Imagery Rescripting and Behavioural Experiments for Mental Contamination in Obsessive-Compulsive Disorder: A Case...

This case study presents the treatment of a young adult with severe mental contamination (MC), a subtype of obsessive-compulsive disorder (OCD) characterized by internal feelings of dirtiness triggered by trauma-related emotions rather than physical contaminants. The patient, Federico, exhibited intense shame and disgust linked to a bullying episode, leading to compulsive rituals and functional impairments. Treatment integrated emotion regulation training, Imagery Rescripting (ImRs), and behavioral experiments, targeting dysfunctional beliefs about emotions. ImRs allowed reprocessing of the traumatic memory and reshaping of self-related meanings of impurity and unworthiness. Behavioral experiments tested and modified catastrophic appraisals of emotional experiences, fostering tolerance of distress without compulsive neutralization. By the end of treatment, Federico's Y-BOCS-II score fell from 42 to 15 (-64%) and his VOCI-MC score from 50 to 9 (-82%), with stability at 3-month follow-up. Follow-up confirmed the stability of gains and increased emotional autonomy. This case supports the utility of combining trauma-focused cognitive techniques and behavioral experiments in MC, particularly when compulsions are maintained by unprocessed emotional memories rather than concrete contamination threats. It highlights the need for individualized interventions in which ImRs may serve as a central component in treating MC symptoms.