- Email: [email protected]
Cognitive-behavioral therapy for OCD
Available online at www.sciencedirect.com
Clinical Psychology Review 28 (2008) 356
Book review Cognitive-behavioral therapy for OCD, David A. Clark (Eds.), 2004 Guilford, New York, #324 pp., $38.00 USD (hardcover) In the preface to this volume, David A. Clark states that the “psychological treatment of obsessive–compulsive disorder (OCD) will be effective only if it is theoretically guided and empirically verified” (p. viii). This assertion sets the tone for his clearly written and exceptionally thorough book on the contemporary cognitive-behavioral approach to understanding and managing this highly complex condition. The book is divided into three parts, the first of which provides an overview of issues related to the diagnosis, psychopathology, and phenomenology of OCD. The issues of symptom heterogeneity and possible symptom subtypes or dimensions are discussed in detail, and the possibility of an “OCD spectrum” of disorders is considered. Dr. Clark also unpacks the various forms of compulsive behaviors that can be observed in individuals with OCD. Readers are treated to an excellent discussion of the differences between overt compulsive rituals, reassurance-seeking behavior, compulsive urges, neutralization, thought control, avoidance, and mental rituals. Clark helps clinicians who might lump such phenomena together under the umbrella of “compulsions,” to see the individual nuances of each. The didactic nature of the first part continues in the second part, which contains chapters reviewing theoretical models of the etiology and maintenance of OCD symptoms. These models include early learning theories and neuropsychological and information-processing deficit theories, yet the focus is on “cognitive appraisal” theories which generally hold that obsessions develop when normally occurring unwanted thoughts are misappraised as significant or threatening. The resulting fear or distress leads the individual to “try too hard” to either dismiss or neutralize the thoughts, or prevent unlikely dreaded consequences (e.g., via compulsive rituals), yet these excessive strategies only maintain the misappraisals (Rachman, 1997). A highlight of the chapters which discuss variations on this general theoretical framework is that each includes a critical appraisal of empirical research which supports (or fails to support) the respective model. Clark's own research interests focus on the deleterious effects of attempted thought control and suppression. In the final chapters of part 2, he synthesizes his own and other investigators' research in this area into a new “cognitive control” model of obsessions (chapter 8) which emphasizes the role of thought suppression failure in the persistence of obsessions. Put succinctly, this model proposes that individuals with obsessions not only try too hard to control the obsessions, but care too much about the consequences of incomplete thought control. In part 3, Clark describes the assessment and cognitive-behavioral treatment of OCD. The clinical strategies are derived directly from the empirically supported theoretical models reviewed in part 2 of the book. Psychometrically valid assessment measures, self-monitoring forms, and rating scales for the assessment of patient-specific symptoms are discussed. Forms developed by Clark, himself, for assessment and treatment planning purposes are reprinted in the book. Readers are likely to appreciate the assortment of case examples that illustrate the use of assessment and treatment techniques, as well as the patient handouts which can be used in therapy. What might be novel for many readers is that the individual cognitivebehavioral treatment techniques are described as targeting dysfunctional cognitions, as opposed to OCD symptoms (i.e., obsessions and compulsions) per se. This further highlights the importance of a thorough cognitive assessment. Part 3 concludes with a chapter critically reviewing the empirical status of CBT treatment for OCD. As the reader will note, this book contains both a didactic and a practical format. One might consider it a treatment manual of sorts, although it does not constrain the clinician with a session-by-session approach. Rather, the reader is presented with a set of effective techniques, the use of which should be guided by a thorough assessment and conceptualization of the patient's condition. As a result of this format, the volume is likely to be of great interest to students, clinicians, and researchers alike. If there is a shortcoming, it is that the implementation of exposure and response prevention, which are widely accepted as the key components of effective treatment for OCD (e.g., Abramowitz, 2006a) are given short shrift. Fortunately, additional resources which describe the nuts and bolts of exposure-based treatment are available elsewhere (e.g., Abramowitz, 2006b).
References Abramowitz, J. S. (2006a). The psychological treatment of obsessive–compulsive disorder. Canadian Journal of Psychiatry, 51, 407−416. Abramowitz, J. S. (2006b). Understanding and treating obsessive–compulsive disorder: A cognitive-behavioral approach Mahwah, NJ: Lawrence Erlbaum Associates. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793−802. Jonathan S. Abramowitz Department of Psychology, University of North Carolina at Chapel Hill, Campus Box 3270 (Davie Hall), Chapel Hill, NC 27599-3270, United States E-mail address: [email protected].
1 November 2004 doi:10.1016/j.cpr.2007.04.008
Clinical Psychology Review 28 (2008) 356
Book review Cognitive-behavioral therapy for OCD, David A. Clark (Eds.), 2004 Guilford, New York, #324 pp., $38.00 USD (hardcover) In the preface to this volume, David A. Clark states that the “psychological treatment of obsessive–compulsive disorder (OCD) will be effective only if it is theoretically guided and empirically verified” (p. viii). This assertion sets the tone for his clearly written and exceptionally thorough book on the contemporary cognitive-behavioral approach to understanding and managing this highly complex condition. The book is divided into three parts, the first of which provides an overview of issues related to the diagnosis, psychopathology, and phenomenology of OCD. The issues of symptom heterogeneity and possible symptom subtypes or dimensions are discussed in detail, and the possibility of an “OCD spectrum” of disorders is considered. Dr. Clark also unpacks the various forms of compulsive behaviors that can be observed in individuals with OCD. Readers are treated to an excellent discussion of the differences between overt compulsive rituals, reassurance-seeking behavior, compulsive urges, neutralization, thought control, avoidance, and mental rituals. Clark helps clinicians who might lump such phenomena together under the umbrella of “compulsions,” to see the individual nuances of each. The didactic nature of the first part continues in the second part, which contains chapters reviewing theoretical models of the etiology and maintenance of OCD symptoms. These models include early learning theories and neuropsychological and information-processing deficit theories, yet the focus is on “cognitive appraisal” theories which generally hold that obsessions develop when normally occurring unwanted thoughts are misappraised as significant or threatening. The resulting fear or distress leads the individual to “try too hard” to either dismiss or neutralize the thoughts, or prevent unlikely dreaded consequences (e.g., via compulsive rituals), yet these excessive strategies only maintain the misappraisals (Rachman, 1997). A highlight of the chapters which discuss variations on this general theoretical framework is that each includes a critical appraisal of empirical research which supports (or fails to support) the respective model. Clark's own research interests focus on the deleterious effects of attempted thought control and suppression. In the final chapters of part 2, he synthesizes his own and other investigators' research in this area into a new “cognitive control” model of obsessions (chapter 8) which emphasizes the role of thought suppression failure in the persistence of obsessions. Put succinctly, this model proposes that individuals with obsessions not only try too hard to control the obsessions, but care too much about the consequences of incomplete thought control. In part 3, Clark describes the assessment and cognitive-behavioral treatment of OCD. The clinical strategies are derived directly from the empirically supported theoretical models reviewed in part 2 of the book. Psychometrically valid assessment measures, self-monitoring forms, and rating scales for the assessment of patient-specific symptoms are discussed. Forms developed by Clark, himself, for assessment and treatment planning purposes are reprinted in the book. Readers are likely to appreciate the assortment of case examples that illustrate the use of assessment and treatment techniques, as well as the patient handouts which can be used in therapy. What might be novel for many readers is that the individual cognitivebehavioral treatment techniques are described as targeting dysfunctional cognitions, as opposed to OCD symptoms (i.e., obsessions and compulsions) per se. This further highlights the importance of a thorough cognitive assessment. Part 3 concludes with a chapter critically reviewing the empirical status of CBT treatment for OCD. As the reader will note, this book contains both a didactic and a practical format. One might consider it a treatment manual of sorts, although it does not constrain the clinician with a session-by-session approach. Rather, the reader is presented with a set of effective techniques, the use of which should be guided by a thorough assessment and conceptualization of the patient's condition. As a result of this format, the volume is likely to be of great interest to students, clinicians, and researchers alike. If there is a shortcoming, it is that the implementation of exposure and response prevention, which are widely accepted as the key components of effective treatment for OCD (e.g., Abramowitz, 2006a) are given short shrift. Fortunately, additional resources which describe the nuts and bolts of exposure-based treatment are available elsewhere (e.g., Abramowitz, 2006b).
References Abramowitz, J. S. (2006a). The psychological treatment of obsessive–compulsive disorder. Canadian Journal of Psychiatry, 51, 407−416. Abramowitz, J. S. (2006b). Understanding and treating obsessive–compulsive disorder: A cognitive-behavioral approach Mahwah, NJ: Lawrence Erlbaum Associates. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793−802. Jonathan S. Abramowitz Department of Psychology, University of North Carolina at Chapel Hill, Campus Box 3270 (Davie Hall), Chapel Hill, NC 27599-3270, United States E-mail address: [email protected].
1 November 2004 doi:10.1016/j.cpr.2007.04.008