Editorial Perspective: Exposures in cognitive behavior therapy for pediatric obsessive-compulsive disorder: addressing common clinician concerns

Professional organizations and expert consensus recommend the use of exposure-based cognitive-behavioral therapy (CBT) to treat pediatric obsessive-compulsive disorder (OCD), but a sizable proportion of clinicians possess hesitancy regarding the use of exposures in treatment. Most notably, this hesitancy relates to concerns about negative patient and parent reactions to exposures. Accordingly, we examine three commonly reported clinician concerns regarding negative patient/parent reactions (e.g. treatment attrition, therapeutic relationship, and treatment satisfaction) among youths receiving exposure-based CBT compared to a nonexposure-based treatment. Based on our findings, there is no empirical support that exposure-based CBT precipitates adverse consequences in treatment (e.g. treatment attrition, poor therapeutic relationship, low treatment satisfaction) relative to nonexposure-based interventions. These results corroborate existing OCD expert recommendations for the use of exposure-based CBT and provide information to mitigate clinicians’ concerns about the potentially iatrogenic impact of exposures when treating pediatric OCD. We briefly present best practice recommendations for implementing exposure-based CBT in pediatric OCD patients.