CBT for Mental Contamination

Prof. Maureen Whittal & Prof. Roz Shafran

Wednesday, 14 December 2022

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Introduction

Why can Obsessive Compulsive Disorder (OCD) be so difficult to treat? This was the question that perplexed the late Professor Jack Rachman. In the early 2000s (Rachman, 2004, 2006), he proposed that an important reason that existing interventions sometimes failed to be effective was that clinicians and researchers had failed to identify a form of OCD that he termed ‘mental contamination’. Over the past 25 years Mental Contamination (MC) has become recognised as a distinct and transdiagnostic construct. MC is defined as feelings of contamination, often located internally, that arise in the absence of direct physical contact with a contaminant, with the source proposed to be human. A recent systematic review involving the presenters found 58 papers on mental contamination,. The studies demonstrated that far from being a rare, unusual form of OCD as might have originally been hypothesised, it was surprisingly common with up to 46% of participants with clinically elevated symptoms of OCD (Coughtrey et al., 2012) reporting aspects of MC. Although particularly intertwined with contact contamination, the studies showed that MC was also associated with a broad range of OCD themes, other psychopathology such as PTSD and psychological constructs such as self-perception. Furthermore, MC tends to behave in the same way as other forms of OCD, notably being associated with imagery and having magical properties such as spreading by contagion.

The original concept of MC proposed that there were different manifestations of MC including visual contamination, self-contamination and morphing. The literature has not followed the original conceptual distinctions between the different forms of MC although these remain clinically important. Instead, the focus has been on the assessment and formulation of MC and its triggers including trauma and, notably, the role of betrayal. Appropriate identification, assessment and treatment of MC can be essential for people whose OCD has previously been classified as ‘treatment resistant’.


The event will be equivalent to 1.1/2hrs of CPD.

Content

This 90-minute webinar will describe the clinical manifestation of mental contamination in OCD and describe its core characteristics, including a comparison between contact and mental contamination. It will provide information on how to identify mental contamination and provide measures that can be used in assessment. The webinar will provide techniques to help derive a shared formulation of MC and engage clients in interventions. The webinar will assume a high level of knowledge of CBT for OCD treatment techniques, and so will provide an overview only on techniques specific to addressing MC including those within assessment, formulation (including the role of disgust), psychoeducation (e.g., the role of the human source in MC, mislabelling mood states), monitoring, surveys, behavioural experiments, addressing the meaning of contamination, imagery and relapse prevention.

Learning Objectives

1. To be able to identify MC and understand the relationship between MC and contact contamination
2. To be aware of techniques to help assess MC and derive a shared formulation of the maintenance of MC
3. To have an overview of specific techniques that can be used in MC
4. To provide information on where further information on MC can be found for more in-depth future learning

Training Modalities

Didactic content, Q&A, polls, video/live role play and experiential components will be used.

Key References


Coughtrey, A. E., Shafran, R., Lee, M., & Rachman, S. (2013b). The Treatment of Mental Contamination: A Case Series. Cognitive and Behavioral Practice, 20(2), 221-231. https://doi.org/10.1016/j.cbpra.2012.07.002
Melli, G., Bulli, F., Carraresi, C., Tarantino, F., Gelli, S., & Poli, A. (2017). The differential relationship between mental contamination and the core dimensions of contact contamination fear. Journal of Anxiety Disorders, 45, 9-16. https://doi.org/10.1016/j.janxdis.2016.11.005

Rachman, S. (2010). Betrayal: A psychological analysis. Behaviour Research and Therapy, 48(4), 304-311.
Rachman, S., Coughtrey, A., Shafran, R., & Radomsky, A. (2014). Oxford guide to the treatment of mental contamination. OUP Oxford.
Radomsky, A. S., Rachman, S., Shafran, R., Coughtrey, A. E., & Barber, K. C. (2014). The nature and assessment of mental contamination: A psychometric analysis. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 181-187.

About the presenter

Maureen Whittal is a private practice psychologist in Vancouver, Canada and Associate Clinical Professor in the Department of Psychiatry at the University of British Columbia. Her research work centred on the development and testing of cognitive treatments for OCD. She had the honour of working with Jack Rachman for 35 years in both research and clinical work. It was in this clinical work that we identified mental contamination which initiated Professor Rachman’s further exploration. She is also co-founder of Anxiety Canada and is now co-chair of its Scientific Advisory Committee.
Roz Shafran is Director of Bespoke Mental Health and a Professor of Translational Psychology at the UCL Great Ormond Street Institute of Child Health. Her clinical and research interests have focused on developing, evaluating and disseminating evidence-based psychological therapies across the age range. She has published over 250 research papers in areas such as OCD, Perfectionism and Eating Disorders. She had the privilege to work with Professor Rachman for over 30 years.

Who should attend

This is a high-level event that assumes a good working knowledge of CBT for OCD. It is aimed at clinicians wanting to understand the nature of mental contamination and how best to treat it.