It wasn’t a cold day when Amy* came to see me, and she looked a little out of place in her gloves and with her scarf over her mouth. But it wasn’t cold that Amy was concerned about – it was keeping herself away from dirt and disease.
Amy’s concern had started as a very understandable response. Admitted to hospital for a minor operation she had caught a “surgical site infection”. It had taken her a long time to get over it, and taken some quite powerful drug treatment.
“If I can catch an infection in a hospital” she told me, “then I can catch one anywhere. And the last one was so bad I don’t want to take the risk again”. As I said, it was an understandable concern, but the way that it had affected her behaviour had become a problem for her.
“At first I was careful about where I would go, where I’d eat – that kind of thing. After a while though I realised that it didn’t matter how clean places looked or were – if a hospital could be that dirty then so could they.
“So I started to make sure that I washed my hands more often and more thoroughly. I started carrying sanitising gel and wipes with me, and even my own cutlery. Then I started to avoid shaking hands with people and that’s getting worse. It was my sister who told me I have to do something when I said I wasn’t comfortable giving my baby niece a cuddle.”
Amy was in tears at the end of what she told me. She was upset not just at how things had got worse, but also at how huge and insurmountable they seemed. She was in despair about where her life had gone, and what she saw as her non-existent chances of it ever getting better.
What I did with Amy was to help her with her constant background level of anxiety. When this had reduced it gave her the leeway, and the belief in herself, to tackle some of her triggers head on. This was using a technique called Exposure and Response Prevention, or ERP.
Using Exposure and Response Prevention I guided Amy through lower stress situations, and helped her to learn to stand the anxiety until it naturally began to decrease. Through this, and through a lot of practice at home and with her family, she was able to re-learn her response.
It took a lot of time, but Amy stuck at it because she could feel the progress that she was making. I last saw her when I bumped into her coming out of a café. It wasn’t her smile when she said hello that meant the most though – it was how she reached out and shook my hand.
* Amy’s real identity has been protected, and she is happy to share her story. If you found this case study about exposure and response prevention interesting then why not sign up for my monthly newsletter here with three stories every month on the quirky side of psychology and relationships.