Video 18. Imaginal Exposure for OCD: Dr. Hembree and Mia. Wright/APA Publishing

Dr. Hembree: okay Mia a great
job on your homework

that was really excellent
you listen to the

imaginal exposure recording about six

times and you did the exposure the

in vivo exposure of walking around and

touching things like doorknobs and other

surfaces and objects you normally

wouldn't touch both at your house and
and

other places you went and you sat down

on the floor and you even ate lunch off
the floor at your

house and at your mom's house
Mia: mhmm

Dr. Hembree: okay and no washing
Mia: no no no

hand washing no extra washing perfect

good for you okay so would you learn
from all that do you think over the

course of the time you've done that

Mia: um it just it got easier
at the beginning it

was really hard and I feel like my
stress

were much higher than at the end um so I

guess that was what we talked about that
habituation

Dr. Hembree: habituation
right yeah the

fact that when you do something like
that that initially makes you anxious

and you do it repeatedly especially in

for prolonged periods of time yeah your
anxiety comes down right we're just not

built to stay indefinitely anxious okay
you notice any other changes or anything

else?
Mia: mmm I noticed that at before doing

the
exposures I was really really anxious um

and then it kind of went down like the

anticipatory anxiety that would also
Dr. Hembree: right right

Mia: discuss
Dr. Hembree: right did that change by say

yesterday
Mia: yeah also the SATs were

initially really high before the
exposure

and then they went down the

more I did that
Dr. Hembree: so you're saying you not

only noticed that it went down during
the exposure but you started feeling

less anxious even approaching
Mia: um hum yeah

Dr. Hembree: okay good
perfect okay all right good okay

all right so you're doing so well
we're gonna take another

step up the hierarchy today like we
planned

right okay so this is the dog leash day
Mia: um hum

Dr. Hembree: did you bring it
Mia: yeah

Dr. Hembree: okay good
all right we'll get to that later in the

session first we're gonna do some

imaginal exposure okay and you remember

what the purpose of that is why why are we

gonna do imaginal?
Mia: um that way I can

kind of relive a story or a situation

that would make me really
anxious and

eventually deal with the fear of

consequence
Dr. Hembree: exactly

Mia: of getting sick
in my case

Dr. Hembree: right so the
idea is this is how we um are

able to have you have exposure to or

sort of a confrontation in imagination

with the consequences you fear of

touching things that are contaminated

and not washing not doing your rituals
okay perfect

so did you write the story?
Mia: yeah

Dr. Hembree:
okay let me see [coughs]

all right good all about taking
the dog for a walk with

that leash and what happens because of
it excellent

okay good you know this so I am not
gonna sit here and read it but

Mia: uh humm
Dr. Hembree: okay so in a

minute when we start what I'm gonna

ask you to do is to close your eyes and

to sort of narrate or or describe the
scene that you've thought about it this

week and wrote out where you're handling
the dog leash and very aware of the way

it's contaminated and I want you to
describe in the story not just what

you're doing but also what you're kind

of feeling and what you're thinking as

you do this and then also leading to the

consequences you fear from handling the

dog leash and not washing okay any

questions before you start
Mia: no

Dr. Hembree: okay so
what's your level right now

Mia: um I would say like a 70

Dr. Hembree: 70 okay all right go ahead
and start

when you're ready
Mia: um

Dr. Hembree: [inaudible] thank you

for reminding me yup
we'll start the recording so you

have that for
homework okay

Mia: so I'm in my house
and the dog starts barking and I know

that that means that I have to take him

out um I
really don't want to so I'm thinking

maybe I should wait until Joe gets home
and he can do it but I know the dog

keeps barking he's gonna wake up the
baby

so I decided to go to the front door and
get the leash I'm not gonna wear the

gloves are usually wear so I fully
experience um touching the leash

but I'm already feeling really anxious

and I look at the leash and I see that

it's gross and full of hair and the dog

has been biting on it and it probably

has saliva and other things and he

stinks [inaudible] been thinking or if

that's dog poop and I get sick and I

just feel myself shaking and really

sweaty and my heart is beating really

fast so I'm feeling really really

anxious but I push myself and I grab the

leash and I get the dog open the door go

out and grab the leash
Dr. Hembree: what's your level now Mia

real quick
Mia: um like 90

Dr. Hembree: 90 okay
you're doing great just keep going

Mia: so I grab the leash and the dog is

pulling and I feel the leash kind of

pushing through my skin and I'm thinking

all the bacteria that's getting there

and I'm gonna get sick I wanna vomit but

I just keep going so I walk the dog come

back home and I just leave the leash in

the front door and I'm thinking I'm

probably gonna get sick I really

wanna
wash my hands really wanna take a

shower but I try not to and I stopped

myself and I'm I'm
feeling really really

anxious so I can't stop thinking about

washing so I tried to go to bed decide

to fall asleep the next morning I wake

up and I already feels like I know I'm

sick I'm shivering and

and I feel like I have a fever and I'm

shaking again and I'm really nauseated

so I go to the bathroom start vomiting

and I know I'm sick I I already got

something I should have washed I started

thinking about that gonna get the baby

sick and I feel really really sick
Dr. Hembree: okay

great job what's your level now
Mia: like 80

Dr. Hembree: 80
okay all right so just to keep

visualizing this I'm gonna describe it

now then you just stay with that image

as much as you can okay so you're in the

house and the baby's sleeping and you're

trying to get some housework done and do

things for dinner suddenly you hear the

dog at the front door barking and

barking and immediately your heart rate

kind of jumps up and you get upset and

anxious because you know that means he

needs to go out and Joe is not going to

be home for hours and you really don't

wanna take him out but you have to and

it makes you scared and upset because

you're not going to use the gloves that

you always use when you have to take

him out so you walk toward the door and

you think well maybe I'll just make em

wait but you realize he'll wake the baby

up if you don't take em so you go

toward the leash and it just makes you

even more anxious to see it and it's

dirty and it's chewed up and it's gross

and you see stains on it and you think

about what those are from and maybe

they're from dog poop and that's gonna

to get on you and you pick it up anyway

and snap it on his collar and as you go

out the door and he lunges outside he

pulls that leash into your hand and you

feel the contamination from the leash

entering your body through the pores of

your skin and you feel like it's just

running up your arm through your

bloodstream and you keep thinking oh my

God what if I get sick from this what if
what if there's some germs in this or

bacteria but you keep walking him until
he finishes what he has to do and you

bring him back inside the house take the

leash off and the urge to wash is so

powerful so strong you want to go scrub

your hands and
get in the shower and wash your whole

body and do it quickly and get all these
germs off from the leash but you don't

do that you don't you make yourself not
do the ritual and then you go back in

then just keep doing the housework and
keep doing things but that's the sense

of feeling sick is staying with you and
worrying about what's going to happen if

you picked up germs from the leash that
night you go to sleep still anxious

still upset about what happened wake up

in the morning and then before you have

your eyes open even a couple minutes you

know that you're sick you can feel your

body being sick you rush to the bathroom

and vomit you can feel the fever and

it's all in your body is just not not

right you're sick and you know it's

because you handled that leash and

didn't wash you didn't do the washing

you needed to do and now you're sick and

the baby will probably get sick and if

only you had done the washing okay

what's your level now
Mia: like eighty

Dr. Hembree: 80 okay
okay you take it back and you do it

again okay good job
Mia: um okay so I'm home um the

dog starts barking