The Continuum Technique is a tool used in CBT to help people challenge irrational beliefs about themselves or the world around them. It’s a pretty simple tool that acts as a contrast to harmful beliefs that we simply accept as true or allow to remain unchallenged.
We’re going to apply the technique to a hypothetical situation that some folks with OCD may be able to relate to. This example involves someone who believes that contamination is going to create a threat to their baby which can then lead to reduced affection, touch, and play. The belief we are going to challenge is: “If I hold my baby without washing my hands I will infect her and she will die.” Please keep in mind that we are talking about excessive hand washing, not typical/recommended hand washing.
The first thing we’re going to do is draw a line with two endpoints, a midpoint and assign a value to each point representing a level of threat to the baby.
Then we would ask the parent to list what they would consider highly dangerous situations that would, with near certainty, threaten the baby’s life and add those to the right end of the scale.
Next, we may ask the parent to list areas he or she would feel are completely safe for the baby and add those to the left end of the scale.
Finally, we would have the parent identify situations she feels may be risky for the baby.
Notice the last item in the middle column. Driving is a favorite example of mine as it is one of the most dangerous activities we do every day and most of us think nothing of it.
This grid can now act as a reference point for the parent in our next step, asking him or her to place “Holding the baby without washing my hands” in the appropriate threat category. In most cases, if not all, the parent would acknowledge that holding the baby without engaging in hand washing beforehand would fall into either the Safe category or somewhere between Safe and Risky.
The continuum technique may not, in and of itself, extinguish the handwashing behavior but it can act as a powerful agent in helping a person buy into changing behavior and in taking the next step which may include exposure.
Continuum is also effective in challenging negative beliefs about ourselves. For example: “I am a failure”. We would define what failure would look like at 100% on the right-hand side, what Perfection would look like on the left and what “Doing Ok” would look like in the middle. Then we would place a marker for ourselves somewhere along the continuum.