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When the Problem is Beneath the Surface in OCD: The Cognitive Treatment of a Case of Pure Mental Contamination

Published online by Cambridge University Press:  07 June 2012

Emma Warnock-Parkes ,
Paul M. Salkovskis  and
Jack Rachman
Emma Warnock-Parkes*
Affiliation:
Kings College London, UK
Paul M. Salkovskis
Affiliation:
University of Bath, UK
Jack Rachman
Affiliation:
University of British Columbia, Vancouver, Canada
*
Reprint requests to Emma Warnock-Parkes, Kings College London, Psychology Department, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK. E-mail: [email protected]
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Abstract

Background: Mental contamination is a phenomenon whereby people experience feelings of contamination from a non-physical contaminant. Rachman (2006) proposes that standard cognitive behavioural treatments (CBT) need to be adapted here and there is a developing empirical grounding supporting the concept, although suggestions on adapting treatment have yet to be tested. Method: A single case study is presented of a man with a 20-year history of severe treatment resistant Obsessive Compulsive Disorder (OCD) characterized by mental contamination following the experience of “betrayal”. He was offered two consecutive treatments: standard CBT and then (following disengagement with this) a cognitive therapy variant adapted for mental contamination. Clinician and patient rated OCD severity was measured at baseline and the start and end of both interventions. Results: Six sessions of high quality CBT were initially attended before refusal to engage with further sessions. There were no changes in OCD severity ratings across these sessions. A second course of cognitive therapy adapted for mental contamination was then offered and all 14 sessions and follow-ups were attended. OCD severity fell from the severe to non-clinical range across these sessions. Conclusions: The need to consider adapting standard treatments for mental contamination is suggested. Limitations and implications are discussed.

Keywords

Obsessive compulsive disordercontaminationwashing compulsionsmental contaminationbetrayal
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 40 , Issue 4 , July 2012 , pp. 383 - 399
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

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References

Abramowitz, J. S., Taylor, S. and McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374, 491–499.CrossRefGoogle ScholarPubMed
Arntz, A. and Weertman, A. (1999). Treatment of childhood memories: theory and practice, Behaviour Research and Therapy, 37, 715–740.CrossRefGoogle ScholarPubMed
Beck, A. T., Emery, G. and Greenberg, R. L. (1985). Anxiety Disorders and Phobias. New York: Basic Books.Google Scholar
Conway, M. A. (2005). Memory and the self. Journal of Memory and Language, 53, 594–628.CrossRefGoogle Scholar
Cottraux, J., Note, I., Yao, S. N., Lafont, S., Note, B., Mollard, E., et al. (2001). A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 70, 288–297.CrossRefGoogle ScholarPubMed
Coughtrey, A., Shafran, R., Lee, M., Enright, S. and Rachman, S. (2011). Remember a time when you have been harmed, humiliated or betrayed: the experimental induction of mental contamination. Manuscript submitted for publication.Google Scholar
Coughtrey, A., Shafran, R., Lee, M. and Rachman, S.J (2012). It's the feeling inside my head: a qualitative analysis of mental contamination in Obsessive-Compulsive Disorder. Journal of Behavioural and Cognitive Psychotherapy, 40, 163–173.CrossRefGoogle Scholar
De Haan, E., van Oppen, P., van Balkom, A. J. L. M., Spinhoven, P., Hoogduin, K. A. L. and van Dyck, R. (1997) Prediction of outcome and early vs. late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy. Acta Psychiatrica Scandinavica, 96, 354–361.CrossRefGoogle ScholarPubMed
Ehlers, A., and Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Elliott, C. M. and Radomsky, A. S. (2009). Analyses of mental contamination: Part I, experimental manipulations of morality, Behaviour Research and Therapy, 47, 995–1003.CrossRefGoogle ScholarPubMed
Fairbrother, N., Newth, S. and Rachman, S. (2005). Mental pollution: feelings of dirtiness without physical contact, Behaviour Research and Therapy, 43, 121–130.CrossRefGoogle ScholarPubMed
Foa, E. B., Kozak, M. J., Goodman, W. K., Hollander, E., Jenike, M. A. and Rasmussen, S. A. (1995). DSM-IV field trial: obsessive-compulsive disorder. American Journal of Psychiatry, 152, 90–96.Google ScholarPubMed
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E. and Amir, N. (1998). The validation of a new obsessive compulsive disorder scale: the Obsessive Compulsive Inventory (OCI). Psychological Assessment, 10, 206–214.CrossRefGoogle Scholar
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151–161.CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale–Brown Obsessive–Compulsive Scale. I. development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.Google ScholarPubMed
Greist, J. H., Marks, I. M., Baer, L., Kobak, K. A., Wenzel, K. W., Hirsch, M. J., et al. (2002). Behaviour therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry, 63, 138–145.CrossRefGoogle ScholarPubMed
Herba, J. K. and Rachman, S. (2007). Vulnerability to mental contamination. Behaviour Research and Therapy, 45, 2804–2812.CrossRefGoogle ScholarPubMed
Houghton, S., Saxon, D., Bradburn, M., Ricketts, T. and Hardy, G. (2010). The effectiveness of routinely delivered cognitive behavioural therapy for obsessive-compulsive disorder: a benchmarking study. British Journal of Clinical Psychology, 49, 473–489.CrossRefGoogle ScholarPubMed
Karno, M., Golding, J. M., Sorenson, S. B. and Burnam, M. A. (1988). The epidemiology of obsessive-compulsive disorder in five US communities. Archives of General Psychiatry, 45, 1049–1094.CrossRefGoogle ScholarPubMed
Ladouceur, R., Leger, E., Rheaume, J. and Dube, D. (1996). Correction of inflated responsibility in the treatment of obsessive–compulsive disorder, Behaviour Research and Therapy, 34, 767–774.CrossRefGoogle ScholarPubMed
Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behavior Research and Therapy, 4, 273–280.CrossRefGoogle ScholarPubMed
Mundt, J. C., Marks, I. M., Greist, J. H. and Shear, K. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.CrossRefGoogle Scholar
Rachman, S. (1994). Pollution of the mind, Behaviour Research and Therapy, 32, 311–314.CrossRefGoogle ScholarPubMed
Rachman, S. (1997). A cognitive theory of obsessions. Behavior Research and Therapy, 35, 793–802.CrossRefGoogle ScholarPubMed
Rachman, S. (2006). The Fear of Contamination: assessment and treatment. Oxford: Oxford University Press.CrossRefGoogle Scholar
Rachman, S. (2009). Vancouver Obsessional Compulsive Inventory Mental Contamination Scale (VOCI-MC). Available on request.Google Scholar
Rachman, S. (2010). Betrayal: a psychological analysis. Behavior Research and Therapy, 48, 304–311.CrossRefGoogle ScholarPubMed
Rachman, S. and Hodgson, R. (1980). Obsessions and Compulsions. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Radomsky, A. S. and Elliott, C. M. (2009). Analyses of mental contamination: Part II, individual differences. Behaviour Research and Therapy, 47, 1004–1011.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1985). Obsessive–compulsive problems: a cognitive–behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1989). Cognitive behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677–682.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, 29–52.Google ScholarPubMed
Singer, J. A. and Salovey, P. (1993). The Remembered Self: emotion and memory in personality. New York: Free Press.Google Scholar
Spitzer, R. L., Kroenke, K. and Williams, J. B. W. (1999). Patient Health Questionnaire Study Group: validity and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. Journal of American Medical Association, 282, 1737–1744.CrossRefGoogle Scholar
Spitzer, R. L., Kronke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of International Medicine, 166, 1092–1097.CrossRefGoogle ScholarPubMed
Torres, A. R., Prince, M. J., Bebbington, P. E., Bhugra, D., Brugha, T. S., Farrell, M., et al. (2006). Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. American Journal of Psychiatry, 163, 1978–1985.CrossRefGoogle ScholarPubMed
Van Oppen, P., de Hann, E., van Balkom, A. J. L. M., Spinhoven, P., Hoogduin, K. and van Dyck, R. (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behavior Research and Therapy, 33, 379–390.CrossRefGoogle ScholarPubMed
Wild, J., Hackmann, A. and Clark, D. M. (2008). When the present visits the past: updating traumatic memories in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38, 386–401.CrossRefGoogle Scholar
Woody, S. R., Steketee, G. and Chambless, D. L. (1995). Reliability and validity of the Yale-Brown Obsessive Compulsive Scale. Behaviour Research and Therapy, 33, 597–605.CrossRefGoogle ScholarPubMed
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