Germ Phobia Treatment: A Look at the Most Effective Therapies

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If the fear of germs is dominating your life, you most likely live near a sink and have limited contact with the outside world. Although preventing the spread of germs and maintaining good personal hygiene is important, you take these concerns to the extreme if you have mysophobia. Mysophobia is an anxiety disorder that causes you to constantly wash your hands to remove germs. If you suffer from this condition, you may also use hand sanitizer constantly, shower many times a day, and avoid shaking hands, taking public transportation, or using public restrooms. Germ phobia treatment does exist, though, to help you manage this condition and reclaim your life.

Cognitive Behavioral Therapy for Mysophobia

Cognitive behavioral therapy (CBT) is considered the most effective treatment for anxiety disorders, including phobias. The goal of CBT is twofold. First, cognitive therapy identifies how your negative thoughts, or cognitions, lead to anxiety. Second, behavior therapy investigates how your actions and reactions promote anxiety. CBT relies on the premise that how you think about or perceive a situation, not the situation itself, affects your emotions. In CBT, changing the way you think about a situation brings changes to the way you feel.

When you receive CBT, you practice cognitive restructuring, that is challenging negative thought patterns that promote anxiety and replacing them with positive and realistic thoughts. The following three steps are involved in this process:

  1. Identify negative thoughts. Individuals with mysophobia perceive germs, or the thought of germs, as more dangerous than they are in reality. Using a public restroom, for example, can seem life threatening because of the ‘dangerous’ germs within. While you may easily identify this fear as irrational, recognizing the thoughts that lead up to it can be very difficult. Therapy will teach you to recognize these thoughts before you begin to feel anxious.
  2. Challenge negative thoughts. After identifying negative thoughts, CBT will train you to evaluate your anxiety-provoking thoughts. Your evaluation will include questioning evidence of scary thoughts, analyzing false or unhelpful beliefs, and testing the reality of negative predictions. The therapist may ask you to conduct experiments to evaluate the pros and cons of worrying about or avoiding germs, and to determine the reality of acquiring germs and the consequences of contamination.
  3. Replace negative thoughts with realistic ones. Identifying your irrational and negative distortions in your thoughts will lead to replacing them with more positive and realistic thoughts. Part of the therapy may additionally involve thinking of and rehearsing calming statements to yourself in situations that typically increase your feelings of anxiety.

The steps and methods you learn in CBT require hard work and practice. Negative thinking is often a result of lifelong habits that are extremely difficult to change. CBT involves homework will lots of practice every day.

Exposure Therapy for Germ Phobia

As part of CBT or used alone, exposure therapy, as the name implies, exposes you to what you fear. Exposure therapy is based upon the behavioral concept of habituation where behavioral and sensory responses diminish after repeated exposure to a particular stimulus.

The stimulus in exposure therapy for mysophobics is germs. With time and gradually increasing levels of intensity, habituation occurs and fear and anxiety eventually lessen. For mysophobics, therapy may begin by looking at images of germs through a microscopic. Then, you may be exposed to germs in controlled situations. These sessions build up to exposure to germs in real-life situations.

In each session, the therapist will guide you in experiencing the fear and anxiety until habituation occurs and theses feelings subside over time. Additional techniques, such as progressive muscle relaxation or deep breathing, are taught to lessen anxiety and promote relaxation.

Extinguishing fear through habituation undoes what has been learned through classical conditioning, in which individuals become afraid of neutral stimuli due to the paired association between neutral, conditioned stimulus (CS) and fear-inducing stimuli (UCS). To reduce or eliminate the fear, you need to unlearn the association between the CS and UCS. As a mysophobic, for instance, you may have learned an association between fear and door handles (CS). In exposure therapy, you would touch door handles again and again until habituation occurs. The association between the CS and fear eventually breaks, and your fear lessens or disappears over time. With ongoing practice, you learn that touching a door handle will not result in terrible consequences.

Response prevention is a second component of exposure therapy and may be used if you carry out ritualized, repetitive behavior, such as frequently washing your hands to neutralize your anxiety. Based on the principle of operant conditioning, response prevention works on the theory that behavior becomes extinct, or gradually stops, when it is no longer rewarded. Washing your hands after touching a door handle, for example, negates the effect of touching it. Since washing your hands reinforces and allows you to avoid or escape contact with possible germs, the behavior cannot stop unless it is prevented. The combination of exposure to germs, along with the prevention of constant hand washing, leads to the most effective treatment for mysophobia.

Germ phobia treatment requires patience and commitment. These effective therapies work if you confront your fear instead of avoiding it. You may often feel as if you are getting worse long before you get better. Continuing treatment, though, will help you conquer your fears.


Jacofsky, Matthew D., Melanie T. Santos, Melanie T., Khemlani-Patel, Sony, and Neziroglu, Fugen. “Behavioral Therapies for Anxiety Disorders”,

Smith, Melinda, Segal, Robert and Segal, Jeanne. “Therapy for Anxiety Disorders: Cognitive Behavioral Therapy, Exposure Therapy, and Other Options”,