Hello, friends with contamination obsessions. I had some thoughts today about the experience that I hope you’ll find helpful. Hopefully it’s not too rambling or irrelevant! To elaborate a bit on your experience. So you’re engaging in compulsions (hand washing) because of some obsessional content. From current research, we know compulsions work for alleviating anxiety, at least for some time. But because compulsions are a form of suppression—trying to eliminate, reduce, or avoid the thoughts—they tend to come back with more intensity. So, paradoxically, compulsions actually feed your obsession rather than alleviate it. So where does that leave you? Well, exposure is about reconditioning your mind to respond differently. Assuming this is a contamination obsession, you may touch something “dirty” while not engaging in a compulsion like handwashing. You may start small, with something that doesn’t trigger you as much, while working your way up to whatever is most triggering for you. A couple notes here: this is going to be extremely difficult and distressing. Which is totally normal, because your brain is so habituated to a certain response (compulsion) that when you do ERP it actually, at least temporarily, feels worse. The compulsion has been your “safety net” in a sense, and your OCD may respond intensely in their absence. It may not feel like anything is happening. It’s going to take willingness and courage on your part to continue on in spite of how it feels. That’s the real and messy work of recovery. Do an exposure for at minimum 30 minutes. Most therapists recommend an hour if you can. Give the exposure your full attention. The idea is once you’re bored with that exposure, you move up the hierarchy. But as you may be noticing, your compulsions are only escalating. OCD cannot be satisfied by a compulsion. It will always crave more, and you will watch your world become smaller and smaller. This is where ACT or acceptance/commitment approaches are so helpful. We spend so much of our life avoiding any uncomfortable feeling. This works in our external world. Say if you touch a hot stove, then avoiding the stove or moving away from it helps you. This is not the case for your internal world. Humans have the ability to connect things via association. So if an animal, say a cat, touches a stove it will get burned and learn to avoid that stove. It won’t reflect on the experience, avoid anything that’s hot even if it’s not a stove, and wonder if something is wrong with it for touching the stove. Your brain goes, “This thing is dirty. What else is dirty? Are people dirty? Is the outside world dirty? I’m noticing dirty things all the time, so maybe everything is dirty. I washed my hands, ok, good. Did I wash them enough? Ok, I’ll do it again. That feels better. Maybe it didn’t work. I saw something that someone got contaminated from their food. Why am I doing this? I don’t want to do this? Please, I don’t want to think about this? If I use bleach, I know that’s clean that’ll work. Yes! Thankfully, I can rest. Wait, maybe I didn’t get all my hands, I’ll do it again. Why can’t I stop? I need someone to help. Just anyone. Let me get online. I’ll ask if anyone else has this, they do! But maybe I’m not like them. How did they stop? Why can’t I do what they did? Maybe I’m broken? Someone please help. Okay, I have to wash again.” That one experience can associate and morph and grow. Unlike the cat, the hot stove follows you everywhere. ACT, or acceptance, isn’t accepting that every thing is contaminated. It’s watching that war in your mind, laying down your weapon, and letting the battle rage while you’re off the field. The fighting may or may not end, but it’s immaterial to your life.