A Strategy to Help Kids Stop Intrusive Thoughts

Why ‘Response’ Matters as Much as ‘Exposure’

Living with emetophobia, OCD, or really any anxiety disorder often means spending an extraordinary amount of mental time stuck on a problem. It’s not just a passing worry — it can consume hours of your day, and sometimes linger for weeks, months, or even years.

One of the main goals of treatment is to break free from this painful mental loop. Exposure and Response Prevention (ERP) is one of the most effective tools we have — but it can be difficult to explain to kids and tricky to implement.

ERP Has Two Parts — and Both Are Equally Important

ERP combines two key strategies:

1. Exposure – intentionally facing what you fear.

2. Response Prevention – learning to respond differently to the fear, instead of falling into old patterns.

The “exposure” part tends to get more attention, but how you respond to something triggering is just as crucial. With repeated exposure, the hope is that your distress naturally decreases or tolerance increases over time and usually no new action is required. Rather, it is about stopping previous actions (compulsions/rituals/safety behaviors). It is called response ‘prevention’ after all. But sometimes, especially when intrusive thoughts are involved, it helps to intentionally add a new mental action. This is where care must be taken because it is very easy for any response to become a new compulsion.

The “O” and the “C” in OCD

A simple way to understand ERP is to see how it targets both sides of OCD:

• O = Obsession → the fear, thought, or image that sets off anxiety.

• C = Compulsion → the thing you do to escape, fix, or neutralize the obsession.

Exposure tackles the O by bringing the fear into focus. This primarily involves thoughts and feelings. Response prevention tackles the C by breaking the habit of trying to “fix” the problem. This usually involves behavioral action or stopping certain actions.

And here’s where it gets tricky: compulsions aren’t always physical. Sometimes, they’re mental. You might try to replace a scary thought with a positive one, replay a scenario until it feels “just right,” or neutralize a disturbing image in your mind. For most people, for example, it is relatively easy to understand how to stop a compulsion like hand washing (not easy to do, easy to understand how it can be done). But how do you stop thinking about something? Don’t wash your hands – Don’t think a scary thought – very different things. In addition, paradoxically, the more you try to NOT think of something distressing, the ‘stickier’ the thought becomes.

The “Figure-It-Out” Compulsion

One of the sneakiest compulsions is what is called the “figure-it-out” compulsion. It is an unexpected compulsion because it is disguised by its familiarity. Normally, problem-solving is a healthy, everyday skill — but anxiety hijacks it. It seems like an obvious way to solve the problem…but can be the worst compulsion of all.

The brain gets stuck on a question, and no matter how many hours you spend thinking about it, there’s never a satisfying answer because the O wants certainty! You might find yourself replaying situations, or analyzing every detail in an endless loop, desperate to eliminate doubt. The result is a ferocious urgency to “figure-it-out”.

Telling someone, “Just stop thinking about it,” doesn’t work.

With ERP, the counterintuitive strategy is to do the opposite of what your anxiety urges you to do. For the “figure-it-out” compulsion, that means not solving the problem. You practice letting the question exist without chasing the answer. It’s less about fixing and more about disengaging. Learning an active way to respond to distressing thoughts that is not a safety behavior is an important element of the strategy.

Explaining Response Prevention to Kids

Helping kids understand ERP can be even harder than teaching it to adults. I find most kids grasp the exposure part of the treatment relatively easy. Changing the automatic mental response is more complex. If grown-ups struggle to grasp it — and to put it into practice — you can imagine how tough it is for children.

A How-to Written Guide for Kids

I usually give adults a written guide to explain how to disengage from the mental debate, but when a colleague recently asked how I’d translate it for kids, I decided to create a new resource specifically for them.

I’m still testing it out, so I’d love feedback. If you work with kids, or if you’re a parent navigating OCD or emetophobia, please feel free to use it, adapt it, and make it your own. You can download it here.