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Ask the Anxiety Sisters

Exposure Therapy

My teenage daughter has a diagnosis of Obsessive Compulsive Disorder because of her intense fear of germs. She is really worried about getting sick. She washes her hands until they bleed. She misses a lot of school, especially in the winter, because she is afraid of the other kids who come to school sick. It has really been disruptive in our lives. After going to a few therapists, we finally found a place that specializes in OCD. They are doing something called “exposure therapy” for her germ phobia. I am a little confused about some of the things that we have to do. For example, I can no longer give her hand sanitizer to take to school or even offer it to her if we are out to dinner, which doesn’t make sense to me because I don’t want her to get sick either. Have you heard of this?

First of all, it is wonderful that you are getting help for your daughter.  We know how challenging it is to find the right resources, and we congratulate you for your persistence. As her mother, you are an incredibly important part of her treatment team and you have every right to sit down with her therapists and make sure that you fully understand the treatment plan. We imagine that they will ask you to do many things (or refrain from doing many things) which might be confusing to you so you must ask questions. The more you understand about the treatment, the better you will be able to support your daughter. And this stuff is not necessarily intuitive, so don’t be shy about requesting explanations.


We certainly do not know the specifics of your daughter’s treatment plan, but we are very familiar with Exposure Therapy. In fact, each of us has gone through it for phobia treatment. Here’s the idea behind exposure: When we have a phobia (irrational fear), we naturally do our best to avoid whatever it is that scares us. This avoidance, however, only makes our anxiety (including our obsessions and compulsions) more intense. Therefore, Exposure Therapy requires us to stop avoiding our fears. It asks us to do the very thing that feels the most impossible and to keep doing it until it no longer feels so difficult. By exposing ourselves to our fears over and over again, we gradually develop a tolerance for the anxiety and, ultimately, we stop feeling fearful altogether.

Obviously, this type of treatment is highly anxiety-provoking in the short term, but it is usually very helpful—if not curative—in the long-term. Both of us benefitted tremendously from Exposure Therapy; although it took some time and quite a lot of discomfort, we both completely overcame our fears!

It sounds like your daughter is obsessed with not getting sick, which has led to a phobia of germs. Her compulsions, designed to soothe her anxiety, include washing her hands excessively and avoiding places (like school) where germs are plentiful. In your daughter’s case, the purpose of Exposure Therapy is to require her to stop avoiding germs so that she will become desensitized to the presence of germs in her life. We imagine that the therapist wants her to feel comfortable with the idea that she—like all of us—will be exposed to germs and will still be okay (even if she does get sick). Repeated exposure to germs is the way to achieve that goal. Thus, anything that allows your daughter to avoid germs (e.g., hand sanitizer) can be counter-productive to her treatment.

Of course you don’t want your daughter to get sick. But OCD is also an illness, and one which can be far more disruptive to one’s life than a common virus. When our children are struggling with mental health issues, it can be so scary and painful. But it sounds like you are really thoughtful about finding your daughter the best help possible, and that you are working to understand how you can be supportive in her recovery. She is lucky to have you in her corner.


Much love,

Mags and Abs

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