Kids with OCD and/or Anxiety | FAQs w/ Dr. Chad Brandt

ocd anxiety in kids
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Kids with OCD and/or Anxiety

Here is all the information from my interview with Dr. Chad Brandt. I’m including the resources he shared, his contact information, and the video if you wish to re-watch it. Also, the interview is transcribed below for hearing impaired readers.



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Dr. Brandt is a clinical psychologist at the McLean OCD Institute of Houston. He specializes in moderate to extreme cases of OCD and anxiety in children, adolescents and adults. If you have any questions for Dr. Brandt, he encourages you to reach out to him at [email protected] or see his website at www.DrChadBrandt.com  

Dr. Brandt offers teletherapy via phone or HIPAA-compliant video software for Texas residents who do not live in the Houston area. During the COVID-19 pandemic there may be options to do teletherapy in other states or countries as well. Contact Dr. Brandt to learn more.


Note: The transcription has not been edited; please email me if you have questions. Sometimes my transcription service types in weird things, but I should be able to figure it out.

FAQ about Kids with Anxiety and OCD

LL: Yeah. All right, well welcome everyone. For those of you who are tuning in, looks like we have a few dozen people on already. If you know me, I’m Lisa Lightner with a day in our shoes and don’t IEP alone, although we’re not going to be talking about too much IEP specific stuff too. Today we are going to be talking about a couple of issues related to our kids. specifically OCD and anxiety with me today is dr Chad Brandt from Houston, Texas. he’s a clinical psychologist at the McLean OCD Institute in Houston right now. He is doing, you know, they’re still on, semi locked down in Texas too, and he’s doing telehealth appointments and runs a clinic there. And why don’t you tell us a little bit more about yourself and what you do.

ocd anxiety in kids
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CB: Yes. Thank you very much for having me. And thank you everybody that’s jumping in. It’s a pleasure to be here. so I’m a clinical psychologist in Houston, Texas and I specialize in treating OCD and anxiety in children, teens and adults. So I spend a good portion of my day with, with kids and teens. so all of my training was all rooted in anxiety disorder. and then I hopped around it in some substance use work for a while. I did some chronic health issue work for awhile and my, my last, golly, I guess three years now has been really focused in on just just OCD. so the McClean OCD Institute of Houston, we’re one of a handful of residential OCD programs. Like I was saying in the country. So we’ll see the, I’ll see like mild and moderate cases of OCD and anxiety, but also see the extreme in the severe cases.

CB: So the people that take 16 hour showers, the people that pray on a loop for hours and hours and hours a day. the people that do really complicated rituals to keep family members alive do and don’t touch certain things. all of that stuff is what I do. so the Corona virus has been very interesting. And in terms of kind of, in a way kind of confirming, I think for some people that germs are real and germs are dangerous, but, but also, you know, it’s, it’s I think good practice in saying, well, yes, germs are real, pandemics are real. and these are the steps I need to take to stay safe and this is how I can continue to live my life. Even in, even in quarantine. I’m kind of like, you’re doing now posted.

LL: Right. So what would you say, what are some misconceptions or things that people, parents particularly don’t know about OCD in children OCD in general Yeah,

CB: that’s a good question. So about 2% of people have OCD, so that’s millions of people. People in the United States, it’s, it’s more common than people think. one thing that’s interesting about OCD is that I think OCD is very, very commonly misdiagnosed and oftentimes by the time a kid gets to me, they will have been diagnosed with two or three or four other things. So OCD can look like ADHD in kids. Sometimes they might be flighty, they might not remember things, they might look like they’re having trouble focusing. It could be ADHD, that could be attention difficulties. It could be that they’re doing a mental ritual that they’re having an intrusive thought, which is, I can talk about more in a second, but they’re having an unwanted thought about germs or about about God or about something else inappropriate and they’re doing something in their head to make the thought go away.

CB: So that might look like ADHD when it’s not. They’re just busy thinking. it can look like a Tourettes or a tic disorder. one common way that OCD will show itself in children is a just right feeling. So a kid who has to put his socks on just right and tries over and over and over and over and over until it feels right. That’s a, we call it a just right OCD thing. And sometimes kids will have little like motions that they do where they do it repeatedly until it feels right. So that looks a lot like a tick. Sometimes it is tick, sometimes, sometimes it blends more into the OCD world. Sometimes they can live together too, which gets a little bit messy. but I think that’s one of the most common misconceptions about OCD is it can look a lot of different ways.

CB: It’s not just about germs and about hand-washing. it can be about a lot more than that. It can and it can really affect a kid. so I can talk a little bit more actually about what OCD is. I should, I should, I should start there. and then I can, it can differentiate a little further. So, so obsessive compulsive disorder, the of OCD stands for obsession. And obsession is an unwanted, usually inappropriate thought that causes anxiety. We could call those intrusive thoughts. is this dirty Am I going to kill my mom in the middle of the night Even though, even though I don’t want to, what if I offended God What if I’m a bad person What if I coughed on us Somebody in school and they dive coronavirus those are all examples of intrusive thoughts. They’re normally uncomfortable and unwanted. that’s the OCD.

CB: And then you’ve got the C of OCD. So the compulsion, that’s the thing we do to make the thought go away. So that could be hand-washing, right Oh no, I’m having a thought about germs and getting sick. So I wash my hands. That could be praying or no, I thought I just offended God. I need to ask for forgiveness over and over. That could doing something until it feels right or until somebody feels safe. so, so OCD can look a lot of different ways. All intrusive thoughts are normally pretty taboo. They’re normally unwanted. They’re normal about sex, harm, harm coming to somebody, harm coming to oneself. so kids, a lot of times if they’re having intrusive thoughts, we’ll hide them. We’ll hold them in. cause they know the thought isn’t like appropriate or good and they’re sometimes afraid to tell somebody about it and then they’ll struggle with it internally. so sometimes kids will hold onto their OCD really close and not tell people and it’ll kind of pop out. And some of the ways I was mentioning, so it might look like they’re not paying attention when really they’re doing a ritual or it might look like they’re, you know, having a tick when in reality they’re there. They’re again doing some kind of ritual. so that’s some of the, the ins and outs of how it can be difficult to understand OCD, especially in kids and they have trouble talking about it.

LL: Okay. So when you and I chatted for a couple of minutes before we started this, and I said, I know in my experience that, you know, in these things, ADHD rarely travels alone. Anxiety rarely travels alone. I mean, I don’t think I know, I don’t think I know one child who has just one condition, they almost always have something comorbid. So what are some of the common Co morbid conditions and how do you piece that out and how do you evaluate that It is OCD and not ADHD or anxiety or something else.

CB: Yeah, that’s a good question. That’s a good question. So some of the things that most commonly come with with OCD, there’s a family of, of OCD type, disorders. So Tourette’s syndrome, your tic disorders, especially in kids, those will run in families, body dysmorphia, body dysmorphic disorder or thinking there’s something wrong with your body is my nose is too big. I got to check my nose. Maybe you need a surgery, maybe we have to push on it. That would fall under the OCD umbrella. That comes a lot with teenagers, boys and girls.

CB: certainly attention difficulties would, would come with OCD. If I’m spending so much time thinking about terrible things happening, it’s hard to pay attention. you could get a lot of worry and I worry and OCD are different, but you can get a lot of worry and if a kid goes untreated or an adult, if anybody goes on untreated with OCD for awhile, they’ll almost always fall into some sort of depression and they might come out of bed and go into it in time. But again, if I’m spending two hours a day showering, instead of talking to my friends, you know, doing afterschool activities or whatever, I’m more likely to feel isolated, and depressed. So in terms of differentiating OCD from, from other things, the, the presence of an intrusive thought, the presence of a thought, that usually doesn’t make much sense.

CB: and the presence of magical thinking is, is very important. when you look at OCD. So that might be a differentiator between worry and OCD. I might worry about, I might worry about getting in a car accident just myself if I were to drive around that would a worry, I’m thinking about something in the future that might happen that is kind of realistic to happen to some degree. And I spend time thinking about it, even when I’m not in the car. That would be a word. OCD would be like an intrusive thought and obsession about getting in a car accident and some ritual to keep myself safe. So every time I think about a car accident I have to tap my left hand three times and that somehow kind of magically keeps everybody safe on the road. So that would be one of the differentiators. And that’s what I look for in kids. A lot of time. Does the talk come back Does it make sense Is it magical

LL: Okay. And what, like is there a magic age or is there an age where you see, more cases kind of manifest themselves Like is it a tween thing, a puberty thing Older kids, you know, is there

CB: OCD, OCD comes, can come very, very early in the life span and can come much later in the lifespan too. So I won’t see any kids younger than five just because at five I can interact with them a little bit. I can give them a handful of tools and the parents more tools to work together at three and four. Nope. You know, we’re running around, we’re doing things. we’re not listening to a therapist, but, but I’ve had parents prove two and three year olds to me or bring a five year old to me who’s had symptoms of OCD since they were two or three of like taking a baby wipe and touching themselves was three times across the body or being able to eat certain foods and not others and being afraid somebody would die if they ate a watermelon for instance. so there are some, some kids that get it really young and then, and then I was sitting. It will sometimes come about during a time of stress. so that would be your transition between elementary and middle or middle and high school can can be a big kind of breaking point where OCD kind of comes through, puberty, college, childbirth, any kind of traumatic event. Some of these things happen later in life so people can really develop OCD from early, early, early childhood into, into pretty early adulthood.

Difference between OCD and ODD

CB: Okay. someone asks is what’s the difference between odd and OCD And she’s been, she says, I’ve been told that OCD can look like odd, but they are very different. Yes. Yes.

CB: Oppositional defiant disorder. Odd. is a child who well, is defiant to, to, to parenting or to rules or to structure. So a kid who just won’t follow the rules, whatever they might be, wouldn’t clean up, wouldn’t listen to the parents and things like that. Normally a kid with those odd is a little, maybe more defiant, is a, is a little more, per potentially angry or kind of dismissive of the parent or the authority figure. A kid with OCD is almost always scared. So the kid might not be listening. If I tell my son, Hey buddy, it’s time to come inside right now and he has to go through a doorway to come inside and he has an OCD concern about doorways. Maybe he thinks if I walk through a doorway in the wrong way, my brother would die. he would be very defiant with me and not wanting to go through the doorway because he would be very scared. He’d be terrified of hurting someone. And so with OCD it would take me coming out and saying, okay, what’s going on How are we feeling How do we handle this So that’s how I might handle and OCT concern. Odd would be a little bit more of here’s the role, here’s the boundaries, here’s the consequences. We can follow the rule now and this happens or we can not follow the rule and this happens. So it’s usually not fear.

OCD and PANS/PANDAS

LL: Okay. does OCD have anything to do with strep levels

CB: that’s a good question. I’m going to get in trouble by answering the question about, about the term pans or pandas. That’s what I figured. Yeah. Yeah, yeah. There is a data that, strep levels can cause some OCD like symptoms in kids. There’s also some data that that’s not the case. So, so the data out there is kind of messy. there is some data that if you take kids with the elevated strip levels and pump them full of antibiotics, they’re OCD symptoms goes, go, go down. That that is true. That happens sometimes. I’ve also worked with kids who’ve had so many different antibiotic regimens with, with no change to their OCD symptoms. what I can tell you about pans and thank you for the question and thank you everybody for the question. but what I can tell you about pans is more than half of kids who have a sudden onset of OCD symptoms at a strep infection will maintain OCD symptoms after the strep has gone.

CB: So you’re likely looking at probably OCD that was built to be there or maybe that was already there that nobody noticed. And then during this time of stress, the OCD kind of popped out and they’re going to have OCD. They just, they just have OCD and the strip was just a kind of a natural stress point where it came out. I think if it was, if, if pans, if it was purely about, you know, the, the antibiotics and the strep and the brain, you would see 80, 90, a hundred percent of kids get better with antibiotics and you don’t see that. So my recommendation for a kid who, who has just been diagnosed with pans or pandas like from a pediatrician, would be to medically take care of it. Get your antibiotics, that’s a good, please don’t avoid antibiotics. but also take your child to a, an OCD specialty therapist, and they can help give you and the kid tools to, to get over the OCD regardless of how much the antibiotics help.

LL: So it can be latent. OCD can kind of be latent in a person and then for whatever reason, they lose coping mechanisms or whatever?

CB: I see OCD. Yeah. You know, I see OCD is like a pattern sometimes. You know, our brains job is to ask a bunch of questions, is it safe Is this dirty Does this cup have germs on it Right. And if I start to take some of those questions too seriously, or I start to, to avoid something like a cup, that fear, I would just produce kind of a fear response. And the more I avoid, the more the fear would build and build and build and build until at some point. there’s just this breaking point where I’m not drinking water out of cups anymore or something like that. So I, I think sometimes those cities, like almost a thinking pattern that we get into that works for a, until kind of hits a hitch and gets caught in a loop and it doesn’t work anymore. And then that’s my job as a therapist. How do we straighten out that loop?

Food Preferences and OCD

LL: Okay. so Jessica asks, how are the food preferences different than ASD, than autism food aversions or sensory food aversions that can be, Oh boy. I could answer that question for an hour and a half. I’ll try not.

CB: OCD can come with a lot of different type of symptoms. So you might have a kid who has an intrusive thought about choking, let’s say. So my obsession is I might choke and the compulsion would be to not eat or the compulsion would be to only drink smoothies or the compulsion would be to not eat certain foods or something like that. So that wouldn’t be a food aversion. Right. That would be a fear. That would be a fear of choking and then the treatment for that would be to have the kid start to eat and take a lot of risks. You might choke, I don’t know. It sounds like your OCT is telling you what you can and you can’t eat. It’d be really nice to eat pizza. Can we practice Can we practice taking a bite of pizza and show the OCD that even though you might choke, Hey, you probably won’t.

CB: And B, you get to eat what you want anyway. so you can get an intrusive thought like about choking or about being poisoned and then you will see a food aversion from that. Or you might have this just right thing, like I was mentioning earlier, a kid who just doesn’t feel right. I only feel right if I put on the right pair of shorts. I only feel right if I eat the right food. I only feel right if I do X, Y, and Z routine in the morning. so that might look a little more similar to some of the food aversions. and assuming there’s not an ASD diagnosis independent, even if there is, you would again practice some kind of exposure therapy and the way I would talk kids through it, I would say, you know, let’s see, let’s see what it really feels like to feel not right. I wonder if we can feel not right and have fun. I wonder if we can do those things at the same time. maybe eat some donuts or eat whatever it is that’s not right and then play a board game or I got video games in my office, I got board games, I got whatever we want. so there’s always this little element of challenging, but it’s important to understand why that there’s the aversion.

Can OCD be turned on and off?

LL: Okay. okay, I’m going to go a couple more questions. And for those of you who are watching, we’re gonna answer these next few questions on OCD and then we’re gonna move into anxiety. so a couple of questions about OCD in school. you know, suggestions for working with the child with OCD and can it be toggled on and off and is it, is it possible that a child would have these issues at home but not at school

CB: Yes. To answer all that is yes. So

CB: kids, I think it’s very important if you have a kid with OCD that a, the kid understands that they have OCD and what that means. And then B, our job is to challenge the kid or challenge the OCD. And we’re doing that because we love them and we think that they’re super tough and we think they can beat OCD and go on and play and have fun and, and live normal lives. So as like an educational therapist, tutor, teacher in any of those things, we wouldn’t want to just the kid to do stuff without telling them some rationale for why this feels like you’re OCD kind of telling you you can’t write or rewrite your letters or something. you know, my job is to show, to, to help you show yourself that you’re super tough and you can do it anyway. So what do you think

CB: Do you think we can do this task and this task together And usually when you present it to a kid in that form, they’re, they’re more likely to go jump in with you, practice with you, try with you a lot of praise, a lot of effort. I really appreciate how hard you’re working. Look at that. You’re doing so great. so, so that would be, something for like teachers and tutors and things to keep in mind. So talk with the parent, talk with the kid. when I work with kids, I’ll, I’ll try really hard to have a conversation with every school counselor and teacher so that the teachers know kind of where the boundaries are. Here’s what we’re working on, here’s what you can do, here’s what you can use and here’s really what we shouldn’t do. So that might be helpful for that in terms of OCD being toggled on and off.

OCD at home but not school.

CB: Oh, absolutely. And in terms of kids having no OCD at school and a lot of OCD at home, that makes a lot of sense. If I’m a kid, if I’m 10, the most important thing to me in the world is that my buddies think I’m cool and it don’t seem weird in front of the other 10 year olds. So at school there’s no way I’m washing my hands and extra time or somebody could see and pointed out and I would get noticed for that. So a lot of times those kids would just like kind of white knuckle through the school day. and then they’ll like hold onto their LC, hold on, it’ll build, build, build, and then it’ll get home and then let it all out and we’ll do a big, big shower or a big, big prayer, a big, big, you know, whatever.

CB: So, so that, that’s really, really, really common. and then in terms of what we would, we would do about something like that, again, I would talk with the parents and the kid, and, and, and have some sort of plan. Is there a way we can challenge here Is there a way we can challenge at home as a teacher, you know, how can, how can I help How can I help you challenge this I think you’re super tough. I think you’re an awesome kid and you can do this and I want to be here to help you kids a little bit up, a lot more that way.

LL: Okay. Marilyn since we skipped over at Marilyn, but we just talked about what to do at school. So hopefully you caught that. and then one more. Who is the best therapist to see for food aversion I don’t know if they mean like specifically like a name or the type of therapist for,

Find a Therapist for OCD

CB: yeah, that’s, it’s, I can, I can, I can answer a couple of ways. in terms of finding, an OCD provider. So a couple things. Any, anybody here, if you want, you can reach out to me. [email protected] is my email. and if you let me know where you’re from. I have resources in a lot of places cause I’ve had residents come from all over the country and the world. So we’re pretty well connected, to OCD providers. I know city providers that also are familiar with ASD and how those things can fit together. so that’s one thing you could reach out to me. you can also go on the international OCD foundation website. I O C D F. Dot org. and the IOC DFE has, find a therapist section. and those are all therapists who’ve had, you know, training in, in, in OCD that that would be able to point you in the right direction.

CB: And I see Jim wrote there type of therapist, type of therapist. If you’re, if you’re looking for OCD treatment, you need one treatment and one treatment only. And that’s called exposure and response prevention or ERP. So that’s based in cognitive behavioral therapy, CBT. It’s also kind of based in act acceptance and commitment therapy. All of these are a lot of acronyms, but you need a therapist who knows ERP. My, my treatment day is probably 90 to 90%, 90 to 95% ERP. and if you’ve got a, if you reach out to a therapist for your kid and they say, Oh yeah, I’ve done ERP before. Oh yeah, like you know, once a week, a couple times a week I’ll do ERP. I would just thank them for their time and find someone who does ERP full time. cause OCD can be very tricky and very squishy.

CB: And if you don’t know, if you don’t get somebody who really knows OCD and how it’s going to try to weasel around on you, it’ll get around you and then you risk, you know, spending a lot of time and effort and money on treatment that isn’t maximally effective. But you also don’t want the kid to think, Oh, well I did treatment. It didn’t work. I, you know, it’s never gonna work for me. I’m broken. I’m different. Like, I never, never want a kid to feel that way. so it’s important to find the right therapist.

LL: Okay. well great. Okay. Cassandra’s question isn’t a nice segue into moving into anxiety cause she lists, you know, she just says you’re talking, you’re also describing symptoms ARFID which I’m unfortunately very familiar with. anxiety, OCD, anxiety, ADHD, you know, SPD, co-morbidity, Cote, morbid, I can’t say it. Comorbid conditions are often hard to separate. so let’s get into anxiety a little bit and then like, so moving into that, how does a parent know when to seek help Like when it’s too much or, you know, when, when is hand washing too much or when should they seek help

Anxiety Disorder in Kids

CB: You know, for any anxiety disorder. Anxiety is the emotion we experience when we anticipate a threat. Fear is the emotion we experience when there’s a real threat in our face. And both of those things are very real and normal and healthy. We should have some anxiety thinking about a test we have to take tomorrow or you know, getting in a car accident or paying our bills. Those things help keep us moving. so anxiety is not bad in and of itself. We should be encouraged to feel it and allow ourselves, feel it and work with it. Anxiety is a problem when it starts to get in the way. When I’m feeling enough anxiety or, or maybe more accurately, I’m avoiding enough that I’m not doing my schoolwork, I’m not interacting with, with my friends anymore, you know, or something like that. in terms of the comorbidities, yeah, I mean if you’ve got that many comorbidities, it’s, it’s good to get in, in assessment from, from a therapist who specializes in this kind of thing. A lot the things like your, your ARFID, your, your OCD or anxiety disorders depending on the kid are treated similarly enough. Some type of exposure therapy, some, some type of desensitization therapy, where we have to practice feeling things we don’t like feeling over and over and over until it gets a little bit easier. but there are differences in these disorders too. So it’s probably the best answer I can give, for something like that.

Anxiety at Bedtime in Kids

LL: okay. Awesome. My own answer there. That’s all right. so anxiety, how can you help We have one child who gets anxious before bedtime. We have another who’s doing some hair pulling and her hair twirling. and another upset when things go wrong. The perfection, the perfectionism.

CB: And I see that the covid concerns are coming up too, which I’m definitely seeing in my practice. so I, there’s a couple things to, to do with this kind of kind of anxiety. so I’ll, maybe I’ll talk about front of ours for a minute cause it’ll be similar to what I would, what I would say anyway. But during coronavirus we’re all in quarantine. While in Texas we’re really not as much anymore, but most of your pain, and, and everybody’s schedule gets messed up. Kids really need structure. Kids really like structure. Even though they push against it, it really helps them. It helps us as adults to, if you’ve got somebody who gets laid off in, in, in their job, in the middle of their working career, there’s so much data that would say if they set themselves a structure of waking up at the same time, getting some exercise, applying for jobs or doing whatever, their mental health really doesn’t change nearly as much as somebody who doesn’t give themselves a structure. So a structure for kids is going to be really, really important. It helps keep them moving instead of getting stuck on their thoughts. now in terms of something like anxiety before bedtime, there’s a, there’s a

CB: way of, of handling sleeping anxiety, where the, the theory is the harder you try to fall asleep, the harder you try to force you to up to sleep, the more awake you’re going to get. And the harder you try to not fall asleep, the sleepier you’re going to get. So I’ve had patients where I’ve told them before, they’re telling me not they’re not sleeping and I’ll just say, you know what I need some more data. I need you to do something for me. Just go home tonight and just whatever you do, try not to sleep, but like lay in your bed, do your normal bedtime routine, no red bulls. just try to try not to fall asleep. Just enjoy your imagination for the whole night. And almost universally the next day they’ll all say, Oh my goodness, this felt great. I just, I slept fantastic.

CB: But then after two or three days, it’ll stop working because they’ll start trying to fall asleep by trying to not fall asleep. Right. So normally anxiety will work that way. The harder we try to kind of run from it, the harder it’ll chase us. And the harder we chase it, the faster it’ll run away. So sometimes an anxiety at bedtime would be about, yeah, I don’t know. I don’t know if we’re going to sleep. Let’s just sit here and enjoy for a minute. I’m enjoying your imagination. Let’s, what happens, and that’s, that might help if a kid has running thoughts. So I see like the hair twirling, pulling trichotillomania excoriation disorder. You know, when we’re anxious we’ll twist or pick our scan or pull our hair. I like a game. I like to play games sometimes with kids that I’ll call thank you brain.

CB: Where, where Well just I’ll just, I’ll tell say to the kid you’ll be you and I’m going to be your brain and I’m going to say a bunch of anxiety things and no matter what I say, you can only say thank you, but that’s the game we’re gonna play right now. And then I’ll just sit there and go, Oh no, I’m never going to fall asleep. What if I never fall asleep What if I don’t go to school tomorrow What if I fail my test cause I didn’t sleep What if everybody gets coronavirus What if they’re going to die And if the kid just says thank you and we can give them enough thoughts like that, then I can just kind of trail off into, I wonder what’s for dinner tomorrow. I really want pizza. No, I want ice cream. And at some point they can recognize, Oh look at that.

CB: If I have a thought and I just let the thought kind of go, the thought actually goes away. It’s the act of trying to stop and figure out and fix every anxious thought that I have. That is really, really important. So you could call that kind of a mindfulness exercise. You could call that self-awareness. but I think it’s just practicing having anxious thoughts and letting them go. It’s okay to have it and it’s okay to not jump into it and figure it out and let it go even though that’s hard. so the hair pulling and stuff is often an anxiety issue. That might be, that might be a way to help with that. If you need a therapist, a referral for the body focused, repetitive behavior, hair pulling, skin picking stuff. Oh goodness. There’s a website and I’m blanking. BFR b.com. I want to say body focused, repetitive behavior is, is the term for that. So there’s another website, that is a list of therapists across States that have gotten training and body focused repetitive behaviors that could help with that. So if that’s helpful, please, please, please reach out and you can, if anybody again wants to email me, I think I see somebody asked for my, my contact info. C Brandt as in Chad [email protected] Again, I’m pretty well connected. I could probably help you find somebody

LL: and I will, I’ll I wrap this up and I’ll put it, I put it on YouTube and I send it out to the mail list and they post it on Facebook and they will have all everything your website, your email address, everything.

CB: perfect. Yeah. Yeah. So you can always reach out to me and hopefully I’m giving you a few other places you can reach out and look to as well. And I see somebody from Canada, my wife’s Canadian.

Anxiety, school refusal and distance learning.

LL: Okay. So I posted something in my own Facebook group the other day and instantly it had, you know, a hundred or 200 Hey me too. Situations and that is I have a child with anxiety and social anxiety and he said he likes quarantine life better. right. He like, of course they do cause there are no demands being put on them. And he says he likes it better. So like I said, instantly like it had 100 or 200. Yeah, me too. Same here. So what can we do for those kids who, you know, don’t want to return to school and they prefer this homeschooling and they prefer being here. Like I said, there are no demands being put on them, you know, and they can, they can finally like exhale.

CB: Yeah. Yeah. That’s a really good question. I think we’re going to run into a lot of that in the fall. Assuming schools reopened in the fall. the, the anxiety is like, it’s, it’s, it’s like your head is, or your mind is like a balloon and anxiety. Your brain is kind of constantly filling it with anxiety. What if I say, what if people judge me What about this What about that Right. So this balloon is constantly failing and it’s up to us to put pressure on the outside by going to school anyway, by doing our project, even though people might judge us by touching the toilet, even though we might get contaminated and die. And what’s happening with the, with, with a quarantine is that the pressure is coming off on the outside, right So the anxiety is filling everybody’s balloon a little bit more.

CB: And then when we think about going back to school, it’s getting that much harder. So I think this is something we will run into. in terms of what to do about it. I would practice a solid month before school starts. Get your kid out of the house, go to Kali. It depends on what’s open, but go to the, go to the mall or the museum or set up play dates again with friends, put them in positions that are maybe a little bit uncomfortable, but certainly doable and potentially fun. anxiety hates fun. I like to have a lot of fun, with my patients. So that might be something that would help you know that you’re going to struggle, know that they’re not going to want to go back to school no matter what. But practicing some of the skills about, having time pressure on you. Again, having social pressure on you again and being able to have fun, succeed, thrive in those environments I think would be really helpful.

Daughter wants to drop out of school due to Anxiety.

LL: Okay. let’s see. Andrea has shared a story. Thank you. She says her child’s have therapy now for OCD. Priscilla daughter wants to drop out of school.

CB: Yeah, sorry to hear that. it depends on the age of, of, of the kid, but one, one thing that, I think is helpful for everybody, kids and adults is to check in with what, what we would say is therapist. Like check in with your values. What are you doing that’s important to you Why are we doing school Right So you might ask your daughter, well, what do you want to do Right What do you want to do with your life I want to be a veterinarian. I love animals, blah, blah, blah. Okay. Okay, well if you want to go be a veterinarian for 40 years and help a hundred million animals and have a ton of fun and all that would be great. You know, you’ve got to do this many more years of school, right I just wonder if it’s worth it. Is it worth it to do this many years of school in order to have this whole many years of something that you would have really liked doing And sometimes if you can touch in with like why we’re doing things, in a way that’s meaningful to the kid. It’s easy for us as adults to say, well, you know, you need money. You need a job. You didn’t get out of my house. I know best I’m the adult you have to go to school. Cause that’s, that’s what,

CB: that’s what the roles are. And those are all true. But to a kid that sometimes I think feels invalidating and they’re like, well no, I’ll be fine. You know, I’m 15, I’ll go get a job at Starbucks and they own a mansion in a couple of years because I’m 15 and don’t have a great concept of money. so giving them more of a reason might be helpful. that’s helpful. And I have to, for Andrea shared a story and I didn’t just have to say how much I love OCD because I’ve, I’ve actually never heard that one before. I’ve heard so many things similar to it, but I’ve never heard that one before. And I love when I hear a new OCD thing, but I think it says a lot about OCD that it’s a constantly spinning, twisting torrent of thoughts that are exactly the same, but you handle them the same anyway.

School Refusal and Anxiety

LL: speaking of school again, what, what treatments or strategies have you found successful in dealing with school refusal as related to anxiety Yes,

CB: the school refusal is, is

LL: fun, isn’t it And it’s on the, it’s on the rise and it is. Yeah, I mean, I’m dealing with so much more than I, like 10 years ago. I don’t even think I ever heard of it. You know, and now it’s everywhere.

CB: Yes. Yes. So it’s a, I think school refusal is a mixture of a couple of things. You’ve got the psychological component underneath that you have to help the kid with, are you anxious How can I help you feel less anxious Right Are you depressed How can we help you to deal with the feelings of depression Do you have OCD How can we do therapy to get rid of the OCD So that’s, that’s always the first thing I think. I think with kids, how do we help with that being said, sometimes I’ll get a kid who’s already refusing school and we don’t have the time to do a month or two of anxiety therapy while they miss school. so you’ve got understanding what’s going on in here, understanding the psychological issue. and then, it’s, it’s a lot of consistencies, a lot of consistent boundaries, consistent rewards, consistent consequences.

CB: You know, depending on the age of the kid, if you go to school, this happens. If you don’t go to school, this happens. We’re not having a big fight about it. I’m not getting in a two hour argument with you about it, but this is what’s going to happen. And then remaining consistent. And that doesn’t have to come in the form of a threat. This is, I love you. School is something we have to do. I also have two other kids and I cannot argue with you two hours a day. So this is, this is now your decision, your 14, this is your decision. But these are the consequences either way. So putting out something consistent and then the hard part is staying consistent as the parent. but usually some consistent boundaries on either end and helping them understand other anxieties or whatever. But a lot of times anxiety is underpinning the score fields on helping them with that, we’ll, we’ll get them moving, but it can be a slow, it can be a slog.

LL: Okay. So what if, and this is, I think this is going to get worse too. As you know, we’re, we’re headed for some real financial woes, I think as a country. a lot of times I think that the peers or whatever you want to call them, issues at school are very much justified and that they’re learning, their learning needs are not being supported, their sensory needs are not being supported. and that’s causing the anxiety.

CB: I think that’s absolutely, absolutely. The truth is hard to do at home.

LL: Yeah. no, well, her daughter is afraid that buildings will fall on her

CB: doll. so you can, you can, I would handle this two ways. If this is like a, and I see, I see down syndrome and ASD. Okay. I didn’t see the down syndrome, so I’m going to change my answer before I, before I give it. Yeah. Okay. Okay. I, this is something that I would, I would deal with, with a lot of reassurance and just slow, gradual introducing the concepts. So we might stand a safe distance away from a two story building, a distance that gives your daughter a, an anxiety level of five out of 10. I’m kinda making this up. I don’t like to give numbers on a guy to usually, but something where, okay, we’re getting close to building, you’re getting a little nervous. We’re also safe. So let’s practice being uncomfortable and hanging out and having fun. That’s a lot of what I would say.

CB: Well, can we do kind of newer building We’re safe, but you’re uncomfortable. But look at you, you’re so tough. I’m so proud of you. Blah, blah, blah, blah, blah. Let’s have some fun. And as you do that over time, you can slowly get closer and closer and closer to one building and then you can start doing it with bigger buildings. But it comes with a lot of support and reinforcement. If we’ve got like down syndrome and ASD, if you’ve got a kid that’s, that’s neuro-typical who’s having the same concerns, I would, I would put a lot more uncertainty into my treatment and I would say, you know, we can never really know. We can never really know if a building’s going to collapse at any point. but, but we have this whole fun life that’s there for you around buildings, you know So I wonder if we could go around these buildings, have some fun, do some stuff, knowing that there’s a point to present chance you would die.

CB: But like a 99.8% chance you’d have a ton of fun and I don’t know, what do you think Is it worth it And sometimes they’ll go with you on that. But I think as parents, sometimes we get in a habit of trying to reassure too often it’s fine, it’s fine, it’s fine. And then the kid says, how do you know it’s fine I’m like, you don’t, you can’t, with perfect certainty, say a building won’t fall over or a car won’t crash or something. So sometimes we help them, we help them into and live with uncertainty. So that might be kind of two ways to handle that.

Behavior Plans and OCD

LL: Okay. how do you make sure that a behavior plan doesn’t reinforce a ritual

CB: yes, it’s a good question. there’s, there’s always a why. There’s always a, there’s always a reason that the OCD is, is, is, attacking, a kid in particular. So, so let’s say there’s a perfectionism thing. This, this might be like a OCD

CB: case. I need to be perfect. If I’m imperfect, nobody will like me. If I’m imperfect, I’m going to die. Somebody is going to die. Something terrible is going to happen. Right And, and so what we’re aiming to do is be imperfect. Yes, sure. But really we’re aiming to kind of take the risk, we’re aiming to challenge the OCD. Can you challenge the OCD and dare the OCD to kill you by being imperfect. Right. And if you, if you keep that underlying concept in mind, it’s, it’s, it’s easy I think to fall, to keep from falling into the OCD traps. But if you, if you just outline like a procedure over and over while like step one is do something in perfectly and just do your homework and perfectly do this and perfectly do that in perfectly, then the kids will find a way to be perfectly imperfect or they’ll delay, they’ll try to be imperfect but still keep everybody alive. So they’ll, they’ll, they’ll, they’ll work around you. Right So understanding the why is, is really, really important with OCD. So, I don’t know if that’s helpful. Reach out to me if you, if, if you want, but yeah, it’s tough. And I think that’s where you need an OCD specialty therapist for something like this. it’s cause it’s, it gets tricky.

LL: Yeah. I’m at Lira, I’m going to skip over your question only because you said your daughter is 20 months old and I think that at 20 months, you know, a lot of it’s normal. Yeah.

CB: A lot of this behavior I’m talking about is normal for two year old or four year old. It’s hard to differentiate. Yeah.

LL: Yeah. And mouthing toys, you know, at 20 months isn’t necessarily abnormal behavior. but we have a couple of questions about perfection, Chisholm and crippling perfectionism that prevents things from getting done. Things are not getting assignments, not getting on time. Tests can’t be completed.

OCD and Perfectionism

CB: Yes, yes. and as you know, I’m, you’re probably going to hear me say the same stuff a couple of times now, but why, why does it have to be perfect That would be something I would want to understand as a therapist. And then I would just want to dare that, that negative belief to come true.

CB: And, and see what happens. So maybe I could use like a contamination example just for the sake of argument, but if somebody had like terrible cup OCD, I’m afraid I might get cancer from the cup, right Or whatever.

CB: typical exposure therapy would be like, okay, get close to the cup, look at a picture of the cup, do this. So the cup, right. And you can do OCT therapy that way, but it’s a long slog. It takes a long time. Sometimes I like to say, well, if you’re ready and if you’re willing, let’s just try to get cancer from the cup. Right. It’s kind of silly. It’s kind of ridiculous. Let’s just try and if you get cancer from the cup while, I’m sorry, you know where to send the lawsuit. but if you don’t get cancer from the cup, maybe we can just move on from the OCD. Right. So I think if we think about that with like a perfectionism thing too, sometimes it comes down to, well, what’s, what, what is the bad thing that could happen And let’s see, let’s try to make it happening, you know, and try to make it happen right now.

CB: You’re, you’re telling me every school assignment has to be perfect or you’re going to fail. Then paradoxically we’re failing because we’re not turning anything in, so let’s try it this other way. and sometimes that’s helpful. Sometimes that breaks them out of the log jam. I, I never argue with a kid or an adult with OCD or anxiety. There’s no, I’m not going to convince you. You’re not going to convince me and I’m not going to convince you that Mrs. Smith is a really hard grader and this problem needs two hours of work. Newborn never going to get through each other. And it’s, sometimes it’s easier to say, well, maybe, maybe she is, I don’t know. Could we try, can we try doing one minute of work instead of a hundred minutes of work and see what happens I, you know, I don’t know. and then sometimes you can get a moving more quickly other than that. But OCD loves a prolonged argument with a parent,

LL: which is great. That is a great segue into Dana’s question, which is what, what advice do you have for parents who are experiencing stress from their child

CB: Oh yeah. So go get your all, go, go find somebody to talk to you. take some time off. Take some time off from, from yourself. From the OCD. From the,

CB: yeah. If we can’t get quarantine.

CB: Yes. Yes. One thing I tell parents a lot of times is OCD just wants to be fed. It’s like a pigeon at a restaurant. You know, if you’ve got this, this, if you’re on an outdoor restaurant, the pigeon comes up and you throw out a French fry. It might take the French for our way for a minute, but it’s going to eat it and it’s going to want another one. It’s going to come back and it’s going to come back and he’s gonna bring his friends and there’s going to be a bunch of pigeons around you before you even know it. so, so the, the trick with OCD is not to give it even one French fry. and the big arguments are French fries and the big discussions or French fries. And the big philosophical discussions are French fries. So I’ll tell parents sometimes it’s okay to say, you know, Finley is my son, you know, Finley, it’s okay dude, I’m so sorry that you’re struggling right now.

CB: And I get that, you know, whatever OCD thing is happening, I get that it’s really stressing you out. But I love you. I really hate your OCD. I don’t want to talk with your OCD. I’m going to go in the other room and when you’re ready I will talk with you about anything in the universe besides fear. The OCD concern we’re stuck on right now cause I love you, but until then, I’m just going to let you work it out and I’m going to be over here and we’ll come together when we’re ready. And sometimes just the separation, right, is fueling for the parent. You get some time to yourself and be, the kid has to work through the problem a little bit on their own, which is usually helpful and come up with a solution and then you guys can come together and talk about something fun or depending on the age of the kiddo I craft or some homework or something. And then you have some nice interactions with each other again, which is really helpful.

LL: okay. Before I want to get into some EF issues, I just want to let you know those who have asked that we’re not going to be making any medication or supplement recommendations today. That’s just, that’s not appropriate to do on Facebook, not having met you or handyman see you, or your child. but Nicole says, can a lack of executive functioning skills contribute to anxiety I would say that’s definitely, yes.

Anxiety and Executive Functioning Issues

CB: Yeah, yeah, absolutely. And then you might look at like, okay, is this an ADHD thing with a lack of executive functioning skills Or is this like a yes D thing Or you know, where are the cognitive or executive functioning skills lack Where’s that coming from In terms of, treatment, but, but the answer is absolutely yes. If it’s hard to think through our problems, if it’s hard to catch and think through our feelings or understand what we’re thinking and feeling at any moment, it’s really easy to get overwhelmed. And when we’re overwhelmed, we make poor choices. We avoid, we get angry and that’s usually starts a cycle that we’ll end up somewhere bad, somewhere unwanted. so that can absolutely be the case and there’s, I don’t have a great resource for that off the top of my head. but I know there are executive functioning like coaches and a lot of therapists have that training

LL: and actually I didn’t, I did not plan this. but next I think next Wednesday, my Facebook live chat I believe is the executive functioning person. She’s an executive functioning coach. if, if not, I mean watch the Facebook page or make sure you’re on my email and you’ll know for sure, but I think it’s next Wednesday at 10. another huge issue for our kids. okay. Can you just quickly address, it looks like maybe we had some late comers to the top, but can you do another maybe two or three minutes on pans and pandas and kind of explain, cause I don’t want to offend any of anyone who’s watching right now. I feel like pans and pandas is being used as a crutch now. I don’t know. I feel like it’s, I feel like it’s like almost like a carrot maybe being dangled that your child has these issues and then I says, Oh, it’s pans and then, you know, don’t take any antibiotics and all your worries go away kind of thing.

PANS/PANDAS

CB: Yeah. I think anything that comes up, not to say that pandas just like came up in the last five years or whatever, but anything that comes up generally people really want to latch onto and grab onto and get to be a part of. So I think there’s maybe some over-diagnosis of it. I have no numbers for that. and I think too, it’s, it’s really, really, if, if my son was struggling, my son was taking a 10 hour shower every day and somebody told me I had a medication that could get rid of it, get everybody out of my way, right. And I would, I would give that to them. so I think there’s a really strong pull into wanting that to be the answer. And sometimes it is. Sometimes that seems to help kids a lot. Sometimes kids get the medication, the OCD symptoms go away.

CB: Life is good and that’s great, but sometimes it doesn’t, right There’s some kids that get your, your the antibiotics and they don’t, it doesn’t show the improvement that they would want. And so it’d be for those kids. And, and I said this earlier and if case everybody missed it, take care of things medically, go to the pediatrician, right. Follow your doctor’s advice. If they say, let’s try to get Biotics, please, please, please try it. Do not say that. I said not to take antibiotics, but if the antibiotics aren’t giving you the relief that you want, there’s therapy that can help with that too. and, and, and you can find a therapist that might be able to do this work or do it in conjunction. I’ve got a number of psychiatrists I work with. I’ve got a number of kids that are on the antibiotics and doing behavioral therapy with me. They’re getting that are getting a lot better.

LL: does, you know, I mean, I know you’re not a pediatrician. Does pans or pandas have a definitive test or is it one of those kind of rule out things where it’s a menu of items and if you check a lot of the boxes

CB: man, I, I at the risk of, of talking outside of my area of competence, you can test for a lot of a lot of things, but there’s, there’s a number of different antibiotics and antibodies and, and, and viruses that you can test for. As far as I know, there’s not like, well this one is pants or like this, we have some data and this is what it would suggest. And then you begin the treatment and you see if it helps. And then again, if the treatment helps, fantastic. Please take it. And if not, there’s behavioral therapy too.

LL: Yeah. Okay. okay. More pans questions. So I think that might be it. It looks like the rest was, was more pants. Oh, Caroline says, what about inflammatory issues or diet Yeah,

CB: it’s not a lot of great data that would say that diet has any impact. there’s, there’s no data, there’s very, very little data that would say anything definitive about any supplements or anything like that. OCD, anxiety can be exacerbated by a medical condition, but regardless of whether or not the condition is there. W we, we still have coping mechanisms. We should be using skills we should be using. so I think it’s still be helpful to find a therapist either way or a professional that could help with that.

Anxiety and Hoarding

LL: Okay. Oh, one more from Amy. She has a little hoarder on her hands already. Eight year old hoarder.

CB: Oh, carrying a bag of stuffed animals. Okay. I have a lot of suggestions. Amy. hoarding. Hoarding is, is really interesting. So you’ve got OCD, which is a fear reaction. And, and the last professional manual that psychology is a science put out, they pulled hoarding separate from OCD. and one of the reasons for that is hoarding tends to come with a grief reaction. like a sadness, I’m losing, I’m losing something kind of reaction. so I would be curious for your, for your daughter, is it more of a fear I’m going to lose something. I’m gonna lose my childhood. I’m, I’m, I’m gonna, I’m gonna be a different person. If I give these things away, that would be more of an OCD concern versus this just feels like a part of me and I’m very sad to be losing it. So that’s kind of one question that, that I would just just have.

CB: but as, as for suggestions, a finding OCD specialty therapist B, start to take some small steps and explain to her why you’re taking them. so this feels like a lot. I’m so sorry. You’re carrying around this big bag and it looks so heavy and over here I’ve got cookies or a board game or something, but it’s hard to play it when your hands are full of this bag. So I wonder if we could start putting it on the bag for a couple of minutes in order to play and have fun. And then if you can get them moving sometimes with that, then you can point out, Oh, look at that. Oh, you put the bag all good for you. How cool is that I wonder if the bag would be a little farther. I wonder if it could be a little more empty.

CB: I wonder if this, I wonder if that, so you’re allowing them to be uncomfortable. You’re putting the discomfort in front of them. You’re not forcing it on them. You know, I’m taking it away right now so you can learn. That’s just a meltdown that will kind of work in the longterm, but it will be a lot of meltdowns. it’s, it’s just an opportunity to see and a lot of praise, a lot of, Oh look how great you are. Look, look how, look how strong you are. I’m so proud of you. That kind of stuff goes a long way.

LL: Okay. Kate, we, if you want to scroll back when we’re finished, we talked about falling asleep and anxiety. probably probably about halfway through. So maybe run the 20 or 30 minute Mark. You might want to take a look there. do you have any comments about neurofeedback therapy for anxiety It’s, it’s new with the data.

CB: It tends to be mixed. the, the data doesn’t seem to be as good as finding a good, OCD and anxiety therapist. somebody else would probably argue with me on that, but I know it’s one of the new things that people are trying. So I tend to think we, we’ve got a really good anxiety and OCD is a set of set of things that we have a lot of really good therapeutic tools for. so neurofeedback might be one of those tools. It’s hard for me to say, but I know we have a lot of good ones as therapists too, right

LL: yeah, and I, I am always on the site. I feel responsible to only recommend things that, you know, have a significant amount of data behind them because it would be irresponsible. You know, none of us has unlimited budgets. So, you know, these are decisions you have to make, you know, and, and maybe if you hundred or $2,000, you know, maybe your family can afford that and it’s worth, we’re, you know, it’s risk, it’s cost, you know

CB: Absolutely. Absolutely. And I think being informed is, is, and that’s where I can, I can say, if you’re trying to find a therapist, at least a good question to ask is, is how, what percentage of your practice is OCD What percentage of your practice is, is anxiety How many of these cases do you have in a given week And again, if you get somebody who says, Oh yeah, I do everything, I do this, I do that, I would just really hesitate. Not that those therapists aren’t good, helpful human beings for somethings, but anxiety, OCD in particular really needs a specialty therapist. so that might be a question to help find a resource. That’s, that’s helpful.

Why do so many kids have anxiety now?

LL: What do you, and this isn’t a question from a reader, what can you say or what is your opinion on, you know, here we are in 2020 and we just have so many more kids with anxiety, you know, and I, and I’m not trying to be old school and say, Oh, suck it up kid, you know, buckle up buttercup and deal with it. I’m not saying that, I’m just saying that, I just know that when I was in school were kids just masking it better? Or it didn’t exist? Or are there environmental factors or is it societal factors? Like why is there so much more childhood anxiety these days?

CB: Question. I, you know, I think there’s more pressure on kids today. maybe for, to get into middle schools and high schools. There’s pressure on the standardized testing pressure and stuff that even 20, 30 years ago, whenever I was in school, I, I didn’t feel so, I think there’s more societal pressure. and I think there’s been a really big focus in school systems and our society generally about helping kids and helping them understand their emotions and work through them. And that’s, that’s a really, really good thing. But with something like anxiety and OCD, the treatment really a lot of times boils down to let’s do the hard thing and we’ll say lean into the anxiety is something we say a lot. And I think sometimes the message message gets lost and it goes from lean into the anxiety and get better to like, Oh, let’s cope, let’s protect to, let’s fall back from, and I just wonder if that’s a little piece of it.

CB: And, and I know they’re, your site is about IEPs in particular. and I, I, I put something on my website about IEP this morning knowing we were doing this. but I, I hesitate, I hesitate really hard to write an IEP for a kid with OCD and anxiety. And if I, because, because now we’re accommodating the OCD. And when you accommodated OCD, when you accommodate anxiety, you feed it, right So if I ever do an IEP and I do do IEPS, I’ll always time limit them and I’ll tell the kid, you know, we’ll talk to the school about this for a month so you can make sure and get your schoolwork done. But during that month, these are the steps that we need to be taking so that we can take that combination away. And it’s not about removing an accommodation from you, it’s about you being able to handle it on your own because you’re super tough and smart and you know, kind of whatever the language is appropriate for the kid. so I, I think it’s just a natural shifting it society used to say suck it up and we knew that wasn’t helpful and we’ve shifted off over here somewhere and we just have to find that zone of it’s okay to have your feelings and sometimes we got to face them.

LL: That’s so that’s an interesting approach. Do you do independent evals for kids for eight or for IWPS

CB: Not too much. I’ll do them for my patients as I see. So, but I haven’t, well you have an evaluation service in Houston, I’ll send them out to.

LL: Gotcha. I was just asking. all right, one last question and then we’ll wrap it up cause it’s almost two o’clock. do you feel art therapy is worthwhile It’s a good question

CB: and the answer is going to be, it depends. So I’ll address the OCD first. OCD if, if you are a child or a family, if anybody has OCD, find a specialist and a is going to do ERP and only ERP and that’s what you need and you don’t need anything different. for, for a young kid in particular or just kind of a generalized anxiety and worry problem sometimes. And sometimes in art therapy play therapy can be a good way for the kids to open up and then when they open up you can have a conversation about facing anxiety and being tough. So the core of like face your face, your anxiety is still in there. So I think it depends how you use the art therapy or the music therapy or that play therapy or things like that. with OCD and anxiety, it’s nice to talk.

CB: It’s nice to have somebody to bounce ideas off of, but you should really be getting challenges. You should be really getting things you can do to feel better. Right at the risk of sounding like super rigid. as a therapist. Like these are the things I’ll tell people when they first come to see me. My job is to help you feel better and for you to never come back and see me again. Right. And that’ll make me very sad when I don’t see you again cause you seem cool, but also you have a life to live. so, so I think it depends on how you’re using it. and I see, one person commenting a lot of times about needing an OCD specialist. So I, I appreciate that feedback too. And if I can, if I can plug something for a second. one of the things, so, so at our clinic in Houston, one of the things that, that we started doing is offering, like intensive, one-to-one services primarily for adults.

CB: We’ll do it with some teenagers too, depending on the case where I might work with somebody like two, three, five more hours in a day for maybe a week or two or even just a couple of days. and, and that type of treatment seems to be really, really effective for OCT and anxiety and break up the systems a lot faster, than it is to come in once a week for a couple of months. so there’s a lot of data coming out that says that this type of treatment for OCD and anxiety is really helpful. So that’s, that’s what we’re doing in Houston. If anybody has any questions, you can reach back and you can reach out to me or I can point to you know, direction. wherever you’re from. I see, I saw somebody from the UK, up earlier and I know there’s like a, just a, empty glut of service, big, the whole of city services in Europe. so I hope so. I hope you reach out to me and we figure something out. but, but sometimes it’s helpful to just clear your schedule, focus, any anxiety or the OCD, really get your skills and turn and then go back to school or go back to work and try them out. so that’s just something we’re doing that if anybody wants to talk about, I’d be happy to

CB: that one. I don’t know of anybody out in Azerbaijan,

CB: but this is, we can, we can, there’s laws and regulations across States and countries and, we’ll, we’ll help you figure out some, some way to get some relief cause that’s, you deserve it. It’s important. Yeah.

LL: All right, well thanks. I mean I learned a lot.

LL: thank you so much for being here. I think everybody else did too. for those of you watching, or if you’re tuning in late and you didn’t get a chance to watch this will be, it will live in infamy, and on the Facebook page forever. And I also will get it posted to YouTube and I send it out in an email and I’ll, and I’ll put it on the blog and everything else. So, it’ll, and I also, I also transcribe it for hearing impaired readers. So, so that’s it. Thank you so much.

CB: Thank you so much for having me and thank you everybody for participating.

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