Pets & OCD: Contamination

Posted by in Contamination/Health-Related Symptoms, Obsessive-compulsive disorder (OCD), OCD Obsessions focusing on pets and animals incorporate all the common themes: contamination, checking, harm, scrupulosity, and sex. In this 3-part blog series, I discuss some of the common ways OCD obsessions may target our lovable, snuggable friends. This article, Part 2, will focus on contamination obsession associated with pets and animals. Part 1 covered harm and violent obsessions related to pets. Part 3 will address sexual obsessions and scrupulosity, as they pertain to pets and animals. Most everybody loves that shower fresh feeling, right? Not only does it feel good, but it’s probably good for us too. Throughout history, cleanliness and good hygiene practices have been instrumental to reducing our vulnerability to germs, disease, and illness. For survival’s sake, to a certain extent, we’re probably biologically-programmed to prefer clean, hygienic environments, over dirty, disgusting ones. Yet, at the same time, our human weakness for all things cute and cuddly leads many of us to choose to co-habitate with wild — or rather, domesticated — animals. This choice brings with it all sorts of opportunities for OCD to stir up contamination worries. Dogs and cats walk around barefoot outside or in litter boxes, and they tend not to wash their paws or bottoms very often (and when they do, it’s only with our assistance). Moreover, dogs have a predilection for both sniffing other dogs’ rear ends and licking themselves in inappropriate places… Naturally, this licking always tends to happen right before they decide to run up to us and lick us on the face. YUCK! So yes, animals can be gross sometimes. But fortunately, most of OCD’s error messages about how dirty, disgusting, dangerous, and unacceptable this is, tend to be overblown. OCD contamination obsessions about pets and animals come in a couple different varieties. Today, we’ll focus on identifying obsessions related to the fear of contaminating your pet, as well as the fear of being contaminated by your pet. Pet Obsessions – Fear of Contaminating Your Pet These pet obsessions involve accidentally contaminating your pet or making it sick. What if I make my pet sick by accidentally feeding it food contaminated with household chemicals or cleaning products? What if the air freshener I spray gets in my cat’s lungs and makes him sick? What if I accidentally feed my dog tainted or spoiled food? What if bugs accidentally got into my kitten’s food? What if I accidentally spread...
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ERP Tip of the Day #2

Posted by in “Pure-O” Symptoms, CBT, Checking-Related Symptoms, Contamination/Health-Related Symptoms, ERP, ERP Tips, Harm-Related Symptoms, Obsessive-compulsive disorder (OCD), OCD, OCD - Treatment, Sexual Symptoms It’s ERP tip time. This series of posts focuses on tips to enhance the effectiveness of your exposure and response prevention (ERP). If you’re interested in more ERP tips, click the following link for all the posts in this series. Exposure and Response Prevention (ERP) Tips for OCD Without further ado, here’s another ERP tip to consider when designing your next exposure. ERP Tip #2 When completing your next exposure, avoid rules that dictate what you’re allowed to think during the exposure. If you try to complete an exposure without having a certain bad thought, chances are that you’re setting yourself up to think that very thought. Instead, design your exposure around having that very same unwanted thought. I love it when people with OCD do exposure, but I don’t love it when they have a long list of impossible preconditions that dictate the form of their OCD exposure. The most glaring example of this is when people dictate the thoughts that they should have during exposure. OCD ERP Tip Don’ts What I don’t like: I’m going to touch that doorknob, but I really hope that it’s not wet or slimy. When it’s wet or slimy, it makes me think that it has blood on it, and that I might really be contracting AIDS. I really don’t want to die, so I’m okay with touching that doorknob, just as long as it’s dry as a bone, so that it doesn’t freak me out. What I don’t like: I’m willing to walk across that mystery spot in the parking lot, just as long as it doesn’t look at all red or brown or sticky or possibly organic in some form or another. If it looks that way, it really freaks me out and then it makes me think that I’m tracking AIDS blood everywhere. What I don’t like: I’m willing to look at pictures of kids, just as long as I don’t have sensations in my groin. When I have those sensations, it really freaks me out and I think there may actually be something wrong with me. What I don’t like: I’m okay with holding my baby, just as long as I don’t think about throwing him down the stairs, snapping his neck, or doing something inappropriate to him. If those violent OCD thoughts show up, I’ll be really freaked out, and I won’t be able to handle it....
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Contamination OCD – Long Shower Exposures

Posted by in Contamination/Health-Related Symptoms, ERP, General, Obsessive-compulsive disorder (OCD), OCD Long shower times? Just a quick announcement… I’m pleased to announce that with our recent office renovations, we now have a spa-like therapeutic shower room that is perfect for individuals with contamination OCD who have excessively long shower times. This room is ideal for those with contamination OCD who wish to work on shower-based response prevention. For individuals with contamination OCD who take really long showers, we are now able to provide office-based interventions for reducing your long shower times. We’ve had great success with reducing our patients long shower times from multiple hours to a mere 10-15 minutes. Reduce Long Shower Times to Short OCD Shower Times We do this first by developing shower-based response prevention guidelines and modeling non-OCD based shower behavior in-session. We essentially use a shower script to help individuals identify normal shower routines (which, to many of our patients’ surprise, DO NOT include hand-washing behaviors between washing each body part). We practice these routines out of the shower so that our patients can get individualized coaching on these routines. These simulated showers are first performed in our therapy rooms with a therapist, but then are performed in virtual reality (VR) in a virtual model of our office-based shower therapy room. Our shower scripts are then digitized and downloaded to our patient smart phones, and we then have our contamination OCD patients practice these routines in self-directed exposures in their own homes (in their own showers, but without running water). Due to this practice, long shower times start give way to shorter shower times. We also have individuals with OCD complete imaginal exposure. Next, we have our contamination OCD patients practice their showers in-office (with running water) in a spa-like shower room. Although our shower is sterilized after each exposure, the very act of using a public shower is, itself, an exposure. To facilitate these shower-based exposures, we use the same digitized audio script that we used in our simulated exposures to guide the shower. Importantly, we’re also available live via specialized audio technology to coach our patients in implementing this protocol. Patients have full privacy in our spa-like shower room, yet they have the benefit of a live therapist coaching them remotely. In the event that a patient deviates from their script and begins taking a long shower, we can pause the script, get them back on track via coaching, and then resume the...
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Imaginal Exposure vs. In Vivo Exposure for OCD

Posted by in “Pure-O” Symptoms, CBT, Checking-Related Symptoms, Contamination/Health-Related Symptoms, ERP, Harm-Related Symptoms, Obsessive-compulsive disorder (OCD), OCD, OCD - Treatment, Sexual Symptoms As I’ve talked about in numerous posts, overcoming OCD involves learning to co-exist with doubt and uncertainty. This idea can be a bit counter-intuitive at first, as many people initially expect OCD treatment to reduce uncertainty. One therapeutic approach that helps with this process is exposure and response prevention (ERP) for OCD. Not surprisingly, ERP consists of two parts: 1) exposure, and 2) response prevention. An exposure is when you do something on purpose to provoke an anxiety spike. By definition, exposures are not accidental; rather, they are pre-planned, deliberate offensive strikes against your OCD. Exposures are designed to help you build up your tolerance to fear-producing situations. Exposures are often completed according to an exposure hierarchy, meaning that people typically complete lower level exposures (i.e., less distressing exposures) before gradually working up to higher level ones. Response prevention refers to the idea that after the exposure, you will allow your anxiety to naturally decrease on its own without artificially forcing it to decrease prematurely through rituals. Response prevention is most effective when one resists ALL rituals, including both behavioral and mental rituals. Behavioral rituals may include things like washing, checking, or rearranging; whereas mental rituals may include self-reassurance, thinking “safe thoughts”, praying, or mental review. Avoidance is also considered a ritual. Exposures come in two forms: in vivo exposure and imaginal exposure (also referred to as “scripting“). In Vivo Exposure for OCD When we think about exposure therapy for OCD, we often think first about in vivo exposure. In vivo ERPs involve directly exposing yourself to feared situations in real-life. For example, a person with contamination OCD might develop a hierarchy of in vivo exposures that involve purposefully touching “dirty things” like doorknobs, light switches, trashcans, animals, or even toilets. The goal of these in vivo exposures is to face the fear directly without ritualizing. This means that after touching these contaminated objects, the person would refrain from washing their hands, using hand sanitizer, getting reassurance, mentally reviewing reasons why it’s okay to not wash, or doing anything else to neutralize the perceived danger of the situation. Likewise, someone with harm OCD might develop a hierarchy based on putting themselves in feared situations. These feared situations should evoke the fear directly or present opportunities for the person to act on the fear. For example, someone who is afraid of stabbing their spouse might expose themselves to situations such...
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