A peek into OCD therapy at The Little Bird House

At The Little Bird House, we specialise in supporting children and young people living with anxiety, trauma, OCD, tics and neuroinflammation-related difficulties.

When OCD takes hold, it can feel as though it quietly moves into the family home — dictating routines, demanding reassurance, and shrinking a young person’s world.

Two of the most effective approaches we use in our work with OCD are:

• Exposure and Response Prevention (ERP) (we use the updated Inhibitory Learning Model)

• Acceptance and Commitment Therapy (ACT)

  
  

Together, they help children and young people face fears bravely and with deep self awareness, while building long-term resilience and psychological flexibility.

But what does this actually look like in practice?

What does OCD therapy look like at The Little Bird House?

First we build safety and trust whilst exploring their understanding of the interoception and how they experience feelings and emotions in their body. We may do this through talking, games or creatively using a wide range of art materials, all depending on the child and their interests and what they feel they can engage and cope with. This could be face to face or online; and for some young people this may initially need to be shorter 15 minute sessions, a few times a week. We may also safely explores emotional pain and their processing of life experiences and emotions, depending on the child's needs.

When they are at a stage of feeling safe in our therapeutic relationship we begin to focus on the OCD.

OCD works in a predictable cycle:

Trigger → Intrusive thought → Anxiety → Compulsion → Temporary relief → Stronger OCD next time

In therapy, we gently interrupt that cycle, facing the fears, reducing the rituals and understanding their physical and emotional reactions and awareness.

ERP helps children gradually face feared situations, create new neuro learning pathways around these fears while resisting the urge to complete compulsions.

This might mean:

• Touching something “contaminated” and not washing

• Leaving the house without checking repeatedly

• Saying a feared word

• Going to school despite intrusive worries

We create a “bravery ladder” together — starting small and building confidence step by step.

The goal is not to eliminate anxiety.

The goal is for the child to discover and be curious about how

• Anxiety rises

• Anxiety peaks

• Anxiety falls

• They can cope

• The feared catastrophe does not happen

Over time, the brain learns that the alarm signal was false.

ACT: Changing the Relationship with Anxiety

While ERP focuses on behaviour, ACT strengthens mindset and psychological flexibility

In sessions, we might:

• Externalise OCD as “the bossy brain”

• Practice noticing thoughts without arguing with them

• Learn how to make space for uncomfortable feelings

• Explore what truly matters to the young person

Instead of fighting thoughts like:

“What if I make someone sick?”

We practice:

“I’m noticing my brain is sending me a worry story.”

ACT helps children learn:

• Thoughts are not threats

• Feelings are uncomfortable but survivable

• They can choose actions based on values, not fear

This is especially important for children who also experience trauma histories, tics, or neuroinflammatory symptoms, where the nervous system may already feel hypervigilant and alert.

This little story is shared with permission and with a different name

Elsie aged 11

Elsie developed contamination OCD following a severe stomach virus that affected several family members. She began washing her hands repeatedly, avoiding school toilets, and asking her parents daily:

“Are you sure I won’t get sick?”

Her parents understandably reassured her — but the reassurance gradually increased to dozens of times per day, building into the night where Elsie couldn't get to sleep unless she had showered for a couple of hours. Her hands and body were red raw, her hair started to fall out.

In Therapy

After initially meeting twice a week for shorter sessions to build safety and trust for about 6 weeks, we then began to focus on her OCD. We mapped the OCD cycle so Elsie could see how the washing was keeping the fear alive.

We created a bravery ladder:

• Touch bedroom door handle without washing

• Touch kitchen counter

• Touch sink in bathroom

• Touch plate of with food on

• Delay showering

  
  

Alongside this, we used child friendly ACT skills to help and empower her to:

• Notice the “sicky story” her brain was telling

• Be aware of what her brain was warning her of.

• Discover how brave she could be when she felt the anxiety and the stories her brain was being ?”

• Connect with her values and who she wants to be in that moment

  
  
  
  

Instead of washing immediately, she practiced saying:

“Thanks brain — I’m choosing brave.”

Her parents learned how to gently step back from reassurance and praise her effort rather than calming her fear.

And initially her anxiety initially spiked — which we had prepared for.

Then:

• The washing reduced

• School attendance improved

• Reassurance dropped significantly

• Elsie felt proud of herself

Most importantly, Elsie learned she could handle uncertainty.

A few tips for how parents can support the work at home- we don't expect you to become therapists — but your role is incredibly powerful.

1. Gradually Reduce Reassurance

Instead of:

“No, you definitely won’t get ill.”

Try:

“That sounds like OCD talking. What’s your brave choice?”

Warmth + consistency is key.

2. Step Out of Rituals

OCD often recruits parents into:

• Checking

• Cleaning

• Repeating answers

• Avoiding places

With guidance, we reduce this gradually and safely.

3. Praise Courage

Notice and reinforce:

• Effort

• Willingness

• Sitting with discomfort

• Attempts — even if imperfect

Bravery grows where it is noticed.

4. Model Tolerance of Uncertainty

Children watch how adults handle “not knowing.”

Phrases like:

• “Maybe, maybe not.”

• “We can’t be 100% sure.”

• “We’ll handle it if it happens.”

help build resilience.

Therapy is always paced carefully and compassionately. We consider trust, regulation, safety, and the wider picture — not just symptom reduction.

OCD rarely exists in isolation. Understanding the whole child matters.

Progress is rarely linear.

You may see:

• Initial anxiety increases

• Pushback or frustration

• Gradual reduction in rituals

• Faster recovery after triggers

• Increased independence

The aim is not zero anxiety.

The aim is a child who can say:

“I feel anxious — and I can handle it.”

If your child is struggling with OCD, you are not alone — and neither are they.

With structured ERP, the flexibility-building skills of ACT, and consistent support at home, meaningful change is possible.

At The Little Bird House, we believe children are far more than their fears.

With the right support, they can learn to live alongside uncertainty — and still spread their wings.