Bespoke Members
Introduction
Mental contamination refers to an internal sense of dirtiness, pollution, or violation that occurs in the absence of direct physical contact and is often experienced as pervasive, distressing, and difficult to neutralise. While most commonly described within obsessive-compulsive disorder (OCD), mental contamination is increasingly recognised as clinically relevant across a range of presentations, including trauma-related difficulties, anxiety, and shame-based distress.
Research indicates that mental contamination is more common than previously assumed and can significantly interfere with treatment when it is not explicitly identified or addressed. Clinically, this may present as limited response to exposure-based interventions, persistent distress despite behavioural change, or difficulties engaging clients in therapy.
This webinar introduces clinicians to the theory, evidence base, and clinical implications of mental contamination, with a focus on improving recognition, formulation, and intervention in everyday practice. The webinar aims to equip clinicians with the specific knowledge required to recognise mental contamination and avoid common formulation and intervention difficulties that can arise when these processes are not identified.
The event will be equivalent to 2 hrs of CPD.
Content
The webinar will begin with an overview of mental contamination, including its phenomenology and how it differs from contact-based contamination fears. Contemporary cognitive-behavioural models will be outlined, with particular attention to the role of perceived violation, betrayal, responsibility, shame, and moral threat in the development and maintenance of mental contamination.
Different forms of mental contamination will be explored, including those arising following physical or psychological violation, self-contamination, visual contamination, and fears of internal change or “morphing”. While clinical examples will draw primarily on OCD, the session will highlight transdiagnostic processes relevant across presentations.
Assessment considerations will be discussed, including how mental contamination may be under-reported and how to sensitively enquire about it in clinical work. The final part of the webinar will focus on treatment implications, including adapting cognitive-behavioural formulations, modifying exposure-based approaches, and using imagery-based and behavioural experiments when mental contamination is central. Brief clinical vignettes will be used throughout to support translation into practice.
Learning Objectives
1) Describe the key features and theoretical models of mental contamination.
2) Recognise different forms of mental contamination across clinical presentations.
3) Conduct an assessment that identifies mental contamination and associated threat appraisals, including responsibility and betrayal-related concerns.
4) Apply formulation-driven, evidence-based strategies to address mental contamination in clinical practice.
Training Modalities
The webinar will include didactic teaching, live polls, and reflective questions. Anonymised clinical vignettes will be used to illustrate key concepts, and guided self-reflection will support clinicians in applying the material to their own clinical work. There will be time allocated for questions and discussion at the end of the session.
Key References
The following references reflect foundational, transdiagnostic, and clinically applied work on mental contamination.
Foundational study: Fairbrother, Newth, & Rachman (2005). Mental pollution: feelings of dirtiness without physical contact. Behaviour Research and Therapy. https://doi.org/10.1016/j.brat.2003.12.005
Measurement of MC: Radomsky et al. (2014). The nature and assessment of mental contamination: A psychometric analysis. Journal of Obsessive Compulsive and Related Disorders. https://doi.org/10.1016/j.jocrd.2013.08.003
Transdiagnostic processes: Coughtrey et al. (2018). Mental contamination: Relationship with psychopathology and transdiagnostic processes. Journal of Obsessive Compulsive and Related Disorders, 17, 39–45. https://doi.org/10.1016/j.jocrd.2017.08.009
Clinical case example: Micheli, E., & Melli, G. (2026). Imagery rescripting and behavioural experiments for mental contamination in obsessive-compulsive disorder: A case illustration. Journal of Clinical Psychology, 1–8. https://doi.org/10.1002/jclp.70083
Relevant reviews: Ojalehto, H. J., & Abramowitz, J. S. (2024). Mental contamination among trauma survivors: A scoping review. Traumatology, 30(4), 661–676. https://doi.org/10.1037/trm0000492
Millar, J. F. A., Coughtrey, A. E., Healy, A., Whittal, M., & Shafran, R. (2023). The current status of mental contamination in obsessive-compulsive disorder: A systematic review. Journal of Behavior Therapy and Experimental Psychiatry. https://doi.org/10.1016/j.jbtep.2022.101745
About the presenter
Dr Josie Millar is a Clinical Psychologist and Lecturer on the Doctorate in Clinical Psychology programme at the University of Bath.
Josie completed her clinical psychology training in Australia in 2006 and has worked across a wide range of adult mental health settings in both the UK and Australia, including primary care, specialist anxiety services, and secondary care. She undertook her PhD in the UK under the supervision of Professor Paul Salkovskis, focusing on obsessive-compulsive disorder. Josie is a Fellow of the Higher Education Academy and an Associate Editor for Psychology and Psychotherapy: Theory, Research and Practice
Her clinical work has focused particularly on obsessive-compulsive disorder, anxiety, and trauma-related difficulties, with a strong emphasis on formulation-driven Cognitive Behavioural Therapy (CBT).
Josie has a longstanding clinical and research interest in mental contamination and its role in the development and maintenance of psychological distress. Her teaching interests focus on translating theory and research into practical, flexible, and clinically useful approaches, with a particular emphasis on helping clinicians develop strong formulation skills and apply evidence-based interventions thoughtfully and effectively in real-world practice.
Who should attend
This webinar is suitable for qualified and trainee clinicians working in adult mental health settings, including psychologists, CBT therapists, nurse therapists, counsellors, and psychological practitioners, across primary and secondary care.
It will be particularly relevant for clinicians working with presentations involving obsessive-compulsive difficulties, anxiety, trauma-related experiences, shame, and feelings of internal dirtiness or violation, as well as those who would like to develop a clearer understanding of mental contamination and its clinical implications. A basic familiarity with CBT principles is helpful, but no specialist prior knowledge of mental contamination is required.