Your Go-To ERP Step for Transit Contamination OCD
Transit contamination OCD can make everyday commutes feel overwhelming and exhausting. This article breaks down a practical ERP step specifically designed for public transportation scenarios, backed by insights from mental health professionals who specialize in OCD treatment. Learn a straightforward approach that helps reduce compulsive behaviors while riding buses, trains, and subways.
Start with One Stop Observation
Early ERP Step: The 'Observation First' Step on Public Transit
When clients present with contamination fears triggered by public transit, their anxiety often sits around 70-80 on a 0-100 SUDS scale before they have even touched anything. The compulsion is not just the hand-washing afterward, but it is also the elaborate avoidance rituals that maintain their fear cycle.
In my clinical practice, early in the treatment I often use what I call an 'observation first' exposure technique. Research has shown that developing an anxiety hierarchy allows clients to move from the least to the most distressing situations, with the therapist providing instructions to guide them in preventing compulsions and tolerating distress (Javaherirenani et al., 2022). Rather than immediately touching surfaces, we start with something more manageable, such as sitting on the bus or train for one stop whilst deliberately noticing contaminated surfaces without engaging in safety behaviours.
The coaching focuses on normalising the experience, and clients sit without hovering or using barriers, simply observing the handrail and seat. SUDS levels are checked every few minutes throughout the exposure. After disembarking, we implement a 10-minute delay before any hand hygiene, during which we process what the clients are noticing, such as their urge, thoughts, and most importantly what is happening to their anxiety when they simply sit with it.
SUDS naturally decrease to 50-60 by the time we disembark from the public transit. This isn't about forcing immediate contact with highly contaminated surfaces, but what matters is showing clients that anxiety decreases naturally when they resist compulsions, even with smaller exposure steps.
Touch Pole Then Contaminate Your Bag
For public transportation triggers, an early ERP step I find incredibly effective is to have the client touch a subway pole and then immediately touch their bag or their clothes with just one finger. This creates what we call "secondary contamination." It stops them from mentally quarantining the original point of contact and forces the nervous system to actually get used to the "germs" spreading, rather than trying to control the exposure.
While the client is sitting with that trigger, I encourage them to describe exactly what their body is feeling in the moment. I'll say something like, "Notice how tight your chest muscles are right now, or the heat in your hands. You don't need to rush to the sink. You are capable of living with this uncertainty of the germs that just transferred to you.
I've seen SUDS spike to a 9/10 almost immediately after that contact. But after staying in that high-stress state for just fifteen minutes, the score usually drops down to about a 3/10 as the brain's alarm system naturally resets.
Remain near Snifflers and Resist Reassurance
Choose a seat near sniffling passengers and stay seated for the set ride time. Notice the story the mind tells about getting sick and answer with maybe and maybe not. Keep eyes on your goal, which is to ride without moving away or asking others to say it is safe. Watch the urge to move or cover up and let it pass like a wave.
Skip later body checks or searches for signs of illness. Mark the end by naming one thing this choice gave back, like time or freedom. Take the seat and remain there until the ride ends.
Buy Tickets without Safety Rituals
Walk up to the ticket machine and touch the screen and buttons as needed. If the keys feel sticky or smudged, let that be part of the practice. Complete the purchase and take the ticket without wiping or checking. Treat this like a small test and note how your worry changes with time.
Travel to your platform without washing, and notice that you still get where you need to go. Let this step show that progress comes from action, not perfect safety. Use a machine today and keep going with your plan.
Sit on Unsanitized Bench with Timer
This step asks for sitting on a used station bench without wiping it first. Set a short timer and let the worry rise like a wave. Notice the thoughts and urge to stand, and let them pass without action. Remind yourself the goal is to grow tolerance, not to feel perfect.
Keep sitting until the timer ends, then carry on with your plan. Over time, the bench will feel more normal, and that is the win. Take a seat and start your timer today.
Hold Escalator Rail and Delay Sanitizer
Hold the escalator rail from the first step to the last without letting go. Pay attention to the feel of the rail and name the discomfort in your mind. Breathe slow and keep your grip, even when the urge to pull away grows. Skip sanitizer and handwashing until a set time has passed after the ride.
Notice how the worry rises, peaks, and then falls on its own. Treat this as practice for riding with ease in busy places. Hold on for the full ride and start your delay timer after.
Grip the Turnstile and Answer with Maybe
Place both hands on the turnstile bar as you enter and hold through the push. Use the word maybe to answer fear thoughts, such as maybe it is dirty and maybe it is fine. Keep your pace steady and avoid wiping your hands or clothes. Rate your fear before and after to see the shift.
Give yourself credit for choosing contact with uncertainty. Delay any washing for a set period and then move on with your trip. Try this on your next entry and commit to the full hold.