Therapeutic FAQs

Ricky and the Spider takes place in a field. Ricky the Grasshopper and Lisa the Ladybug are very unhappy. For a certain time now a Spider has been living in their neighborhood and has been putting specific demands on them. As a result, Ricky can only hop through the fields if he hops in a distinct pattern. As for Lisa, she has to count all of her polka dots before she falls asleep each night. The Spider frightens the insects by threatening them, saying that horrible things will happen to them if they don't follow her orders. That is why they carry out her orders and get further and further entwined in the web of obsessive-compulsive disorder. One day, Ricky is so confused that he decides to ask Dr. Owl for help. Dr. Owl is to be well trusted with Ricky's problem, but first he must find a child that understands and that is willing to help him…

Ricky and the Spider was developed to help support behavior therapists in their work with children who suffer from obsessive-compulsive disorder. With a rate of approximately 2%, OCD is a frequently diagnosed psychiatric illness amongst children and youth. Both cognitive behavior therapy as well as the use of medication has proven to be the most effective form of treatment for the disorder. Unfortunately, there is a lack of psychotherapists available to treat OCD. One of the reasons for this is a lack of materials available for working with children. The computer game Ricky and the Spider integrates the most important therapeutic treatment elements of cognitive behavior therapy in a playful manner. The game helps to facilitate the understanding of the illness, its consequences and its subsequent treatment by illustrating this metaphorically. Ricky and the Spider aims to encourage children to confront their OCD and offers support to behavior therapists treating children with OCD.

Ricky and the Spider contains various elements of cognitive behavior therapy that are based on well renowned treatment approaches for children (March & Mulle, 1998; Piacentini, Langley, & Roblek, 2007) as well as adults with OCD (Foa et al., 1983; Foa et al., 2005; Salkovskis, 1999).

The following themes are covered in Ricky and the Spider:

• the description of OCD as a disorder that continues to expand if given room to do so (level I);
• the explanation of the thought filter, that has been damaged by the disorder and allows absurd thoughts through (level II);
• the explanation of the tools necessary to overcome OCD as well as the challenge to externalize the obsession by giving it nicknames (level III);
• establishing a hierarchy of the obsessions / compulsions with the help of the compulsion map (level IV);
• the instruction to partake in the first exposure task (level V);
• the realization of further exposure tasks using the tools learned in level III (level VI);
• the enactment of new exposure tasks with psycho-education in order to prevent relapse (level VII);
• the presentation of a certificate, which summarizes what has been learned while playing the game (level VIII). This certificate is to be printed out in color and signed by the therapist.

In each level the treatment concept is explained. After the first four levels, which deal with psycho-education, the child should complete the worksheet on the computer by answering the questions. For homework another worksheet with similar questions is to be completed. As of level five the therapeutic homework consists of carrying out their own exposure tasks, called ‘courage tasks’ in the game. How and when to approach this part of the therapeutic homework can only be determined by the thera- pist in collaboration with the parents.

Working through a level takes approximately 15 minutes. Each level is relatively short, however, compact in terms of content. We recommend looking at the level together with the child and then letting the child recount the content of that level. After having completed the worksheet on the computer it would be advisable to play the level again. To reaffirm the psycho-educational content of the game, worksheets, which are similar to the computerized ones, can be given to complete at home. No more than one level should be completed per therapy session.

Ricky and the Spider is not a self-help game and is not of interest to children who do not suffer from OCD. Children with the disorder, who play Ricky and the Spider without the guidance of a therapist, will most likely recognize some of their own symptoms while playing the game. However, we recommend only playing this game within the framework of a cognitive behavior therapy session. Only the therapist can judge which exposure tasks are suitable for the child at each stage and how they are to be carried out. If the child is already familiar with the game before actually beginning therapy there will be no surprise effect, thereby impeding the optimal usage of the game to help treat OCD.

Ricky and the Spider was conceptualized as a working tool to help support behavior therapists in their treatment of children who suffer from obsessive-compulsive disorder. It is not magic. It does, however, help to facilitate the therapist’s job, by providing both a metaphor that illustrates what OCD is, and homework assignments to reaffirm what has been learnt. As with any psychiatric disorder, the treatment of a child with OCD needs to be handled by a therapist in cooperation with a child psychiatrist.

Naturally, we understand that parents would like to use Ricky and the Spider for their child suffering from OCD even if they are not currently undergoing treatment with a psychotherapist. The child playing the game without the guidance of a psycho-therapist risks being disappointed because psychotherapeutic computer games in themselves are not sufficient to alleviate/eliminate the disorder.

Foa, E., Grayson, J. B., Steketee, G. S., Doppelt, H. G., Turner, R. M., & Latimer, P. R. (1983). Success and failure in the behavioral treatment of obsessive-compulsives. Journal of Consulting & Clinical Psychology, 51, 287-297.
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., et al. (2005). Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine, and Their Combination in the Treatment of Obsessive-Compulsive Disorder. Am J Psychiatry, 162(1), 151-161.
March, J. S., & Mulle, K. (1998). OCD in children and adolescents. A cognitive-behavioral treatment manual. New York: Guilford Press.
Piacentini, J., Langley, A., & Roblek, T. (2007). Cognitive-Behavioral Treatment of Childhood OCD. It's only a false alarm. New York: Oxford University Press.
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research & Therapy, 37(1), S29-S52.