Let´s take the case of Barbara; she has a cleaning compulsion, a very common manifestation of OCD. Her house is immaculate; there isn´t a stray object, a speck of dust or any dirt to be seen in any corner or crevice of the house. This is certainly a great, clean environment to live in; however, the drive to keep her house so clean is compelled by an exaggerated fear of germs and dirt.
We all want to avoid germs, but few of us would spend hours, upon hours, cleaning surfaces that have already been cleaned, wiping off door knobs every time someone has touched them, following people around the house, cleaning up after them. Barbara has been unable to keep a boyfriend because frankly, they were just too messy and brought too many germs into her environment.
For Barbara, the fear of germs is real but it is so overpowering, so encompassing that it has consumed her life. She can´t go to the bathroom at work, because there are just too many germs, she cleans and straightens her office every time someone enters and then leaves it.
She wears gloves every day, warm or cold, because she doesn´t want to touch the buttons in the elevator or door handles at her office that have been touched by so many. The compulsions, the obsessions plague her mind. The only way to keep the deadly thought of germs invading her body, breaking it down, making her sick and maybe causing her death away is to clean and then clean some more.
Barbara needs to expose herself to the feared germs in incremental steps. Since her home is already an exceptionally clean environment, this is a good place to start. She should touch the surfaces in her home and not wash her hands. She should then reduce the number of times she cleans the surfaces in her home.
Have a family member come and visit and refrain from following them around cleaning. Once these victories have been achieved, dealing with the outside world can begin. She should remove the gloves and start touching the elevator buttons and door handles.
If she needs to wash her hands afterward, that´s fine, it´s about incremental steps. Barbara needs to limit herself to straightening up her office two times a day, when she arrives and when she leaves. Start with small victories and build on the successes.
While Barbara is exposing herself to her fears she will need to practice both positive thought redirection and calming techniques to deal with the fears and dread that will pop up.
For Barabra, positive thought redirection will involve refocusing her thoughts away from the germs, to the fact that she has already cleaned that area, or that other people touch elevator buttons without dying. It will also involve a focus on what she can get accomplished if she´s not working rather than cleaning and what that will mean for her both professionally and personally.