Assessment for Disgust Based OCD

I have been working with clients with emetophobia (fear of vomiting) for quite some time now. Through my research working with people who struggle with emetophobia, I have come to find that many of them struggle with the sensory experiences that come with seeing, feeling or hearing vomit. Many also would describe feeling disgusted by vomit. It led me to devise a new treatment protocol by implementing disgust-based OCD practices within my emetophobia program. This would mean moving away from classic Exposure and Response Prevention techniques (have them expose themselves to vomit until they habituated from the anxiety), and more to managing each vomiting situation by permitting comfort-based strategies. The goal of our treatment is to expose the anxiety-provoking situations and then when confronted with the vomit move to tolerating the distress and using techniques (listening to music, watching a video etc) to manage the discomfort of the vomiting stimuli.

When it comes to OCD work around disgust, exposure may not be the only way to treat disgust-based symptoms. This may mean that crutches (accommodations) can be used to help the patient gain better mastery of the situation until they are ready to fully engage in tolerating the disgust. As the patient moves through their hierarchy of disgust-based items/situations, accommodations can be tailored or modified to help the client gain a better sense of mastery. The client will participate in activities they value and build a list around those times. We would then find ways so that they can do them as comfortably as possible and then do it often enough with fewer accommodations each time.

Disgust Based OCD Treatment Practices

• Patients improve faster and described a better sense of mastery through this treatment protocol.

• It combines both Exposure and Response Prevention with Acceptance and Commitment Therapy – both evidence-based practices for OCD and other anxiety-related disorders

• Very well tolerated by patients who struggle with OCD or other specific anxiety disorders.

Disgust Based OCD – CBT-I Therapy Work

Education is also provided on the narrative that the patient describes when they are triggered by their OCD. The client may imply that they feel contaminated which may be part of the imaginal story that the individual has formed regarding their contamination concerns. The patient may imagine a narrative that may be influencing them to feel a certain way about whatever it is they deem as contaminated. For example, someone may struggle with thinking feces may transfer to them if they were to touch certain objects. This may be accompanied by a disgust response. The goal of treatment is to help the individual recognize the narrative that they are telling themselves is happening between feces and the contact item and educate them on how it is imagined. The purpose is to interrupt the obsessional dialogue and help them by stopping their compulsions. We want to make sure that the patient is aware of their imagination taking over and how it influences how they perceive the situation.