My son is fearful of doing certain things for fear of something bad happening. His therapist says he has magical thinking OCD. What is this?

Children (and adults) who have magical thinking OCD become preoccupied with lucky or unlucky numbers, symmetry, cleanliness, colours, words, actions, objects, certain people, religion, or superstitions and link these to “bad things” happening.

My son will not touch objects handled by certain others because he thinks this will bring harm to our family. He also thinks others will contaminate him, even if they don’t touch him. And if he doesn’t shower afterwards, and when OCD tells him to, he thinks something bad will happen.

Magical thinking is based on irrational thinking. By not touching an object for example your son perceives this as “preventing” harm.  Magical thinking is also called thought-action fusion. There are two elements with this. These are moral thought-action fusion (Moral TAF) and likelihood thought-action fusion (likelihood TAF)*. The first makes a child (or adult) believe a certain emotion is real. for example, feeling guilt or shame for  a perceived wrongdoing, or thinking they’ve spread germs and feeling responsible for that. Yet, what they believe is actually based on feelings not facts. Likelihood TAF on the other hand is where a child believes a “bad thing” is more likely to happen simply because they had a thought about it; or because they didn’t do what OCD wanted.

What’s the solution?

First, avoiding touching objects is a compulsion. Your child does this avoidance behaviour to counter his fears and to relieve anxiety momentarily. However, it is the compulsions that strengthen the obsessions and keeps OCD going in a circle. Other compulsions include confessing, seeking reassurance, checking, praying and uttering certain “safety” phrases under one’s breath. The solution therefore is cognitive behavioural therapy (CBT) with exposure response prevention (ERP).

So how does CBT with ERP correct the thinking errors?

First, the cognitive side of therapy helps address thinking errors.

Example: “My friends have dirty habits (thinking error); I feel that they have passed germs to me because I spent time with them and now I feel dirty (faulty belief). I will now have to de-contaminate by showering and washing my clothes (compulsion to relieve anxiety momentarily). If I don’t my mother will die (magical thinking).

New rational interpretation: “Not all my friends have dirty habits; even if they do it doesn’t mean their habits transfer to me or spread germs on to me. This means de-contaminating isn’t required. It also means nothing bad will happen because intrusive thoughts are not real.”

What about the behavioural side, how does this work?

The behavioural side of therapy (ERP) is where a child delays doing their “safety behaviours” (compulsions). When preparing for exposures, a therapist helps a child write out a “magical thinking list” or for an older child this would be called a hierarchy or fear list. Each fear (obsession) on the list is graded in severity on a 0-100 scale. The least distressing fear is faced first (exposure) and the usual behaviours are resisted (response prevention) for an agreed length of time, and until the obsession decreases both in intensity and frequency. They continue like this until all their fears have been faced and each is reduced to around 20-25% on the anxiety scale.

How can I support my child through CBT/ERP?

It’s a good thing to gauge anxiety before, during and after an exposure to help your child monitor progress and set-backs, and making adjustments where needed. For example, if an exposure on his fear list seems too high, he can come down one; or if too low, he can go up one. It’s also important to stand back and give your child leg room. Keeping a few paces back will help him manage anxiety without feeling closed in and he’ll begin to see that this does come down eventually without intervention (see demonstration below). With practice he will see that he is capable of building distress tolerance which will encourage him to continue with his exposures. Occasional supporting comments are helpful, e.g., breathe easy, keep going, nearly there etc. Outside of exposures you can remind your child that the more he practices not giving into compulsions (all compulsions) the less high his anxiety will reach on the distress scale overtime.

anxiety without avoidance

What if my child remains fearful, and continues to believe OCD is keeping him “protected”?

Explain that it can’t ever be certain that nothing bad will happen in life; however, in all the hundreds of years that people have suffered from OCD, there has never been any proof to show that intrusive thoughts make things happen. Why not also visit my OCD Kids Web!

Disclaimer: This article is information-based only. Please consult with your child’s doctor or mental health provider before carrying out suggested exposures.

* Arthur S. Reber

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