Rec. Readings

Recommended Readings

Mark L. Berger, Ph.D. with commentary by Steven Phillipson, Ph.D.Managing Obsessive-Compulsive Disorder: A Sufferer’s Question and Answer Guide Gail Steketee, Ph.D. and Kerrin White, M.D. When Once is Not Enough: Help for Obsessive Compulsives. Lee Baer, Ph.D. Getting Control: Overcoming Your Obsessions and Compulsions. Edna B. Foa, Ph.D. and Reid Wilson, Ph.D. Stop Obsessing! How to Overcome Your Obsessions and Compulsions. Fugen Neziroglu, Ph.D. and Jose A. Yaryura-Tobias, M.D. Over and Over Again: Understanding Obsessive-Compulsive Disorder.

 


NEW PUBLICATION AVAILABLE:

Dr. Phillipson has co-authored a new booklet that will be of interest to OCD Sufferers.

This work is: MANAGING OBSESSIVE-COMPULSIVE DISORDER: A SUFFERER’S QUESTION AND ANSWER GUIDE BY MARK L. BERGER, Ph.D. WITH COMMENTARY BY STEVEN PHILLIPSON, Ph.D

See below for details


Mark L. Berger, Ph.D. with commentary by Steven Phillipson, Ph.D. Managing Obsessive-Compulsive Disorder: A Sufferer’s Question and Answer GuideThis booklet is unique because it presents OCD from the perspective of a patient and his cognitive-behavioral psychologist. It contains the story and insights of one who has struggled with OCD for over 45 years and the commentary of his pioneering behavioral therapist. It was designed to be informative and helpful to OCD sufferers and their loved ones. It is written in an accessible, non-academic style.

The booklet offers concise answers and commentary about the following questions:

  • How to effectively conceptualize the OCD threat?
  • How does OCD originate?
  • The role of drugs in treating OCD?
  • How to understand Cognitive-Behavior Therapy (CBT) for OCD?
  • What common difficulties arise in CBT for OCD and how to manage them?
  • How to handle perfectionism?
  • What is the role of determination, will, and motivation in the struggle with OCD?
  • How to deal with a relapse?
  • What is the role of humor in coping with OCD?
  • How you can benefit from group therapy?
  • Can a person with OCD treat himself?
  • OCD and depression?
  • What is Obsessive-Compulsive Personality Disorder (OCPD)? How does it compare with OCD? How a sufferer can have aspects of both OCD and OCPD?
  • What is the importance of “moving on” beyond OCD, of finding an interest, passion, or meaning in life?

The booklet is available only from the co-author, Mark L. Berger. Please send a check for $20.00 ($18.00 for the booklet and $2.00 for postage) to: Mark L. Berger, 6831 Ranch Drive, Columbus, Georgia, 31904. Include your address and he will send it out to you. Your money back if not satisfied.

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Gail Steketee, Ph.D. and Kerrin White, M.D. When Once is Not Enough: Help for Obsessive Compulsives. Oakland: New Harbinger Publications, 1990. Pp. 229. $13.95 (pb.). ISBN 0-934986-87-8.Steketee and White’s book on the diagnosis and treatment of OCD is clearly written and easy to follow. The book focuses primarily on behavioral treatments, though it does address other forms of treatment. The exercises that address many aspects of OCD can be tailored to meet the needs of your symptoms.

The authors present comprehensive definitions of OCD, obsessions and compulsions by explaining the terminology used in the Diagnostic and Statistical Manual (DSM-IIIR). They also make the distinction between OCD as an illness and OCD as a diagnosis. The diagnosis changes as the illness is better understood while the actual illness does not change.

In addition to clearly defining the components of OCD, Steketee and White explore disorders related to OCD, such as trichotillomania, hypochondriasis, body dysmorphic disorder, eating disorders, and Tourette’s. Obsessive Compulsive Disorder is also compared to Obsessive Compulsive Personality Disorder, as the distinction between the two is frequently unclear.

The biological bases of OCD are presented in a manner that is easy to understand. There are many factors that contribute to OCD (biological and psychological) and no single factor has complete control over the disorder. Serotonin, brain structure, and genetics are factors that potentially impact on OCD. The authors emphasize that you be cautious when reading the latest research on OCD. There is a difference between facts and findings which is often unclear.

There are many theories about the origins of OCD, and some are briefly discussed. While the authors mention the psychodynamic and cognitive theories, the behavioral/learning theory is given the most attention. The behavioral theory can be used to explain how OCD develops from personal experiences and how it can grow from one ritual to multiple rituals.

As OCD’s development can be understood from a behavioral perspective, so can its treatment. Steketee and White describe the research done on many types of behavioral treatment in great detail. One of the most researched forms of behavioral treatment is the exposure treatment method, a form of systematic desensitization. The basis of this treatment is intentionally facing the obsession. This can be done with visual imagery or with varying degrees of exposure (in vivo). Another effective approach for confronting your obsessions involves paradoxical intention. By increasing the frequency of the obsessions, the anxiety they create actually lessens. A third type of exposure has you repeat your fears out-loud. The fears do not have the same impact once you have vocalized them.

Research has also been done on blocking methods which are designed to manage compulsions. As the name suggests, the individual attempts to block responses to obsessions. One way to block compulsions is to physically prevent yourself from doing them. If you find yourself already in the process of a ritual, you can stop in the middle. Another aspect of the blocking method is punishing yourself for following through on the compulsion. Theoretically, the desire to engage in the compulsion will decrease if it becomes associated with something negative.

Steketee and White compare these two methods of exposure and blocking. The most effective approach seems to be a combination of the two. For someone whose OCD is related to contamination, this may take the form of deliberately exposing yourself to dirt and then not allowing yourself to wash.

Planning how you are going to treat your OCD is very important. The authors recognize how critical it is to the treatment’s success and devote an entire chapter to preparation. The first big hurdle is getting up the courage to commit yourself to treatment. Then you need to evaluate your needs. If you feel your OCD is severe or quite complex, you may need to seek a professional for assistance. Foundations are listed to help you select a therapist. Before actually beginning any treatment, it is essential that you have a clear understanding of what you’re treating. One way to help you clearly defining your symptoms is by keeping records of your rituals and fears.

When reducing your obsessive fears through direct exposure, there are several steps to progress through. A hierarchy of situations and objects that are related to obsessions can help you choose how to approach treatment. After ordering things, you can decide how to expose yourself to your fears. This includes the duration and frequency of the exposures. White and Steketee emphasize the importance of tolerating the anxiety, as it allows for desensitization. Friends and family can provide support during these times, referring to a collection of guidelines and helpful things to say.

Some obsessions cannot be addressed through actual exposures, so imagery must be utilized. Constructing scenes can help to expose you to the anxiety caused by the obsession. There are many components to doing this: sensory experiences, emotional responses, physiological reactions, behaviors, thoughts and ideas. By including these, a scene is more likely to have an impact that will eventually result in desensitization.

When working to stop rituals, planning your prevention is important. You may delay your response until you no longer feel the need to engage in the ritual. Limiting the ritual or only doing parts of it also be effective. There are guidelines for helping you determine how to manage your rituals.

Medications are commonly used for treating OCD. Steketee and White acknowledge that medications may not help everyone, but that people should take advantage of them if they do help. They provide an overview of how medications are tested and which medications have been found helpful in the treatment of OCD. The risks and benefits are presented for each medication. Drug alternatives are also presented and the medications are compared to behavioral therapy. The most effective treatment seems to be a combination of the two treatments.

There are other strategies for treating OCD. Psychotherapy appears to be unsatisfactory for most, though it has had an impact for some people. Hospitalization is rare, though it may benefit those whose OCD is especially bad. Electroconvulsive Therapy and Psychosurgery tend to be the final alternatives. Both have progressed greatly over the years, but many are still reluctant to consider them viable options.

During and after treatment, complications are likely to arise. It is not uncommon for people to lose their motivation. They may also have trouble complying with the demands of the treatment. New obsessions may develop as old ones begin to fade. Treatment may be complicated by the presence of other psychological disorders and conflicting personality styles. People may have relationship problems as loved ones adjust to changes in the OCD. Finally, as strange as it may seem, people often have trouble living without their OCD. Strategies are offered for managing all these potential complications.

The final chapter addresses issues in understanding and treating OCD. At the time of publication, these were future issues, though many are now current issues in OCD. The diagnosis of OCD and the characteristics associated with it will continue to be refined as the disorder continues to be better understood. Cognitive compulsions and coping skills target the discomfort associated with facing rituals. New drug treatments have more specific effects that impact on the brain’s chemistry. Family therapy and support groups are available for people with OCD as involving other people seems to be quite helpful

When Once is Not Enough is a clearly written book that addresses the basic components of OCD. Some components are out-dated, as it is almost ten years old, but the majority of the book continues to be relevant. This is an easy read with important references that are useful when planning a treatment program.

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Lee Baer, Ph.D. Getting Control: Overcoming Your Obsessions and Compulsions. New York: Plume, 1992. Pp. xiii, 234. $12.95 (pb.). ISBN 0-452-26889-3.Baer’s book on the diagnosis and treatment of OCD is a must have for those suffering from OCD and their friends and family. The foundation of the treatment programs is behavioral, though it has been influenced by Baer’s experiences at a multidisciplinary clinic. The various exercises are placed in the context of actual case histories, making it easy for you to relate them to real life scenarios that you may encounter.

In addition to comprehensive description of OCD, there are clear definitions of obsessions and compulsions, making the point that they are actually more common than you would think. More people are identifying themselves as OCD receives increased publicity. While the cause of OCD is still unknown, Baer makes the point that there are some leads in finding an answer. They include genetics, chemical imbalances, and brain differences.

Baer acknowledges the many different types of OCD yet manages to generally place them into seven large categories: cleaning rituals/fear of contamination, checking rituals/safety fear, repeating rituals and counting compulsions, compulsive slowness, superstitious obsessions and compulsions, saving or hoarding rituals, and obsessions without compulsions. For each of these categories there is a description of the common symptoms, a case example, and a comparison that serves to distinguish OCD symptoms from everyday behaviors. In addition to everyday worries and rituals that everyone has to some degree, he also addresses Obsessive Compulsive Personality Disorder, drug abuse and pathological gambling, delusional thoughts, and other illnesses with obsessions and compulsions. There is even a chapter towards the end of the book that is devoted solely to problems related to OCD.

Baer provides an overview of the various treatments available for OCD. Behavior therapy is given the most attention as it is the basis for the programs presented in the book. The concepts of exposure, response prevention, and habituation are clearly defined and examples are given. The applications and concerns of behavior therapy are also addressed (for example: length of treatment, degree of symptom reduction, and application for different types of OCD). The principles of behavior therapy are also introduced in this chapter Each component is individually addressed and explained in relation to the entire therapy.

In addition to behavior therapy, the chapter also covers medication and other treatments. The benefits and side effects of medications are discussed. Baer does not recommend using medication alone to manage symptoms, but rather suggests combining it with behavior therapy for the best results. Baer believes that other therapies can generally be avoided, as the behavior therapy is the most effective and can lead to results for nearly everyone.

Baer offers several tests to assess the different aspects of OCD. The tests are designed to determine which OCD symptoms you have and how severe they are, the strengths of you beliefs related to obsessions and compulsions, the degree of avoidance due to OCD, and the overall level of depression.

The next step is setting goals for your treatment program. There are both long-term and practice goals. The chapter shows people going through the various steps in setting goals for each type of OCD and provides worksheets at the end of the book to help you work through those same steps. Also, there are several tips here to help you determine what goals are right for you. Baer then gives guidelines for tailoring behavior therapy to meet these goals.

After finishing your treatment program, there is a chapter designed to help you stay in control of your OCD. While you can’t cure OCD, it is possible to greatly reduce your symptoms. Baer reviews the long-term results of behavior therapy for each type of OCD and supplements it with people who have worked through each type of OCD and how they are dealing with it now. There are also some ways to help you get the odds in your favor so you can continue to stay in control and maintain your results.

There is an entire chapter devoted to problems related to OCD. Trichotillomania is a disorder that revolves around hair pulling. The individual feels increasing anxiety or distress and, by pulling her hair, relieves this stress. Another problem related to OCD is Tourette’s Disorder, which is characterized by uncontrollable twitches, tics and outbursts. It differed from OCD because there is no rumination and the individual can’t explain why they did something. It is not uncommon for someone with Tourette’s to also have OCD. Tourette’s and Trichotillomania are often treated with habit reversal. There are some examples of this treatment.

The last group of problems are excessive body worries: dysmorphophobia, bowel and urinary obsession, and hypochondriasis. Not only are they each clearly defined, but there are treatment plans and case examples for each. These problems are also compared to OCD, because, despite many similarities, they are truly separate and different disorders.

While medications have been touched on throughout the book, there is one chapter devoted solely to the many different medications used to treat OCD, including: clomipramine, fluoxatine, and sertraline. Each medication is individually addressed, paying attention to the applications of the drug, its side effects, and the recommended dose ranges.

Baer takes the time to address some of the common questions asked by those who have OCD and their friends and family. They include questions about different types of therapy, what results can be expected, how to find a therapist, and what to look for in support groups.

Support is also the focus of the final chapter, which is written especially for family, friends, and helpers. The goal is to help them to understand what OCD is and how they can be supportive. There are sections about dealing with friends or family members with OCD and those who won’t get help for their OCD. The end of the chapter is designed for someone who has been asked to be a helper. It addresses the demands made of the helper in setting goals, practicing assignments and providing encouragement. There are also things to consider that may impact on the relationship between the person with OCD and the helper. Baer recommends agreeing on a set of rules before starting and gives examples of some rules.

Getting Control is a comprehensive book for anyone who has OCD or who knows someone with OCD. Its clear writing style makes it easy for anyone to follow and the many examples show how the behavior therapy can be applied to practically any situation. After reading this book, you will feel that someone truly understands what you are experiencing and you will know that you are not alone.

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Edna B. Foa, Ph.D. and Reid Wilson, Ph.D. Stop Obsessing! How to Overcome Your Obsessions and Compulsions. New York: Bantam Books, 1991. Pp xvii, 247. $11.95 (pb.). ISBN 0-553-35350-0.This self-help book is one of few that presents a program that has proven effectiveness. Unlike many other books available on OCD treatment, the programs described here have been evaluated by leading clinical centers. Additionally, the book has the benefit of Edna Foa’s extensive experiences as one of the leading scientists in OCD.

According to the authors, the goal of their book is “to bring help for your worries and compulsions into your home” (xv). The easy-to-use format allows you to do just that, by tailoring the programs and exercises to meet your own needs. You could develop a program on your own or with the assistance of a mental health practitioner.

There are seven symptom patterns that are addressed: washers/cleaners, checkers, repeaters, orderers, hoarders, thinking ritualizers, worriers, and pure obsessives. Each of these is discussed separately, as common features are identified (broken down into situations that causes distress; thoughts, images, and impulses that cause distress; feared consequences of not avoiding or ritualizing; and common compulsions).

There are short questionnaires to help you to analyze your particular OC and to determine the components of your own self-help program. One of these exercises consists of evaluating the level of distress you experience related to the common features of your OC.

The initial program has four challenges: 1. Become determined to conquer your problem. 2. Gain perspective that your worries are irrational. 3. Consider that ritualizing is not the only way to reduce your distress. 4. Accept your obsessions instead of resisting them. To help you meet these challenges, there are exercises to help you determine what to do while you are obsessing. They are also to help you let go of your worries and tensions. Another method is to followed structure practice exercises. In addition to addressing obsessions, there are also suggested methods for dealing with compulsions.

The intensive three-week program can be tailored for each of the symptom patterns. There are guidelines for preparing for the program and for using the many techniques. There are also specific examples for each symptom pattern that you can use for the basis of your own program.

The book briefly addresses medical treatments, primarily Anafranil, Prozac and Fluvoxamine. After discussing the positive and negative aspects of the various prescriptions, the authors emphasize that they do not consider medications to be a replacement for the treatment programs presented in the other chapters.

The final chapter of the book relates the success stories of people who have recovered from their OCD. With each person’s story, you learn of their symptoms and their reactions to treatment. They show that, while the program may not be easy, it is possible to overcome your obsessions and compulsions.

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Fugen Neziroglu, Ph.D. and Jose A. Yaryura-Tobias, M.D. Over and Over Again: Understanding Obsessive-Compulsive Disorder. San Francisco: Jossey-Bass Publishers, 1997. Pp. x, 228. $12.00 (pb.). ISBN 0-7879-0876-2.This book presents itself as a “survival manual for the patient.” In addition to answering questions that the patient, family, friends and therapist may have, it provides hope and inspiration for all. Beginning with the roots of OCD (ancient times and demonic possessions) the authors demonstrate a deep understanding of how OCD impacts on the individual.

There first of a number of tables throughout the book, presents complex information in a format that is easy to follow and understand. The tables cover OCD characteristics, symptoms, and primary qualities.

Case examples are used in the entire book, helping to illustrate the various situations people may find themselves in. Some examples relate the turning points in peoples’ lives and how they chose to seek treatment. Recognizing that OCD comes in many forms, the authors provide examples to address these different types of OCD.

Part of OCD’s nature is its onset and different manifestations. In addition to describing the symptoms and characteristics of early and late onset, the authors address questions that people often have about the disorder. Other conditions related to OCD are also described.

There are many issues to consider when beginning treatment. The authors describe the role of goals within treatment and the chances of not improving. The biological basis of OCD is also addressed, as it can impact on the efficacy of treatment.

The most common approach for OCD is behavioral treatment. Frequently asked questions are answered and an actual case provides examples of treatment. Related therapies are also described.

Biological treatments are often combined with behavioral treatment. The most commonly prescribed drugs are presented with their dose ranges, common side effects, and potential interactions. Factors to take into consideration and questions a doctor will want to know are listed. There is a helpful table which consists of other medications, their trade and generic names, and the types of medications they are.

Another option available for people suffering from OCD is in-patient treatment. The authors present the potential benefits of hospital treatment, in addition to its drawbacks. Depending on your type of OCD and its severity, hospitalization may be a viable option; however, the majority of people have their treatment needs met with out-patient treatment.

OCD impacts on social relationships. People end up feeling socially isolated as their OCD assumes a bigger role in their lives. Treatment can be tailored to address social skills training and other issues may arise. One of these issues is deciding whether or not to tell friends and family about the disorder.

Families are often brought into the OCD. People can become dependent on their family to help them with the demands of OCD. The main problem areas with families include repetitive questioning, self-absorption, and strange or bizarre rituals. These can often lead to many difficulties, particularly when the individual refuses help.

Treatment of OCD follows a long, and often bumpy, road. Many factors contribute to success or failure in treatment including: personality factors, support systems, and other family members with OCD. Relapse is always a possibility, frequently associated with a number of situations and stressors. Knowing this can happen, people can take several steps to help avoid relapse.

It is not uncommon for people with OCD to also have other disorders. Comorbid conditions are outlined with case examples. Their connections with OCD are also explained.

The book ends with 100 questions often asked about OCD. They range from OCD’s potential interactions and patterns to its impact on relationships and lifestyle. There are also guidelines for families coping with OCD. The twenty suggestions encourage family members get involved with the treatment.

Over and Over Again is a wonderful introduction to OCD. It’s concise and easy to follow with illustrative tables and case examples. This book does not outline specific treatment programs, though it does prepare people for the demands that such programs will make. Over and Over Again truly is a “survival manual for the patient,” providing hope for family, friends, therapist and the patient.

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