Contamination is one of the most common fears in OCD. About 1/3rd of people with OCD will have co-morbid depression. A common process in contamination is that of ‘contagion’ or transfer. It can include mental contamination where the source is usually inside the body or all-over dirtiness or polluting thoughts about sex, violence, or blasphemy.
Contamination is associated with avoidance behaviour, compulsive washing, checking and mental rituals. The motivation to prevent contamination may be to prevent harm, losing control or to avoid feelings of disgust. Newer developments In CBT include the role of inhibitory learning in exposure and how this overlap with behavioural experiments and understanding of the problem by testing Theory A / Theory B. Exposure in contamination includes transfer of the “contaminants” and spoiling of compulsions such as washing.
Special consideration in therapy is required for intrusive sexual and violent images. Newer treatment interventions include imagery rescripting for aversive memories and concurrent treatment for depression (for example improving sleep, diet, exercise, social activity and reducing shame).
By the end of the workshop participants will
- Understand the phenomenology of obsessional contamination (physical and mental) with special reference to the law of contagion and transfer
- Understand the phenomenology of unacceptable thoughts and images and the processes that maintain them
- Be knowledgeable about the emotion of disgust and derivatives such as self-disgust (shame), guilt, and contempt in contamination
- Use appropriate assessment scales and conduct a functional analysis of cognitive processes and behaviours to develop a formulation
- Conduct a real risk assessment for polluting thoughts
- Understand the role of inhibitory learning in exposure and the overlap with behavioural experiments
- Conduct exposure and response prevention, behavioural experiments, drop safety seeking behaviours and do “anti-OCD” tasks.
- Conduct imagery re-scripting for aversive memories
- Treat co-morbid depression
Rachman, S. (2006) The Fear of Contamination: Assessment and treatment. Oxford University Press
Veale, D, Willson, R, (2006) Overcoming Obsessive Compulsive Disorder. Robinson