“<i>The ultimate exposure”</i>: a qualitative exploration of the impact of COVID-19 on adults in treatment for obsessive-compulsive disorder with contamination fears
Creators: name: Atwell, Josephine
name: Milicevic, Denise
name: Skepper, Brian
name: Minchin, Emma
name: Smith, Maddison
name: Juraskova, Ilona
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Microbiology
subject: FOS: Biological sciences
subject: Pharmacology
subject: Biotechnology
subject: Biological Sciences not elsewhere classified
subject: Science Policy
subject: Mental Health
subject: Infectious Diseases
subject: FOS: Health sciences

description: Risk of infection and emphasis on hygiene practices during the COVID-19 pandemic had the potential to exacerbate cognitive distortions and decontaminating rituals for people with obsessive-compulsive disorder (OCD), especially those with the contamination/cleaning subtype of OCD. Existing literature has been mostly quantitative, involving mixed OCD samples, with minimal specific focus on contamination symptoms. This qualitative study aimed to explore the impact of the pandemic on the symptomatology and treatment of Australian adults undergoing treatment primarily for contamination obsessions and washing and cleaning compulsions. Twelve adult clients diagnosed with OCD with contamination obsessions and washing compulsions completed semi-structured interviews. Transcribed interviews were analysed using thematic analysis. Participants’ intrapersonal and interpersonal experiences were captured by four overarching themes and 12 subthemes: (1) <i>Evolving Self-Concept</i>, (2) <i>Changing Symptomatology</i>, (3) <i>The Family and Home</i>, and (4) <i>The Pandemic Environment</i>. Interactions with the pandemic environment altered participants’ perception of themselves and their OCD, influencing the frequency and nature of subsequent engagement with the environment. Clinical implications include: The importance of de-stigmatising OCD, tailoring psychological support during the pandemic context, and modifying exposure and response prevention to ensure that its principles are upheld in the event of another health crisis. <b>What is already known about this topic</b>:
Symptom exacerbation during COVID-19 appears to be influenced by poor insight, reduced resilience, overestimation of threat, and contamination symptoms.COVID-19 health advice, including heightened promotion of hygiene, posed challenges to in-vivo exposure treatments for OCD clients with contamination concerns.Public hygiene practices may have heightened attentional biases to contamination among OCD clients, causing difficulty in distinguishing rituals from normative washing behaviour. Symptom exacerbation during COVID-19 appears to be influenced by poor insight, reduced resilience, overestimation of threat, and contamination symptoms. COVID-19 health advice, including heightened promotion of hygiene, posed challenges to in-vivo exposure treatments for OCD clients with contamination concerns. Public hygiene practices may have heightened attentional biases to contamination among OCD clients, causing difficulty in distinguishing rituals from normative washing behaviour. <b>What this topic adds</b>:
 A novel, qualitative focus on contamination OCD in adults during the latter phase (2022) of COVID-19. In-depth insights into intrapersonal and interpersonal lived experiences of adults with contamination OCD during COVID-19.Important considerations for future public health events, particularly regarding remote facilitation of evidence-based OCD treatment.  A novel, qualitative focus on contamination OCD in adults during the latter phase (2022) of COVID-19.  In-depth insights into intrapersonal and interpersonal lived experiences of adults with contamination OCD during COVID-19. Important considerations for future public health events, particularly regarding remote facilitation of evidence-based OCD treatment.