67.4 WHEN DO I GET TO TOUCH THE DIRTY TOILET SEAT AND OTHER FUN EXPOSURES: TIPS FOR CLINICIANS

Abstract

Clinical experience teaches that few, if any, children presenting with OCD or any anxiety disorder enter therapy eagerly wishing to confront their fears. Young patients rarely ask questions like, “When do I get to touch the dirty toilet seat?” Instead, they demonstrate expected levels of avoidance. Research on inhibitory learning indicates that the key elements in successful exposure are decreasing emotionally driven behaviors such as avoidance, as well as reinforcing new approach behaviors that enable greater tolerance for anxiety. A previous study noted that the key element in psychotherapy is engaging patients’ willingness to change. Gamelike and fun exposures increase treatment engagement, propel motivation, and consequently foster greater willingness. Humor, fun, and silliness when implementing exposures make the tasks more appealing. Exposure therapy is a powerful yet underused treatment method. Some research indicates that the utilization rate of exposure matches or is less than the use of nonevidence-based, questionable clinical practices in treatment-as-usual community settings. This presentation aims to increase child psychiatrists’ skills in crafting fun and engaging exposures with children and adolescents. Accordingly, the session is entirely consistent with the conference themes emphasizing translational science to enhance the quality of patient care and training and build excellent service delivery systems.