Choosing between SPACE and ERP in Treating Childhood OCD

SPACE is an increasingly popular, evidence-based, approach to the treatment of childhood OCD and anxiety. It is a 12 session program that empowers parents to support their child in overcoming their anxiety instead of accommodating anxious avoidance. Whereas classic Exposure and Response prevention (ERP) therapy (a form of Cognitive Behavioral Therapy or CBT) for children involves a therapist working directly with the child and includes the parents as necessary, SPACE has the therapist working exclusively with the parents.

A few randomized control trials have demonstrated that despite not involving the child in the treatment, SPACE is no less effective than individual CBT in treating childhood anxiety. Dr. Lebowitz, the treatment’s developer, explained that SPACE should not be seen as the treatment for kids who refuse CBT, but as another first line treatment for child anxiety.

In my own clinical experience I have been highly impressed by the clinical effectiveness of the treatment. Having been trained in both ERP for children and SPACE, the decision of which to use, or which to use first can be challenging.

Currently, to my knowledge, no research exists determining which factors would lead a therapist to choose one treatment over another. Until such research is conducted, I believe two factors; the degree of child motivation and the nature of the child’s compulsions (independent vs. dependent on parents), may be of particular imporance in making this determination.

The chart below (mobile and desktop version, respectively) lists all the permutations of these factors and the treatment approach I would use based on clinical experience.