The aim of exposure therapy is to purposefully trigger anxiety so that the anxiety sufferer can practice feeling uncomfortable while not engaging in the usual rituals or escape strategies. If this sounds fun to you, I know of some other activities you might enjoy such as traveling by plane with 2 preschoolers and no Ipad, eating a durian and, an oldie but goodie, scraping your fingernails along a chalkboard (do they even make chalkboards anymore?). The fact is that anxiety is not fun, and we all try to avoid it. When it comes to helping children with anxiety, one of the biggest challenges is helping them to understand why on earth they would ever want to feel those yucky, horrible feelings on purpose. I mean, really, how could that possibly help? In these situations, it can be extremely helpful to add some fun to the process. If you’re looking for ways to engage a child (or adult) in the exposure therapy process, here are some tips to get you started: 1. Make it a game show: Have the exposures be the “challenges” in a game show. And therapists and parents, don’t be afraid to accept challenges yourselves. Leading by example can be very effective. 2. Play a boardgame: Trivial pursuit for perfectionism around knowledge, Pictionary for perfectionism around drawings, Scattergories for perfectionism around speaking/language, Charades for social anxiety, Cards Against Humanity for scrupulosity (for adults). Also try playing a game with the rules stacked against the client if you need to expose someone to an “unfair” situation (e.g. Scrabble with the client getting 3 tiles and their opponent getting 5). 3. Replace an OCD physical ritual with a silly body movement: Do a dance on that crack on the sidewalk instead of avoiding it, Give the therapist a fist bump instead of tapping on the table. 4. Use fun items for contamination exposures fun: Paint, slime, sand, mud, oil, glue, etc. 5. Have everyone in the room mess up something about their appearance on purpose: Only put makeup on one eye, mess up your lipstick, make your hair stick up in the air, miss a button on a button-up shirt 6. Say things “wrong”: Answer questions wrong on purpose. Tell a story the wrong way (exaggerate, make things up). Have Mom describe her daughter’s favorite cartoon completely wrong (would anger some children with “need to correct” symptoms). Read a difficult tongue twister outloud as fast as you can, with a goal of speed rather than the accuracy. 7. Watch a standup comic bit (more for adults): Comic’s love to joke about taboo subjects, including common OCD fears (racism, masturbation). This might take some of the air out of the OCD fear of the subject. 8. Contamination scavenger hunt: Go for a walk around the block, or around the therapy clinic, and touch triggering objects. 9. Answer Trivia about OCD (for psycho-education): Define OCD, habituation, natural exposure, planned exposure. How do you get rid of an OCD fear? What’s the difference between a ritual and a coping skill? 10. Play acting: Have the therapist or parent play the part of OCD (acts as the Worry Voice, Worry Trick, False Alarm in the child’s head). The client plays the part of themselves. Allow the client to practice resisting the demands of the Worry Brain. 11. Make wishes: This is helpful for clients who are worried about their thoughts making bad things happen. Have the client wish that the therapist wins the lottery. Have them watch passing cars and wish for them to get flat tires, have them watch passersby and wish for them to trip. 12. Introduce art into therapy: Have client’s design and create their own “fear thermometer” to help them rate their anxiety. Draw a picture of what OCD looks like. Draw pictures of preferred characters from Disney, Pokemon, comic books, manga, etc, and “mess them up” on purpose. Work with wet clay or finger paints. 13. Allow the client to act like the therapist and tell others how they should fight their OCD urges. 14. Do something “bad” (for scrupulosity fears): Toilet paper the halls of the clinic, write a mark in one of the therapists’ books, write down a bad word, tell a lie, say you’re not sorry for something. 15. Introduce reinforcers/rewards: Allow the child to use one of the toys in your office after each success. if you have Itunes or Spotify on your computer, allow the child to choose a song after each exposure. In implementing some of these ideas, you will hopefully find the anxiety-avoider better engaged with the therapy process. As you progress, keep an eye out for the development of any new rituals. You may also want to gradually reduce the “fun” aspect of the exposure, as the client gets the hang of exposure therapy, just to make sure s/he is still experiencing discomfort and challenging themselves.