Got Anxiety? Compulsive washing — face, embrace, erase (part 4 of 4)
Mary B. Barmann, MFT
As mentioned in our previous articles seen within this series, those with contamination OCD typically behave in the same manner each time they begin to experience obsessional fears related to contamination.
They will first attempt to avoid direct contact with any object or person believed to be associated with certain contaminants. Examples may include:
Touching certain objects with only one hand.
Staying away from objects that people typically touch such as doorknobs, handles, light switches, faucets, etc.
Waiting for others to open doors.
Never taking the top newspaper in a stack of papers.
Using disposable gloves to grasp items.
Refusing to enter doctor’s offices and hospitals.
In addition to avoidance strategies, the person will also engage in several different forms of compulsive washing and cleaning rituals in an attempt to be 100% certain they have not been contaminated.
Unfortunately, avoidance, reassurance-seeking behaviors, and the use of rituals bring about a short-term feeling of relief, and only serve to strengthen and maintain this condition.
Research studies and clinical experience have consistently demonstrated that the most effective strategy for treating any form of OCD involves the use of a technique known as Exposure & Response Prevention.
EXPOSURE & RESPONSE PREVENTION (ERP)
Although one’s default response when faced with fear producing triggers is avoidance, this response pattern will always prove to be ineffective. Instead, we need to “run towards the roar” — that is, directly face and embrace the feared object or situation.
We frequently remind our patients that anxiety is probably the only condition we work with, in which the treatment causes the condition to get worse, before it gets better. This is because exposure sessions consist of deliberately interacting with the objects or situations which trigger one’s anxiety — triggers which the person is consistently used to avoiding.
In addition, during these exposure sessions, the individual is also required to refrain from engaging in any type of behavioral or mental compulsions. The later requirement represents the “Response Prevention” aspect of treatment.
When Exposure is conducted correctly, over a sufficient period of time (usually 10-12 weeks), triggers which caused high levels of anxiety in the past, now provoke little, if any anxiety, thus erasing the need to use avoidance behaviors, as well as past rituals.
Looks look at an example of how to correctly implement this strategy. However, as we have cautioned in the past, it is always best to be working together with a mental health professional who is specifically trained to treat OCD.
EXAMPLE OF AN ERP EXERCISE
Recall the Obsession-Ritual Cycle we discussed earlier in this series. First, a trigger is observed. Next, the trigger elicits a disturbing intrusive thought (e.g., “I see contaminants which could harm me”). At this point the individual becomes quite anxious, and then begins to perform a particular ritual (compulsive washing).
Following this ritual, there is a temporary feeling of relief (lower levels of anxiety). Exposure & Response Prevention exercises are designed to break this cycle. Seen below, is one example of how to conduct an initial exposure session for compulsive hand-washing, prior to moving onto more difficult exposures.
Choose 1 trigger which results in very little anxiety regarding the possibility of coming into direct contact with something you believe contains contaminants.
Continue exposure to this trigger for no less than 1 hour (the longer, the better).
Take note of your level of anxiety, on a scale of 1 to 10, and approximately every 5 minutes record this number. It’s normal for your anxiety level to spike to its highest level more than once during an exposure session.
NEVER stop an exposure session when your anxiety level is high; wait until the time period is over, or until your levels have been reduced by at least 50%.
REFRAIN from ANY type of washing ritual during AND AFTER the session.
These sessions should be conducted every day, for at least 10 days. Following this time period, use the same exposure principles for another trigger which you feel is slightly more difficult to handle.
In addition to using exposure, also practice reasonable washing rules, and post them in the bathroom, kitchen, etc. For example:
Use only soap & water (no disinfectants).
Wash hands for only 15 seconds or less.
Dry hands on a towel you have used for at least 4-5 days.
Take only 1 shower per day.
Limit shower time to no more than 10 minutes.
There are another 10-12 washing rules we recommend, but are too lengthy for this article. For those who are interested, feel free to email us for more information.
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.