Best Practice for Youth with Anxiety and OCD​

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The main evidence-based treatment for anxiety and OCD is Exposure-Based CBT (sometimes also referred to as “exposure therapy,” “exposure and response prevention,” or “gradual exposure”). Exposure-based CBT (Ex-CBT) consists of helping youth face their fears and supporting them to reduce their use of avoidance or compulsive behaviors to ultimately help them learn to manage and tolerate their distress more effectively. Ex-CBT strategies can include having the client make a list of uncomfortable situations and ranking those situations from easy to hard (i.e., building a hierarchy), helping the client to gradually face their uncomfortable emotions (e.g., anxiety) in a supportive way, and reducing the use of behaviors or compulsions that feel better in the short term but maintain anxiety in the long term. While incredibly effective, Ex-CBT is also quite challenging to deliver. Many clinicians struggle with how to balance coaching youth to approach anxiety-provoking situations and cope with anxious thoughts and physical symptoms, while also providing a safe and validating space that is responsive to youth’s culture and context. These challenges can be magnified when working with marginalized or minoritized clients, as Ex-CBT protocols were originally developed for largely homogenous populations.

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Clinicians have shared with us that having support on how to combine basic principles of Ex-CBT with best practices in culturally responsive care is essential to providing high-quality care.