Cheryl Spends Four Hours Every Day in the Shower, Scrubbing

Multiple Choice

Cheryl spends four hours every day in the shower, scrubbing her skin raw with a loofa brush, fearing that she is contaminated with urine or feces.She sees a cognitive-behavioral therapist for treatment.The cognitive-behavioral therapist is most likely to write which of the following notes about Cheryl's case?

A) "Guarding against own unacceptable urges; uses reaction formation as a general defense."
B) "Engages in superstitious behavior; probably associating handwashing with some previous situation where it led to reinforcement."
C) "Neurotransmitters not functioning properly; needs medication."
D) "Consciously uses distracting thoughts to reduce anxiety over cleanliness."