COGNITIVE DRILL THERAPY IN MENTAL CONTAMINATION: A CASE STUDY

Cognitive Drill Therapy (CDT) relies on repetitive verbal exposure of ideations related to feared consequences for psychological management of OCD and phobia. We are presenting a case of OCD with predominantly compulsive type who was having prominent features of mental contamination. He is a middle aged married male having his own professional law practice. His contamination OCD got triggered about two years back after gall bladder operation. He was being treated with SSRI for a few months. He was referred for psychological management. The severity ratings on Y-BOCS measure was 43. His OBSD consisted of a large number of dirty objects; either touch or even being in proximity of dirty objects elicited severe distress in him leading to compulsive cleaning and washing his hands/body, clothes and objects; also he tended to avoid exposure to dirty objects by restricting his professional activities and going outside. The primary danger ideation was fear of spreading contamination to other objects in his house and work place. He was psychoeducated regarding his disorder and the role of feared cognition and compulsive acts in the maintenance of his compulsive behavior. Cognitive drill was applied in-vitro and at verbal level. No in-vivo behavioral exposure was done in therapy sessions. Typically, he was required to make his hands/body dirty in imagination and then mentally touch domestic objects and keep verbalizing that the touched object has become dirty. He demonstrated substantial reduction in his compulsive behaviors within six therapy sessions which were being maintained on two weeks and then six weeks follow up. More follow ups are being conducted. His Y-BOCS severity rating dropped substantially. There is a tremendous improvement in his socio-occupational functioning as well as perceived self-efficacy. The improvement is also validated by the reports of his family members. It is implicated that in-vitro and verbal exposure can ease the exposure task for the patients as well as the therapists.