This book is part of a very useful series published by Robinson, each of which looks at applying CBT to a particular area of Mental Health (Anxiety, Depression, Low Self-Esteem, Anger & Irritability etc). Each book is written by a leading practitioner/researcher in the particular area of concern. Having now worked with CBT for many years, I believe that it is at its most useful when dealing with some of these specific Mental and Behavioural Health issues.
Although they are written as self-help books, in my experience they can also be useful to therapists as a practical introduction to working with a problem area. In some cases, therapist and client can work together using the book as a resource. CBT is, after all, an educative process where therapist and client collaboratively discover what will work best for the client's improvement (indeed, all psychotherapy can be seen as a form of structured experiential learning). A book like this can be a useful map for a part of the journey.
In this particular book, David Veale and Rob Willson outline the nature of OCD and the CBT approach to working with it. They point out that the use of the word "obsession" in everyday usage is different from its meaning in the context of OCD. Here it refers to any distressing thought, image or urge, "...associated in the person's mind with the power to prevent harm occurring" (p. 10). Such obsessions are therefore associated with Safety-seeking Behaviours (an important concept in the CBT of any Anxiety Disorder) which tend to maintain the obsession.
Other important concepts described are
* The over-importance of thoughts.
* Inflated responsibility & Magical thinking.
* Overestimation of danger.
* Perfectionism.
* Attention biases.
In relation to recovery from OCD, the main approach described is that of Response Prevention, which has been well established in the evidence base for quite a long time as one of the most effective ways of working with these issues. Veale and Willson sum up the process as follows:
1. Develop a hierarchy of triggers
2. Face your fear
3. Make exposure long enough
4. Make exposure frequent enough
5. No anxiety-reducing strategies
6. If you do a ritual, repeat the exposure
7. Monitor progress
Other approaches described include the "Theory A & Theory B" approach, where different possible interpretations of the client's thoughts and feelings are tested using behavioural experiments, and Mindfulness Meditation, which is now being incorporated into CBT approaches to a number of problems, including Chronic Pain and Depression.
The authors also include some useful forms in the appendices, in relation to both assessment and treatment.