Cognitive Behavioural Therapy for OCD

By Karen Hastings

OCD is a condition that can be managed with CBT, either by using a CBT based self-help book or via more intensive therapist support.

OCD is characterised by obsessions and compulsions. An obsession is a persistent thought, image or urge that comes into your mind and sets off feelings of anxiety and distress. These obsessions occur frequently, are intrusive and not easy to get rid of. For example, common obsessions in OCD include, thoughts or images of violence, blasphemous thoughts, fear of contamination, sexual thoughts or images and excessive concern with health. In OCD a compulsion is an act or ritual that is repeated and repeated in reaction to an obsessive thought. A compulsion may be an behavioural act such as repeatedly checking the door is locked or a mental act such as saying something or picturing something to make the distressing feeling, associated with the obsessive thought feel better.

Usually when I treat people for OCD using CBT therapy techniques in Fife, I find that the method that the person with OCD uses to cope with or solve their OCD, is the very factor keeping their OCD going. This is because people with OCD commonly give a special meaning or powerfulness to their obsessive thoughts, usually that having the thought will lead to something bad happening to themselves or others. As a consequence, the person will usually mistakenly believe that the way to solve the obsessive thought is to try to block it or carry out a compulsion to “undo” the thought. What we know is that our brains work in such a way that trying to block a thought will only make it more frequent and whilst carrying out a compulsion will make the person feel better initially, it will actually feed the OCD so that the problem keeps going.

This can be likened to having “just one puff” to get rid of a craving for nicotine when trying to give up smoking. Whilst for a short period the craving is dealt with (distressing feeling in OCD), it actually leads to stronger and increased cravings.

When working with clients who have OCD a lot of time is spent identifying the persons OCD maintaining factors. Typical factors that keep OCD going include: giving thoughts more meaning then they deserve, misunderstanding about why you have the particular obsessions you have, avoidance and safety seeking behaviour (avoiding anxiety triggered by the thought by blocking or undoing the thought with a compulsion, avoiding situations that you associate with the obsessive thought, asking others for reassurance), giving too much time and attention to your obsessions, trying to control your thoughts and thinking biases.

CBT therapy works by helping the person unravel the factors that maintain their OCD in order to build a different solution to overcome it. Treatment will then involve exposure and without responding, with the support of your therapist. This basically involves accepting your obsessive thoughts in such a way that you learn to tolerate the anxiety which accompanies them without carrying out any compulsions. Eventually the anxiety naturally fades so that you will be able to experience the thought without finding it distressing. This is called habituation.

Bibliotherapy: Freeing yourself from Depression, Anxiety, Stress and OCD

If you feel that you could manage your depression, anxiety, OCD or stress if only you had the tools, then why not try a good self-help book. This is a cheaper option for those who cannot afford private therapy or give those waiting to see an NHS Cognitive Behavioural Therapists (CBT), the foundation to begin to manage their own mental-health.

There is wealth of self-help books out there and it can be overwhelming deciding which ones will be most useful. I regularly prescribe reading and practical exercises taken from self-help manuals as part of CBT and Occupayional Therapy and at my therapy practice in Fife. In this article, I list and describe some of the books that I have found most useful in relation to specific problems, in a bid to make choosing the book for you a bit easier!

For Obsessive Compulsive Disorder

My book of choice is “Overcoming Obsessive Compulsive Disorder – A self-help guide using Cognitive Behavioural Techniques” by David Veale and Rob Willson. This book is a clear and practical step-by-step guide to regaining control of your OCD and your life! The book contains a CBT approach that is specifically aimed at OCD. This is very important since some CBT approaches used to treat other problems such as anxiety and depression can be unhelpful when applied to OCD. This book is applicable to OCD in it’s varying forms, e.g. for those who experience pure obsessions, for those who carry out internal mental rituals and for those who display compulsive behaviours. What I like about this book is that it is very frank and can help to show the person with OCD that they need not be ashamed of the content of their intrusive thoughts, images and urges. Some of the people I work with using CBT in Fife, have found that they need help in applying the book from a therapist.

For Depression

I recommend “ The Cognitive Behavioural Workbook for Depression” by William Knaus. This book combines Cognitive Behavioural Therapy, Rational Emotive Behavioural Therapy and common sense in an easy to follow format that includes practical exercises that can help you find your way out of a depressive state. By practising the techniques presented in the book, you can learn the skills to defeat depressive thinking. The book takes into account all factors related to being depressed that can make any action difficult and gives you tips on how to deal with procrastination, lack of energy and motivation.

I also recommend “The Mindful way Through Depression – Freeing Yourself From Chronic Unhappiness” by Williams, Teasdale, Segal and Zinn. Mindfulness is a technique that has its origins in Buddhism but that is used without any religious connotations within the field of cognitive therapy to help people learn to break the cycle of mental habits such as rumination and self-blame which perpetuate depression. Mindfulness involves disengaging from this type of mental activity. This book is written in the format of a program and includes a CD to follow of guided mindfulness meditation practices.

Mindfulness techniques are very useful for anxiety and OCD disorders also.

For Anxiety and Stress

A useful book that I use with people seeking CBT therapy, Dunfermline is “The Anxiety and Phobia Workbook” by Edmund Bourne. This is a really comprehensive book that gives step-by-step guidance in overcoming anxiety and covers various factors including relaxation and meditation skills, exercise, coping with panic, dealing with negative self-talk and irrational beliefs, visualisation, self-esteem, medication, nutrition and more.

Finally a book that it more general but useful for anxiety, depression or stress is “Mind Over Mood – Change the Way you Feel by Changing The Way You Think” By Greenberger and Pedesky. This is a simple to follow book that really targets illogical and irrational thinking styles that drive depression and anxiety. It includes worksheets to follow.

Finally, its important to remember when considering a book to begin self-help that like therapy, self-help books and the exercises they direct you to do, must be practiced diligently and consistently in order to work.