Before treatment, 70 percent of patients were classified as having severe O.C.D., and nearly three-quarters had previously been in therapy. Some 42 percent were taking antidepressants. The study did not have a control group.
At the Weill Cornell program, the participants, ages 10 to 15, practice exposures in a mock class. Dr. Falk gives them assignments to induce anxiety based on their individual triggers. She told the 12-year-old in the red tie and blazer — who is petrified of not acting “right” out of fear it will cause something bad to happen — to “be really inappropriate and rude, and eat in the middle of class and make a mess.”
She instructed a 12-year-old girl in a Harry Potter “Butterbeer” T-shirt to write about what she did on her recent birthday. The child has many compulsive behaviors involving writing and often has to erase and rewrite, something that causes problems in school.
For a 10-year-old with braces and a purple streak in her hair whose O.C.D. is triggered by not knowing certain things, Dr. Falk instructed the other kids to “tell me something secret and rude” that she couldn’t hear.
As class got underway one day, the boy, at Dr. Falk’s urging, ditched his tie and blazer. He was eating an orange. “Make fun of me,” encouraged a 14-year-old who has spent most of the session doodling.
The girl with the writing compulsion put down her pen and wailed. “Oh my god. It looks like an ‘I’ with a top hat on it,” she said, staring at her paper.
Dr. Falk looked it over. “I can understand it perfectly,” she said. “Let it go, which is going to be better for you long-term.”
Before the kids left, Dr. Falk wrote a new homework assignment on a colorful notecard for each of them, more exposures to complete before the next group meeting — the very next day.