Treating contamination fears
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
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.
Doctor of Medicine, University of London
Master of Philosophy, Royal Free School of Medicine
Bachelor of Medicine and Bachelor of Surgery, Royal Free School of Medicine
Bachelor of Science in Psychology, Bedford College, University of London
Fellow, British Psychological Society , FBPsS
Dec 2015 -
Fellow of the Royal College of Psychiatrists, FRCPsych
Member of the Royal College of Psychiatrists, MRCPsych
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.