Deconstructing Contamination Fears: A Graded Exposure Plan for OCD

You and your therapist will create a list of contamination situations, from least to most anxiety-provoking. Rate each one: 0 to 100 on the anxiety scale.

Example hierarchy:

Touch a door handle (30). Touch a handrail (40). Shake someone’s hand (50). Touch a public phone (60). Touch a bathroom door (70). Use a public bathroom (85).

Start with the lowest item. Touch the door handle. Then notice the urge to wash your hands. Do not wash for at least two minutes. Observe the anxiety spike. Watch it peak. Watch it go down. It always goes down.

Write down the peak anxiety and how long it took to come down.

Repeat the same exposure two to three more times this week. Each time, the peak will be lower.

Then move to the next item on the hierarchy.

This is not about getting comfortable with contamination. It is about learning that the anxiety will go down without you having to do a compulsion. The contamination itself is harmless. Your fear makes it feel dangerous.

The compulsion is what keeps OCD alive. Every time you wash to neutralize, you tell your brain: this was actually dangerous, and I needed to fix it. So your brain keeps sending the alarm.

The exposure teaches your brain: the alarm goes off, I feel scared, and nothing bad happens. The alarm is a false alarm.

This is hard. Do it anyway. Bring the data to your next session.