Kevin Majeres MD | How to do “Pan-Exposures”
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How to do “Pan-Exposures”

27 Jun How to do “Pan-Exposures”

inIn OCD, contamination can magically spread from object to object, as I reviewed here. This magical propagation of contamination gives OCD tremendous power; but it is also provides half of the key to its undoing.

The other half of the solution comes from how people with contamination obsessions typically  live within a hierarchy of safety: perhaps the garage is very contaminated, but the hallway is less so, and the kitchen not at all, while the bedroom is especially clean and pure. Of course, the hierarchy depends on what’s considered contaminated; but almost every person with contamination OCD will experience some version of the hierarchy.

I will now describe how to do pan-exposures; this is particularly meant for my patients with whom I am doing this treatment (so that they can use it as a reference if you doubt the procedure; if you happened to find this on the web and are reading it, it’s a good idea that you be working on this with a therapist of your own.) You will need to have a contaminated object, and a supply of paper towels.

1) Roll up a paper towel so that it’s a long, narrow cylinder. With this clean paper towel, touch EVERYTHING in your house, at least all major pieces of furniture or decorations. (We are doing this to level the safety-hierarchy.)

2) Again roll up a paper towel, and again touch everything in your house, but this time go in the REVERSE ORDER from what you did above.

So far, this is the same for all people with contamination obsessions. Now the instructions have to vary, depending on whether your contamination spreads “chemically” or “electrically.” This is a key distinction. To find out which you are, take a rolled up, clean paper towel and touch it to the contaminated object. Does the whole paper towel become equally contaminated by the contact? If so, this is “electrical spread.” If the paper towel seems more contaminated at the part that made direct contact, but less or not-at-all contaminated in the distant half of the roll, this is called “chemical spread,” by me, since the propagation seems to behave as if it’s something moist (for instance, the longer the contact is kept between the two objects, the more the contamination would “seep” up the towel, eventually contaminating the whole length of the roll; with electrical spreaders, this happens instantaneously). Both types of spreading have their own advantages.

For electrical spreaders, the following would work:
3e) Take a paper towel and touch it to the contaminated object. Then take another paper towel, and touch it to the first paper towel (the contamination will spread to the 2nd, but typically there is some “impedance” and the 2nd is not as fully contaminated as the first.) then take a third paper towel (label them) and touch it to the second; then a fourth and touch it to the third; and so on, until you reach the point where it feels safe enough to do exposures with. Typically people are OK once it is five or six degrees removed.

4e) Then take the furthest degree-removed paper towel and touch it to EVERYTHING in the house. Repeat this every day until your anxiety never gets above a 5 out of 10 in severity.

5e) Then go down one degree, and again touch EVERYTHING in the house. By the time you get down to the first-degree paper towel (the one that touched the original contaminated object), you will find that you are able to move on to the object itself, using it to touch everything in the house. This would have been unimaginable at the beginning of the exercise; but after working through all the degrees of paper towels, it will have become substantially easier — without having to have enormous distress at any given moment in the treatment.

For chemical spreaders, the strategy is slightly different:
3c) Take a clean paper towel, rolled up into a “wand,” and touch it briefly to the contaminated object. Then immediately tear the paper towel “wand” in half, and throw away the portion that made contact with the object. Using the distant half, touch EVERYTHING in the house. Repeat this daily until your anxiety stops getting above a 5 out of 10 in severity.

4c) Repeat 3c, except this time tear the wand in two about one inch closer to the end that made contact with the object; throw the portion that made contact with the object away, and touch everything with the distant section. Do this daily until anxiety stops getting above 5/10 at its peak.

5c) Repeat 4c until you come to the very end of the wand; then use whole wand to touch everything in the house. After doing this daily until anxiety doesn’t get above 5/10, you should be able to use the contaminated object itself, touching everything in the house with it. If this still seems like too big a step, repeat using the whole wand, but leave it progressively in longer contact with the object. Similarly, you could wet the paper towel before making contact.

Using these principles, people can overcome all contamination obsessions. It is a gradual approach. It’s power comes from how it makes use of the magical spread of contamination — treating it as the Achilles’ heal that it is, using it to very gently and gradually undo the obsession itself.