After six weeks of trying to write this blog post, I came to the conclusion that I simply could not identify with a fear of contamination. I couldn’t imagine experiencing a deep feeling of being unclean, an unshakeable physical and emotional belief that something unseen will make me sick and that there are no cleaning products available that can adequately wash away the grime. There was no way I could relate to having to stay away from anything potentially dirty so as to avoid a two-hour shower ritual, or to reducing my water consumption because every toilet seems like a biological landmine. And then last week I spent three days camping at a music festival. Now I get it.
Fear of contamination is a particular type of obsessive-compulsive disorder (OCD), involving obsessive thoughts about making yourself or others sick through contamination, plus compulsive decontamination behaviour, like excessive washing, sanitising, and avoiding touching or spreading contaminants. Music festivals are a particular type of social activity involving obsessive music fans putting themselves at risk of making themselves and others sick through contamination, without being about to complete any kind of over-the-top decontamination behaviour like, say, washing their hands with running water.
People with OCD are not delusional. Their Calm and Rational Brain is well aware that their fears are excessive and their behaviour disproportionate. But, when facing a potential contaminant, their good old Automatic Brain provides them with the unsettling feeling of being unclean or contaminated. Automatic Brain then convinces them that if they don’t complete their cleaning ritual, they will get horrifically sick, they will make someone else horrifically sick, or – at best – that the intense feeling of grubbiness will never diminish.
People at music festivals, on the other hand, are completely delusional. They spend more on wellies than they spend on a tent, and more on a beer than on dinner; they buy albums at Rough Trade that will later be resented for not adequately recapturing the magic of the festival; they believe that glitter paste is a good idea when there is no running water; they think that the only secret to looking like Kate Moss at a festival is the donning of short shorts; they are confident that their position at the back of the crowd is the only thing stopping them from playing Courtney Cox to The Tallest Man On Earth’s Springsteen. And in all but two of those examples, when I say “they”, I mean “I”.
Despite a three-day, multi-layered suspension of disbelief, one thing that I’m not delusional about is this: music festival goers don’t tend to die from horrific diseases. For the first few hours in the fields, my Automatic Brain tells me that the socially accepted laws of sanitisation cannot miraculously stop applying, and I get an intense feeling that I am contaminated in some way. Then my belief shifts to the festival-accepted laws of sanitisation, which is that I will definitely get sick, unless I ritually lock in those germs by coating them with a layer of antibacterial gel. When the gel runs out and I’m still Not Dead, I am forced to accept that perhaps in my normal life I am generally more cautious than is strictly necessary. Any residual feeling of grubbiness is easily diminished with copious amounts of Welsh cider.
The Technique – Exposure and Response Prevention (ERP)
The thoughts, feelings and behaviour in fear of contamination are all coming from the automatic part of the brain, which doesn’t learn from education, it learns from experience. If you ritually wash your hands for ten minutes every time they get dirty, then your automatic brain will never truly believe that you were unlikely to have fallen ill without the ritual. If, however, you deliberately expose yourself to dirt, and then prevent yourself from doing your usual cleaning response, and don’t get some kind of terrible illness, then Automatic Brain will start to learn that the cleaning is not as necessary as it previously believed.
In practice, this often involves going to extremes – like using a Glastonbury toilet and then visiting Pie Minister without being able to wash your hands – just to prove to that part of the brain that our bodies are much tougher than we think.
The aim is to prove that without your cleaning ritual:
- You won’t get a horrific illness
- The intense feeling of anxiety will eventually subside
For someone with OCD, using a festival toilet would easily be an extreme enough example to reach the anxiety levels needed to lead to a shift in belief. But for someone like me without a fear of contamination, using a festival toilet is unlikely to change anything for me, and it certainly does not raise the anxiety high enough to experience the technique in a way that someone with OCD might experience it. Especially when the toilet is at a family-friendly folk festival in the Brecon Beacons. I hope this is the first and only time anyone ever says this, but unfortunately the toilets at Green Man just weren’t dirty enough.
One of the cognitive behaviour therapy gurus for OCD, Paul Salkovskis, says that the therapist has to be prepared to take it one step further than the client: if you’re asking your client to touch the shoe, you have to be willing to lick the shoe.
I knew what I had to do: I had to lick the welly boot. Not a euphemism.
1. I didn’t get a horrific illness.
2. The intense feeling of anxiety did eventually subside.
And the unexpected:
3. It’s possible for someone to take a decent slide show of photos whilst laughing hysterically at their subject.
The closest I came to dying was a twinge in the stomach which could well have been from licking the boot, but it could have equally been from the distinct lack of fibre all weekend, or from plain old disappointment at Ben Howard being the Sunday night headliner (a reaction probably not surprising from someone who still uses Kate Moss as a cultural reference).
I did feel anxious and uncomfortable. I did feel like that feeling would not go away on its own. I did find that the feeling did go away on its own once I rejoined the masses.
The experiment itself was unpleasant and emotionally draining, and I can’t imagine what it would be like for people having to put this technique to put into practice in less desirable surroundings. It confirmed what I've often heard said: that our work with clients would be far more productive if only the NHS would spring for a ritualistic burning of a Green Man effigy.
As time passed I was grateful for the ridiculousness of the experiment. When the anxiety flashed back into my body periodically throughout the night, I could shrug it off with a shake of the head and the thought, “Who licks a shoe, honestly?”
© Cognitive Behave Yourself, 2013. Excerpts and links may be used, provided that full credit is given to Jane Gregory with a link to the original material. For CBT in North-West London please visit www.hampsteadcbt.com.