Workshop 13 - Mental Contamination in OCD: A Cognitive Approach to Identification and Treatment

Mental contamination (MC), defined as feelings of dirtiness or pollution in the absence of physical contact, has been found to be in present in almost half of people with obsessive compulsive symptoms and overlaps with contact contamination (CC). People high in MC are often those with the most severe overt compulsions (e.g., hours in the shower, scrubbing themselves to the point of the skin being raw, chapped and bleeding) as well as avoidance which can be extreme.

A substantial amount of theoretical and empirical work has been completed on MC and its relationship to trauma, disgust and other manifestations of obsessive-compulsive disorder (OCD). However, work on the treatment of MC has not kept pace. One of the aims of this presentation is to provide an overview of the assessment and treatment strategies to use with clients with different forms of MC. This workshop will begin with the description of the clinical manifestation of MC in OCD and its core characteristics, including a comparison between CC and MC. Information will be presented on how to identify MC and measures will be provided that can be used in assessment and tracking of progress.

Building on the phenomenology, we will provide an overview of establishing a shared formulation of MC and how to engage clients in interventions. The main components of treatment will be presented, including psychoeducation (e.g., the role of the human source in MC, mislabelling of mood states), monitoring of specific episodes of MC and the role of appraisal. The meaning of contamination will be discussed through the use of surveys and behavioral experiments. Experiences associated with feelings of betrayal and humiliation are commonly associated with the onset of MC. The role of imagery and imagery rescripting to combat these upsetting precipitating events will be discussed. People with MC can experience a high personal moral code which is often imputed on others and in turn contributes to an explanation of how a stimulus becomes a trigger. Strategies will be presented to contain and limit the imputation of morals on others as well as decrease the individual’s own moral code. Treatment strategies will end with a discussion of relapse prevention. The session will be interactive with role-plays, videos and experiential exercises.

Session outline:

I. Phenomenology of MC
a. Comparison to contact contamination (CC)
II. Identification of MC
a. Self report assessment tools
b. Self monitoring of MC episodes
III. Building a case formulation
a. Focusing on the role of appraisal
b. Identification of factors that contribute to maintenance of MC
IV. An overview of treatment strategies for MC
a. Psychoeducation and the meaning of contamination (role of appraisal)
b. The role of imagery and imagery rescripting
c. Addressing the imputation of a high moral code (if present)
d. Relapse prevention