Workshop 1

David Veale, South London and Maudsley NHS Foundation Trust and the Nightingale Hospital, London

Contamination is one of the most common fears in OCD. About 1/3^rd 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).

Key learning objectives:

By the end of this workshop, participants will be able to:

• 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

David Veale is a Consultant Psychiatrist at the Centre for Anxiety Disorders and Trauma (outpatients) and at the Anxiety Disorders Residential Unit at the South London and Maudsley NHS Foundation Trust and the Nightingale Hospital London (private inpatient ward for OCD) and a Visiting Professor in Cognitive Behavioural Psychotherapies in the Department of Psychology at the Institute of Psychiatry, Psychology and Neurosciences, King’s College London. He is past President and a Hon Fellow of The British Association of Behavioural and Cognitive Psychotherapies, a Fellow of the British Psychological Society and of The Royal College of Psychiatrists. He is a Trustee of the OCD Action, the BDD Foundation and Emet Action. He has published about 150 peer-reviewed articles and four self-help books.

Key References

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

Sundermann, O. & Veale, D. (2022) Obsessive-compulsive disorder – an updated cognitive behavioral approach. In: Evidence Based Treatments for Anxiety Disorders and Depression. Cambridge. Ed: Todd, G. and Branch, R. Cambridge University Press. ISBN 9781108355605

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