OCD and Anxiety Program

At CBTTexas™, we specialize in ERP, the gold-standard, first-line treatment for:

• Obsessive-Compulsive Disorder (OCD): all subtypes, including contamination, harm, symmetry and order, taboo/forbidden thoughts, religious and moral scrupulosity, doubt, uncertainty and existential concerns, somatic and sensorimotor OCD, magical thinking, and superstitious presentations.
• Social Anxiety Disorder: fear of judgment, embarrassment, rejection and negative evaluation from others
• Panic Disorder and Agoraphobia: fear of physical symptoms and fear of being trapped without help
• Health Anxiety: obsessional fear of illness or bodily symptoms
• Specific Phobias: fear of flying, vomiting (emetophobia), animals, injections, driving, etc.
• Generalized Anxiety and Intolerance of Uncertainty: chronic worry, over-preparation, reassurance seeking

ERP is based on decades of research and clinical success. It’s recommended by the American Psychological Association, the International OCD Foundation, and the National Institute for Health and Care Excellence (NICE) as the most effective treatment for OCD and anxiety disorders.

ERP is based on the conceptual framework that avoidance, compulsions, and safety behaviors maintain fear and anxiety. These behaviors train the brain to believe that feared situations are dangerous and that only avoidance or ritual can keep the person safe. ERP breaks this cycle by teaching people to face what they fear, and resist the urge to escape it. By gradually approaching feared triggers and not engaging in the usual rituals or avoidance, the brain learns a new, corrective message:  

• “This is uncomfortable—but it’s not dangerous.”
• “I can handle this.”
• “I don’t need to be 100% certain in order to live my life.”

This process doesn’t just change behavior, it actually rewires the brain to reduce fear and increase flexibility. ERP is not just “exposure for exposure’s sake.” It’s highly collaborative, personalized, and goal-directed.

We begin with a comprehensive assessment and develop a detailed exposure hierarchy- a list of situations, thoughts, or sensations that trigger anxiety or compulsions. Together, we decide where to start and how to move forward. In ERP, clients learn to:

• Confront feared thoughts, images, situations, or sensations
• Tolerate distress without engaging in compulsions or avoidance
• Sit with uncertainty rather than chasing reassurance or control
• Reduce safety behaviors like checking, mental reviewing, or seeking comfort
• Break rigid rules imposed by anxiety (e.g., “I must avoid that or something bad will happen”)
• Build values-based behavior, where choices are guided by what matters- not by fear

Therapy sessions may include in-session exposures, between-session assignments, and, when appropriate, real-world coaching or community-based exposures to help clients face triggers where they happen. We work at a pace that’s challenging but doable. 

For children and adolescents, ERP can be adapted to be developmentally appropriate, creative, and engaging. We always involve parents or caregivers to support exposure tasks, reduce accommodation, and reinforce progress at home. 

However, you don’t have to change your child’s behavior to help them get better. 

In fact, some of the most powerful changes come from what you do as a parent. When a child is resistant to therapy or struggling to engage, we may instead choose to engage in a treatment course of SPACE, a parent-based treatment developed at the Yale Child Study Center, for families of children and adolescents with anxiety disorders and OCD. SPACE is an evidence-based program designed to reduce children’s anxiety and improve family functioning by empowering parents to respond more effectively. Rather than placing pressure on a child to participate in therapy or face their fears directly, SPACE focuses on changing parental accommodations, the well-intentioned behaviors that parents engage in (like offering excessive reassurance, modifying routines, or helping a child avoid feared situations) that can unintentionally maintain or worsen anxiety over time. In SPACE, parents attend weekly sessions with a trained therapist- often without their child present. Over the course of treatment, parents learn how to:

• Identify the ways anxiety or OCD has taken hold in the family system
• Reduce accommodations that reinforce avoidance and fear
• Set compassionate, consistent limits in a supportive way
• Respond effectively to distress and resistance
• Promote confidence, independence, and emotional resilience in their child

SPACE is rooted in the belief that parents can be powerful agents of change, even when your child is unwilling or unable to engage in therapy. Unlike traditional parenting advice, SPACE provides a structured, evidence-based roadmap for reducing your child’s anxiety while preserving warmth, connection, and empathy. 

Whether you’re the parent of a young child or a struggling teen, we’ll help you take effective, supportive steps to bring relief to your whole family.