Helping kids face their fears one brave step at a time.

Maybe your child asks "Are you sure?" over and over before bed. Maybe your teen washes their hands until they're raw, or has to redo homework until it feels "just right." Maybe your whole family has started working around a fear, skipping places, changing routines, or answering the same question again and again. You might be asking yourself, "How do I help without making it worse?"

You're not doing anything wrong, and this is very treatable. Exposure and Response Prevention (ERP) is the most well-researched treatment for childhood OCD, and exposure-based therapy is highly effective for many kinds of anxiety and phobias. At SageMind Psychology, our team makes ERP gentle, gradual, and collaborative, and we coach parents every step of the way.

Available in person in Brooklyn Heights and online in New York, New Jersey, and 40+ additional states.

What is ERP?

ERP is a specialized form of Cognitive Behavioral Therapy (CBT). When kids feel anxious, they naturally try to make the feeling go away by avoiding, asking for reassurance, checking, or doing a ritual like washing or counting. These behaviors bring quick relief, but they also teach the brain that the fear was real and the ritual was necessary. Over time, anxiety gets bigger and bossier.

ERP breaks this cycle. With their therapist, kids gradually practice facing the things that make them anxious (the "exposure") while holding off on the ritual, reassurance, or escape (the "response prevention"). Each time, they learn that the anxious feeling passes on its own and that they can handle more than they thought.

Many kids find it helpful to think of OCD or anxiety as a bossy voice they can learn to talk back to. The goal isn't to never feel scared. It's to help your child stop letting fear make the rules.

Signs ERP could help your child

Parents tell us things like:

• "My son asks me the same questions over and over, and my answers are never enough."

• "She washes her hands so much that her skin is cracked."

• "They have to touch things a certain number of times or redo things until it feels right."

• "He's terrified of throwing up and won't eat at friends' houses."

• "My daughter won't sleep anywhere but home or let me leave the house without her."

• "They keep confessing small things they think they did wrong."

• "My teen checks their backpack, the door, and their homework again and again."

• "He gets upset by scary thoughts and asks if they mean he's a bad person."

• "Our whole family has changed our routines to keep from setting off their anxiety."

These behaviors don't automatically mean OCD or any specific diagnosis. Our clinicians look at what's driving them and recommend the approach that fits. You don't need to know the diagnosis before reaching out.

What ERP can help kids and teens with

ERP and exposure-based therapy may be used for concerns including:

• Obsessive-compulsive disorder (OCD): Unwanted, upsetting thoughts paired with rituals like washing, checking, counting, redoing, or asking the same questions. ERP helps kids resist rituals and learn they can handle uncertainty.

• Reassurance seeking: Needing to hear "It's okay" or "Are you sure?" again and again. ERP helps kids tolerate not knowing, and parent coaching helps families step back from the reassurance cycle.

• Specific phobias: Strong fears of things like vomiting, needles, dogs, storms, the dark, or elevators. Kids face the fear one small step at a time, so it gradually loses its power.

• Separation anxiety: Intense distress about being apart from a parent, hard school drop-offs, or trouble sleeping alone. Planned, gradual practice being apart helps kids build independence.

• Social anxiety: Fear of being judged or embarrassed that leads kids to avoid speaking up, ordering food, or joining activities. Small, brave social steps build real confidence.

• Health worries and panic: Worry about getting sick, checking the body, or fear of the physical feelings of anxiety. Kids learn these sensations are uncomfortable but safe.

• School avoidance: Stomachaches on school mornings, frequent calls to come home, or missing school. Along with ERP and parent coaching, our School Refusal Program offers focused support.

• Perfectionism: Erasing, rewriting, or redoing work until it feels "just right." Kids practice doing things "good enough" on purpose and learn they can handle imperfection.

Many kids experience more than one of these, and anxiety and OCD often show up alongside ADHD or autism. ERP can be adapted for neurodivergent kids, with adjustments to pacing, communication, and sensory needs. Learn about our neurodivergent-informed therapy.

ERP at every age

Anxiety looks different at 5, 10, and 15. Treatment should, too.

• Young children: Treatment is playful and caregiver-centered, using games, small "brave practice" challenges, and lots of encouragement. For very young children, parent-guided behavioral strategies are often a better fit than traditional ERP. Learn more about our Children's Center.

• School-aged children: Kids learn about anxiety in kid-friendly language, sometimes giving OCD or worry a name so it's easier to boss back. Together with their therapist, they build a "brave ladder" and earn rewards for climbing it.

• Teens: ERP helps teens work on intrusive thoughts, checking, social fears, perfectionism, and avoidance. Teens help set their own goals and choose their own steps. Many teens feel embarrassed about their thoughts, and our clinicians won't be shocked by them.

What ERP looks like

Step 1: Learn how anxiety works

Your child learns, in age-appropriate language, how fears and rituals feed each other, so anxiety starts to feel less mysterious and less in charge.

Step 2: Build a brave ladder

Together, your child and their therapist list challenges from easiest to hardest. Your child helps decide where to start.

Step 3: Practice facing fears

Starting low on the ladder, your child practices a challenge, like touching a doorknob without washing, or saying goodnight without asking "Are you sure?", and stays with the feeling until it gets easier.

Step 4: Practice at home and school

Kids practice between sessions in the places where anxiety shows up, and parents learn how to coach that practice.

Step 5: Keep climbing

As each step gets easier, your child moves up the ladder and builds confidence that they can handle uncertainty.

ERP is never about forcing a child to face their biggest fear. Kids help choose every step, and we move at a pace that feels challenging but doable.

How parents help

Supporting your child doesn't always mean making the anxiety go away.

When your child is scared, it's natural to reassure them, answer the same question again, or change plans to keep them comfortable. Most families end up working around anxiety or OCD in some way. These responses come from love, but over time they can keep the anxiety cycle going.

Parent coaching is a core part of ERP for kids. We help you respond with warmth and confidence, gradually reduce reassurance and accommodation, and cheer on brave behavior, so your child learns that you believe they can handle hard things. For teens, family involvement is balanced with their growing independence.

Programs for extra support

For some families, a more specialized program can help:

• Kids and teens whose anxiety comes with big emotions or meltdowns: our DBT for children and adolescents

• Teens who want to practice skills alongside peers: our DBT skills groups

• Kids and teens who need more support than weekly therapy: our Intensive Outpatient DBT Program for children and teens

• Families who want a clearer picture of what's going on: our psychological assessments

A team behind every family. Our clinicians work together, receive ongoing supervision, and consult on cases, so your child benefits from the experience of the whole team. We are LGBTQIA+ affirming and neurodiversity-informed. Meet our clinical team.

Getting started is simple

Your child's first brave step starts with a 15-minute call.

1. Book a free 15-minute consultation. Tell us what you're seeing, ask questions, and get a feel for how we work.

2. Get matched with the right clinician. We'll pair your family with the team member best suited to your child's needs.

3. Start therapy. After an intake session, your child begins building skills, and you get support too.

We offer ERP in person at our Brooklyn Heights office and online (telehealth) in New York, New Jersey, and 40+ additional states. Online sessions can be especially helpful for ERP, since kids can practice right at home, where many rituals happen.

SageMind Psychology is an out-of-network practice. Many families use out-of-network benefits, and we provide superbills to help you seek reimbursement. Learn about rates and insurance.

Book your free consultation or contact us with questions.