Professor David Veale

Treating fears of physical and mental contamination in Obsessive Compulsive DIsorder

July 6th 2021 09.30 to 16.30 (London)

 

Treating contamination fears

Abstract

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).       


Learning objectives

By the end of the workshop participants will 

  1. Understand the phenomenology of obsessional contamination (physical and mental) with special reference to the law of contagion and transfer

  2. Understand the phenomenology of unacceptable thoughts and images and the processes that maintain them

  3. Be knowledgeable about the emotion of disgust and derivatives such as self-disgust (shame), guilt, and contempt in contamination

  4. Use appropriate assessment scales and conduct a functional analysis of cognitive processes and behaviours to develop a formulation

  5. Conduct a real risk assessment for polluting thoughts

  6. Understand the role of inhibitory learning in exposure and the overlap with behavioural experiments

  7. Conduct exposure and response prevention, behavioural experiments, drop safety seeking behaviours and do “anti-OCD” tasks.

  8. Conduct imagery re-scripting for aversive memories

  9. Treat co-morbid depression

References

Rachman, S. (2006) The Fear of Contamination: Assessment and treatment. Oxford University Press

Veale, D, Willson, R, (2006) Overcoming Obsessive Compulsive Disorder. Robinson

 

Professor David Veale

Information about David

Professor Veale is a Consultant Psychiatrist at the South London and Maudsley NHS Trust and The Priory Hospital North London. He is also a Visiting Professor  at the Department of Psychology, King’s College London.

David is a Consultant Psychiatrist at the South London and Maudsley NHS Foundation Trust and the Priory Hospital North London and a Visiting Professor in Cognitive Behavioural Psychotherapies at the Institute of Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London. He is past President of The British Association of Behavioural and Cognitive Psychotherapies. He is co-director at the Centre for Anxiety Disorders and Trauma at the Maudsley and the Anxiety Disorders Residential Unit at the Bethlem. His website is www.veale.co.uk. He has published about 100 peer-reviewed articles and four self-help books.

David specialises in obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), health anxiety and a specific phobia of vomiting (emetophobia). He is also interested in the rapid treatment of depression using Wake and Light Therapy. and nutritional psychiatry.

Education/Academic qualification

  • Doctor of Medicine, University of London

    1995

  • Master of Philosophy, Royal Free School of Medicine

    1989

  • Bachelor of Medicine and Bachelor of Surgery, Royal Free School of Medicine

    1982

  • Bachelor of Science in Psychology, Bedford College, University of London

    1979

Professional Qualifications

  • Fellow, British Psychological Society , FBPsS

    Dec 2015 - 

  • Fellow of the Royal College of Psychiatrists, FRCPsych 

    2003 - 

  • Member of the Royal College of Psychiatrists, MRCPsych

    1987 - 

 

Books by David Veale

This is a selection of books written by Professor Veale that might be of interest if you would like to join his workshop or find out more about his work,

71l6pJjhXTL._AC_UY436_QL65_.jpeg
41kOctQugjL._SX333_BO1,204,203,200_.jpeg
41ENpiIYTKL.jpeg
41jFZGIF03L._SX383_BO1,204,203,200_.jpeg
711tq1b6OPL._AC_UY436_QL65_.jpeg
419KUJaikWL._SX317_BO1,204,203,200_.jpg

 

The OCD 'Bully'

People with OCD often consider their OCD to be like a bully or a demon that has to be obeyed. During the process of cognitive behaviour therapy, they may be encouraged to “externalise” their bully and to act against it by doing the opposite to what the bully demands. Clinicians at the Institute of Psychiatry decided to make  a humanoid version of an OCD bully or monster. On the outside of the bully are various manifestations of OCD – for example a clock that represents the wasted time of compulsions; a toilet seat that is full of “germs”; knives for fears of being violent; words such as “Paedophile” and numbers such as “666”. The bully has several eyes to depict the vigilance for threat. A door in its chest opens to reveal a heart of stone. At the base is a broken mirror.

The Bully was featured in the British Medical Journal (BMJ 2010; 341: c2596).


It was unveiled by Professor Jack Rachman on 9th March 2010. Professor Rachman  is a leading authority on OCD and used to work on the unit in the 1980s. It is now on permanent loan to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital from David Veale, who commissioned the piece from his friend Steve Caplin.

 
 
  • Twitter
  • Instagram
  • Facebook

©2020 by CBTReach. Proudly created with Wix.com