Narrator: Stephanie's fear of contamination has colonized every aspect of her life. Her whole house is subject to a decontamination ritual as strict as the one she uses on herself.
Stephanie: I have to clean in a certain way, and I start at the front door, and I work backward. Once I start cleaning I can't stop and I have to decontaminate in the perfect way, nothing can go wrong. If it does, the contamination jumps to something else. It's really frightening when something gets contaminated. You know it's only a matter of time before it takes over everything.
Narrator: Stephanie is starting her therapy. She's been taking Prozac, which often helps OCD, but it hasn't been enough. Dr. Udine has come to convene cognitive behavioral therapy. Today, Stephanie is going to bring in the mail, which she hasn't done for a year.
DR. UDINE: So how nervous is this making you? Give me a number.
Stephanie: It's 40 right now.
DR. UDINE: It's 40 right now.?
Stephanie: Maybe 30. It's ok.
DR. UDINE: It's low. Good. Excellent.
Stephanie: It makes me nervous to put it down. I don't want to put it down anywhere.
DR. UDINE: OK, I will help you.
Narrator: For Stephanie, who has a terror of contamination from bodily fluids, the thought of handling envelopes, which someone might have licked shut, is particularly repugnant.
DR. UDINE: Is recognizable.
Narrator: The idea is to expose Stephanie to situations that cause her anxiety, but then prevent her from doing the compulsive cleaning rituals she normally would do to contain it.
Stephanie: 40 maybe.
DR. UDINE: Good. Just go for it. Just pounce on it. Don't be too careful. Good. Excellent. Alright, now that you've done this, your hands are all contaminated. Is it?
Stephanie: It's difficult.
DR. UDINE: Is it difficult? How difficult Stephanie?
Stephanie: 50.
DR. UDINE: At 50? That's OK. You can tolerate it. It's alright. Remember I told you it's going to be very difficult for you. OK? What could you touch? I mean touching Jake would be too hard for you right now, would it? OK. What can you touch that's not that hard?
Stephanie: The couch.
DR. UDINE: The couch. You could touch the couch?
Stephanie: The back of the couch.
DR. UDINE: So let's do that. Ready? Good. And when you do it [inaudible] I would like you to touch the couch everywhere.
Stephanie: Oh, OK.
DR. UDINE: OK, I know it's hard for you. OK. Can I do something to help with your anxiety?
Stephanie: Can you touch the couch first?
DR. UDINE: Yes, absolutely. I want you to touch it like this. OK?
Stephanie: OK.
Narrator: Stephanie's contaminated her hands, and now Dr. Udine wants her to spread the contamination around.
DR. UDINE: Now that's very difficult for you, but you're able to do it—
Stephanie: —it's better.
DR. UDINE: It is better already? Good. You know the anticipation usually makes it worse. So you want to pounce on it as fast as you. can. So you see, the reasons it happens is, and the reason it's called exposures is it's the things you've been avoiding, and you don't get a chance to test. You were very courageous already, might as well capitalize on it.
Narrator: Stephanie has to spread the alien germs she imagines are on the letter all over the couch.
DR. UDINE: I'm gonna move so that you can do it.
Narrator: Infecting the couch is one thing, but can Stephanie go one stage further, and expose her son, Jake, to the germs?
Stephanie: OK.
DR. UDINE: Good. I like the energy that you're showing going towards—
Stephanie: Because I'm angry at it.
DR. UDINE: You're angry at the OCD? Good. I like that. I want you to be angry at the OCD, not at yourself.
Stephanie: Yeah.
DR. UDINE: OK? I'm angry at your OCD too. It's ruining your life.
Stephanie: Yeah.
DR. UDINE: I want us both to be able to—
Stephanie: I can handle Jake.
DR. UDINE: You can?
Stephanie: Yeah, I can.
DR. UDINE: Let's do it.
Stephanie: Come here, honey. Oh well, maybe not.
DR. UDINE: It's all right.
[hyperventilating]
Stephanie: Are you sure it's OK?
DR. UDINE: It's wonderful.
Stephanie: You're sure it's all right to do it?
DR. UDINE: It is OK. It's OK to do it. Yes. I'm positive.
Stephanie: [inaudible]
DR. UDINE: When we go to the higher items, I won't reassure you, but for the first time, absolutely.
Stephanie: I don't want to put him on the couch.
DR. UDINE: Good.
Stephanie: I don't want to put him on the couch.
DR. UDINE: Yeah. Just hold him for a little while.
[sobbing]
DR. UDINE: Yeah. Just hold him for a little while. Hi mommy. Hi mommy.
Stephanie: It's OK though, it's OK to put him on the couch.
DR. UDINE: It is OK to put him on the couch. It is. Because remember, you just touched, and you—
Stephanie: OK.
DR. UDINE: And we're just doing an exposure, and it's—
Stephanie: It's not, I'm not a bad mother if I do that?
DR. UDINE: You're asking me for reassurance.
Stephanie: OK.
DR. UDINE: You're OK? Hi Jake!
[baby crying]
DR. UDINE: He doesn't know me very well. Good. All right. How does it feel? What do you—
Stephanie: Um—
DR. UDINE: What are your [inaudible]?
Stephanie: 60. Going down.
Narrator: 75 % of people with OCD show some improvement with cognitive behavioral therapy.
DR. UDINE: Our experience with other people who have this kind of OCD are that many of them will get a lot better by the end of treatment.
Stephanie: I know it's making me feel free.
Narrator: Stephanie has been through nine sessions of her therapy now.
Stephanie: I'm well on my way to life again, and have made incredible progress in many small ways.
Narrator: One of the most important things is that she can now let Jake pick things off the ground and behave like a normal child while she behaves like a normal mother.
Stephanie: I've been able to re-organize in my mind what is something to be fearful of, and what is not. Jake and I are a team. And we're out there discovering together. Because for a year, I stopped experiencing things and looking at things. That's bark. Gotta look for more of those, see if you see any. See if you find any. Something that I would have been able to do before, I can do without even thinking about it. Oops! You alright bud? I can let spontaneous things happen. You can call that a cure, but the OCD's not gone. The obsessive— the obsessions— gosh, the obsessions maybe are gone. Compulsions are— no, the obsessions are maybe still there— I don't know. It's hard to say when you become— you know, who is normal, anyway?