Here’s what cognitive-behavioural therapy for OCD involves

A strong body of evidence supports cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD).  Beyond showing that CBT is effective, studies have also demonstrated that this treatment produces clinically meaningful reductions in both symptoms and diagnoses. When using CBT, practitioners typically begin by presenting children and parents with information about the disorder, including explaining what the treatment will involve. As part of this process, children are often encouraged to give the disorder a “nasty nickname” — to help them resist their symptoms and not blame themselves for having OCD. Children also identify their specific obsessions, compulsions, triggers and avoidance behaviours as part of developing the treatment plan.

To address physical OCD symptoms, children learn specific behavioural strategies such as relaxation and breathing techniques. Children also learn cognitive strategies such as challenging their beliefs about the likelihood of feared outcomes coming true. Children then practise exposure and response prevention, the core component of CBT. This involves children confronting their obsessions while resisting the urge to engage in compulsions. For more information, see Vol. 16, No. 1  of the Children’s Mental Health Research Quarterly.

Causal factors for obsessive-compulsive disorder are still unknown

Studies examining potential risk factors for obsessive-compulsive disorder (OCD) have identified both biological and environmental variables. Yet, the unique contribution of each identified variables was relatively small. This suggests that more research is needed to understand how OCD develops. In particular, studies identifying additional modifiable risk factors will be particularly helpful in informing and guiding the development of preventive interventions.

Still, research on protective factors for OCD is also beginning to emerge. For example, a prospective study in a representative sample of 515 adolescents identified one modifiable protective factor. Specifically, having higher emotional stability was associated with having fewer OCD symptoms in adolescence. (Emotional stability was defined as the ability to regulate emotions, or maintain a balanced affect over time.) For more information, see Vol. 16, No. 1 of the Children’s Mental Health Research Quarterly.

What is the prevalence of obsessive-compulsive disorder?

A recent meta-analysis estimated that 0.3% of children meet diagnostic criteria for obsessive-compulsive disorder (OCD) at any given time. This equates to about 18,500 children in Canada and 2,300 children in BC. OCD also starts early, with nearly 25% of boys who develop it doing so  before age 10 and with 25% of overall cases emerging by age 14. This early onset makes it crucial to identify these young people and provide effective treatments quickly, so children can thrive and so OCD does not persist into adulthood. For more information, see Vol. 16, No. 1  of the Children’s Mental Health Research Quarterly.

What is obsessive-compulsive disorder?

Many children experience repetitive thoughts and behaviours. A preschooler may insist on having the same book read to her every night for several months. A middle-schooler may frequently express his displeasure about attending a new after-school program. But these kinds of typical behaviours differ from the more intense, enduring and impairing obsessions and compulsions that are the hallmarks of obsessive-compulsive disorder (OCD).

Obsessions involve recurrent and persistent thoughts or images that are intrusive, unwanted and time-consuming, taking more than an hour per day. Compulsions, meanwhile, are repetitive behaviours or mental acts that a child feels obliged to do, typically to relieve distress associated with an obsession. Young people with OCD usually experience both obsessions and compulsions. These may include fear of contamination, fear of being aggressive, wanting to make things “just right,” as well as distressing sexual or religious thoughts. For more information, see Vol. 16, No. 1 of the Children’s Mental Health Research Quarterly.

Bullying can be reduced

A systematic review by the Children’s Health Policy Centre found five interventions that reduced at least one form of bullying, albeit with only modest effects for some interventions. Four of these programs were delivered in classrooms and showed success from the early years to adolescence: Youth Matters (elementary schools); Roots of Empathy (elementary and middle schools); Bullies and Dolls (secondary but not middle schools); and Media Heroes (middle and secondary schools). One clinical intervention Integrative Family Therapy — was also effective at reducing bullying by teenage boys.

These findings suggest several implications for practice and policy.

  • Reach children across a range of ages. The effective antibullying interventions we identified can be delivered in elementary, middle and secondary schools. So, programs can start early and be offered across a range of ages, which means they will reach more children to prevent the harms that come with bullying.
  • Invest in reducing all forms of bullying. Most of the programs we reviewed aimed to reduce face-to-face bullying. But one program — the 10-session version of Media Heroes — effectively reduced cyberbullying. Efforts to reduce cyberbullying could be modelled on this successful program and evaluated for effectiveness in BC.
  • Ensure adequate program duration. Two unsuccessful programs stood out for being particularly brief. Both Incremental Theory of Personality Intervention and the four-session version of Media Heroes were delivered over one day. In contrast, the five successful programs ranged in length from three weeks to two school years. So, interventions should mirror these longer durations.
  • Watch for unintended consequences. Bullies and Dolls led to very different outcomes based on the grades students were in. While the program reduced victimization for students in Grades 8 and 9, it increased both victimization and perpetration for students in Grades 6 and 7. So this program caused harm for younger students and should not be used with them. As well, these findings illustrate the importance of always monitoring outcomes to ensure that program benefits outweigh harms. Evaluating programs in BC is particularly important when programs have been developed and tested elsewhere, and when there are no replication randomized controlled trials.
  • Recognize that some children and families can benefit from the help of a mental health practitioner. Schools are excellent venues for reaching large numbers of children with antibullying programs. But some young people may need the support of a practitioner to address bullying and other aggressive behaviours. The clinic-based Integrative Family Therapy may be a helpful option for teenage boys who bully others.

Adults play crucial roles in creating and sustaining the environments that help children flourish and keep them safe. These roles include striving to ensure that homes, schools and communities are free of bullying in all its forms, for all children. For more information, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.

Roots of Empathy supported by Indigenous people

Roots of Empathy is a Canadian-developed program that aims to reduce bullying, aggression and violence in general. Certified instructors deliver the 27-session program over one school year to students in kindergarten and Grades 4 and 8. More than 165,000 BC students have participated in Roots of Empathy. And the program’s reach continues to grow. Many First Nations, Inuit and Métis communities in BC and throughout Canada have been delivering the program. It has also garnered noteworthy support from the Assembly of First Nations. In 2008, this organization endorsed a resolution supporting the program, citing its compatibility with traditional First Nations teachings and world views. For more information, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.

What protects children or puts them at risk of bullying?

Researchers have examined risk factors for both engaging in bullying and being bullied. One particularly robust meta-analysis incorporated 153 studies that included children from kindergarten to Grade 12. Researchers began by classifying children’s experiences with bullying into three categories: perpetrator only, victim only, and both perpetrator and victim. Some of the risk factors for being involved in bullying include:

  • Living in communities experiencing challenges (e.g.: high crime rates)
  • Having academic challenges
  • Having lower status among peers
  • Having peers who encourage negative behaviour
  • Having a negative view of oneself

In terms of identifying what can protect children from both bullying others and being bullied, the news is less encouraging. A meta-analysis that included 19 studies of youth aged 11 to 18 years identified only one protective factor: older age reduced the risk of perpetrating bullying.  For more information, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.

Nov. 20 is Universal Children’s Day

The United Nations’ Universal Children’s Day, which was established in 1954, is celebrated on November 20 each year to promote international togetherness and awareness among children worldwide. UNICEF, the United Nations Children’s Fund, promotes and coordinates this special day, which also works towards improving children’s welfare.

Universal Children’s Day is not just a day to celebrate children for who they are, but to bring awareness to children around the globe who have experienced violence in forms of abuse, exploitation, and discrimination.

But in a report by the Children’s Health Policy Centre, published last year in the journal Evidence-Based Mental Health, estimated that one in eight children has mental disorders at any given time, causing symptoms and impairment, therefore requiring treatment. Yet even in high-income countries, most children with mental disorders are not receiving services for these conditions. The report discusses the implications for this situation, particularly the need to substantially increase public investments in effective interventions. It also discusses the policy urgency, given the emerging increases in childhood mental health problems since the onset of the COVID-19 pandemic.

Readers can get access to the report, here.

Bullying happens in Canada and BC

Data reveals important information about Canadian children’s experiences with bullying. A study of 1,000 youth ages 10 to 17 found more than 26% reported being bullied at least once in the past month, with most reporting both in-person and online experiences. And among BC students aged 12 to 19 years, 53% reported experiencing at least one of three forms of bullying in the past year. This included 39% having been socially excluded on purpose, 38% being teased to the point of feeling bad or extremely uncomfortable, and 8% being physically bullied. As well, 4% of students reported missing school due to bullying in the past month.

Many of the same bullying experiences were documented among Métis students in BC. Specifically, 41% were socially excluded on purpose, 47% were teased to the point of feeling bad or extremely uncomfortable, and 13% were physically bullied. For more information, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.

Experiences of bullying are relatively common

A recent meta-analysis of 80 studies involving youth ages 12 to 18 found that just over 34% reported perpetrating in-person bullying and just over 15% reported perpetrating cyberbullying. While rates of in-person bullying were slightly more than double those of cyberbullying, the two types were strongly correlated, leading the study’s authors to conclude that in-person bullying and cyberbullying were in essence just different ways of enacting similar behaviours. For more information, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.