Conducting exposure and response prevention treatment for contamination fears during COVID-19: The behavioral immune system impact on clinician approaches to treatment

Authored By: Dean McKay, Charlene Minaya, & Eric A. Storch

Government and health officials have put in places various public health measures to contain the spread of COVID-19 during this global pandemic (e.g., social distancing, wearing a mask). While these strategies are essential to containing the spread of the virus, they present unique challenges for people with fears of contamination due to obsessive-compulsive disorder (OCD), as well as clinicians. Contamination fears associated with OCD often involve sanitizing or avoiding various objects, surfaces, or places in order to avoid potential contamination.

Treatment for people with OCD—particularly those with fears of contamination—often involve exposure and response prevention to feared situations; for example, exposure might involve having a person touch a feared object and response prevention might be refraining from handwashing, a behaviour that helps them to reduce their anxiety. Such strategies directly counteract measures taken to contain the spread of COVID-19, limiting clinicians’ ability to deliver exposure therapies. In addition, clinicians’ own reactions in response to the pandemic (e.g., disgust-related experiences), as well as their own beliefs about contamination, may limit their ability to effectively deliver exposure therapies. Disgust-related experiences involve activation of the behavioural immune system, which is a person’s evolved tendency to detect and avoid potential sources of illness.

The purpose of this study was to examine whether clinicians’ physiological disgust-related reactions (i.e., goosebumps, tingling, coldness, shivers) and fear of the unknown are associated with their beliefs about delivering exposure therapies. A total of 139 OCD treatment specialists participated in a survey assessing disgust-related reactions, fear of the unknown, and beliefs about exposure therapies. Results indicated that clinicians with greater physiological disgust-related reactions—particularly coldness, which is a common reaction in response to potential sources of illness—were more likely to have negative attitudes towards using exposure therapies. As clinicians’ caseloads of clients with OCD increased, negative attitudes towards exposure therapies decreased. Fear of the unknown was unrelated to clinicians’ attitudes towards exposure therapies.

Clinicians treating clients with OCD must attempt to balance their own concerns of infection when providing therapies involving exposure for OCD. When developing exposure therapies for clients with fears of contamination, clinicians must also balance the delivery of exposure therapies with new public health measures for containing the spread of disease.

Lay summary written by: Geoffrey Rachor. Edited by: Michelle Paluszek.

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