr. Leigh Weisz 1:10:03

I love that there’s that it’s for written fourteens.

Dr. Aryn Froum 1:10:07

Yeah. And John March’s book from years back. Yeah, Talking Back To OCD. So, you know, a lot of good one too. But the parents aren’t alone in this. There is in they can see on the website. There’s there’s a huge community here. And and I guess one more thing I’ll say or is the kids and teenagers that I have worked with over the years, who come here with OCD tend to be so kind and conscientious and hard working, you know, that that they are struggling tremendously, but who they are at their core is, is so lovely and so optimistic, right? And when they can get on board with the treatment, and they have the support of their family, they can really make great strides. It’s a privilege to be able to do this work. Right?

Dr. Leigh Weisz 1:11:10

Well, we’re very lucky to have you in our area to refer to,

Dr. Aryn Froum 1:11:16

like I say the same to you.

Dr. Leigh Weisz 1:11:19

But to hear this niche is very, very special. And indeed sadly so we’re glad to be able to send people to the best. And again, I just wanted to thank you so much for your time for your expertise, and for sharing with with our audience. And everyone. My pleasure. Thank you and everyone, please check out more episodes of our podcast, go to copingpartners.com and click on podcast and article and thank you as always for tuning in.

Outro 1:11:51

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