Treating Contamination OCD During COVID-19

Source: Rachel Conrad, used with permission

Constant discussion about COVID-19 can be overwhelming for anyone, but for children with contamination OCD, it can trigger catastrophic thoughts. Dr. Rachel Conrad explains her work and shares tips on how we can also balance these thoughts.

Rachel Conrad, M.D., practices Child and Adolescent Psychiatry at Brigham and Women’s Hospital and is an instructor in the Harvard Medical School Department of Psychiatry and affiliated with the Harvard Medical School Center for Bioethics. She trained in psychiatry at Emory University and completed one fellowship in Child and Adolescent Psychiatry at Boston Children’s Hospital and a second fellowship in Bioethics at Harvard Medical School. She teaches the Medical Ethics and Professionalism course at Harvard Medical School and lectures on Child and Adolescent Psychiatry to medical students, residents, and fellows. She has authored numerous publications relating to mental health, resilience, medical education, and ethics.

Jamie Aten: How would you personally define obsessive-compulsive disorder?

Rachel Conrad: Obsessive-compulsive disorder (OCD) is surprisingly common but often overlooked among children and adolescents. Kids with OCD have unwanted, sticky thoughts that upset them, and they may develop unusual habits in their attempts to control or get rid of those thoughts. Sometimes they have sticky thoughts about germs and illness, and they might go to great lengths to avoid germs, such as developing extensive routines related to washing. This type of OCD is called contamination OCD.

Kids with contamination OCD are in a complicated situation during the pandemic: the pandemic seems to be discussed nonstop, and we have new rules about wearing masks and other actions to prevent the spread of illness. For these kids, hearing about COVID-19 might trigger catastrophic thoughts about illness and even death. Instructions to avoid germs might spiral to such frequent handwashing that their skin is damaged. Their sticky thoughts and worries might become so intense that they take over their minds, so the kids are not able to do both what is important and also what makes their lives fun and interesting, like learning, enjoying time with friends, and spending time outside.

While I was at Boston Children’s Hospital, I started an online psychotherapy program for adolescent girls with OCD so that they could support each other during the pandemic.

JA: What are some ways understanding OCD during COVID-19 can help us live more resiliently?

RC: It’s not only kids with OCD who have catastrophic thoughts—we all have catastrophic thoughts sometimes. Recognizing the real danger of the pandemic without allowing catastrophic thinking, or “catastrophizing," to take over our minds—and ruin either our fun or our ability to function—is tricky. We adults (even doctors and scientists!) may struggle to balance our concerns while continuing to build a life worth living.

One way to increase our resilience is to recognize when a catastrophic thought has first arisen in our mind. Building recognition of and attention to our thoughts is a key component of both mindfulness and cognitive psychotherapy. With this enhanced awareness, we can then reflect on the ripples of our catastrophizing. We can pay attention to the way we feel when we have catastrophic thoughts by noticing the associated emotions and physical sensations in our bodies.

Hiding our worries or wrestling with catastrophic thoughts alone is typically not helpful. Simply observing the thought and talking about it may reduce the thought’s power. The adolescent girls with OCD in my group felt that having a space to be open and honest about their worries was invaluable. Adults also benefit from having a space where they can share and process their anxieties together.

JA: What are some ways people can cultivate resilience amidst this pandemic?

RC: Supportive relationships, self-care, and compassion are more important than ever. We all must stay connected to our values and continue to build lives worth living—lives that are engaged, challenging, and connected to people who care about us.

Connecting to meaningful relationships and feeling that we belong is critical to our well-being. Staying in touch with friends can be difficult during the pandemic. We might need to meet outside, wear a mask, or chat on FaceTime.

Self-care might require creativity during the pandemic. If our favorite activities are not accessible, we might need to adapt. We can try out a new hobby or learn a new skill. One girl in my group began sewing masks, and another learned American Sign Language online.

Our group found Mindful Self-Compassion very helpful. The first step of Mindful Self-Compassion is to acknowledge when we are struggling. Many of us will notice that we actually beat ourselves up when we have an uncomfortable feeling—we often shame or criticize ourselves for feeling upset, which makes us feel worse. The second step is to remind ourselves that struggling is normal, and everyone has uncomfortable feelings sometimes. Finally, we must choose to treat ourselves with kindness and gentleness instead, the way that we treat a friend.

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JA: Any advice for how we might use what you have learned to support a friend or loved one struggling with a difficult life situation?

RC: Many of our friends and family may be experiencing stress, worry, and catastrophizing right now. The first step to supporting them is simply to recognize when they are struggling. Acknowledge their thoughts, feelings, and situation without telling them what they should be doing differently or trying to change, fix, or minimize what they are feeling.

For example, you could say, “I can see that you are struggling with this, and given everything that is happening right now, it makes sense that you are feeling (stressed or worried or disappointed or frustrated or sad or lonely).” This shows them that you are paying attention to them and care about how they feel. You can reflect back or summarize what they shared with you about their situation and their feelings. You might tell them that many people are struggling and feeling stressed right now.

Simply recognizing what someone is feeling and giving them an opportunity to share openly without experiencing either judgment or unwanted advice may help them feel better. At the very least, they will feel less lonely and more understood.

If someone needs professional help for depression or anxiety that interferes with their ability to function, they should see their primary care doctor and consider requesting a referral for a psychotherapist or psychiatrist. If someone has thoughts about not wanting to live, they should call the National Suicide Prevention Lifeline at 1-800-273-8255.

JA: What are you currently working on that you might like to share about?

RC: I am working with a team at Brigham and Women’s Hospital Developmental Risk and Cultural Resilience Laboratory to study the mental health of college students and young adults during the pandemic. The CARES 2020 Project (COVID-19 Adult Resilience Experiences Study) was launched to track the health and well-being of people 18 to 30 years old for the next two years.

We recently published a study on depression, anxiety, and PTSD among young adults with pre-existing mental health diagnoses, which found that the rates of depression, anxiety, and PTSD are high among all young adults, but those with a pre-existing mental health diagnosis are particularly vulnerable. We will be publishing more research specifically exploring the mental health of college students during the pandemic soon!