Return to:
News and Views
Reviews: Books
The OCD Workbook: Your Guide to Breaking Free from Obsessive Compulsive Disorder
By: Bruce M. Hyman, Ph.D., & Cherry Pedrick, R.N. Oakland, California: New Harbinger Publications, Inc., 1991. 217 pp. $19.95 (paper)
Obsessive-compulsive disorder (OCD) is a neurological condition that causes those affected to have unwanted thoughts, and often forces them into repetitive behaviors to rid themselves of those thoughts. This disorder is not rare, it occurs in 2.5% of the general population (p. 2). The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder is a book designed primarily for adults 18 and older, most notably those struggling with obsessive-compulsive disorder, family members of those struggling with OCD, as well as for those that are simply interested in learning about this disorder. Throughout the text, the authors provide both first person accounts of dealing with OCD, fictitious case vignettes of others dealing with the different types of this disorder, as well as charts and graphs that the reader completes as he or she goes through the self-directed program.
Hyman and Pedrick divide The OCD Workbook into four parts. Chapters 1 through 3 discuss the symptoms of OCD, how it is diagnosed, and how the disorder is treated, so that the reader is able to understand the intricacies of the disorder. The authors describe six separate types of OCD: checkers, washers and cleaners, orderers, pure obsessionals, hoarders, and people with scrupulosity (those that obsess over religious and moral issues). They provide personal accounts of each type of the disorder. This helps those with OCD to realize that they are not alone, and while their subtype of OCD may be rare, it does exist in other people, and can be treated.
Hyman and Pedrick also include a section on what OCD is not. Many people may be confused about OCD and assume that certain behaviors are indicative of the disorder. In this section, they provide a checklist of symptoms so that one can discover whether or not he or she is truly living with OCD. They also discuss the causes of OCD so that people can see that the disorder is caused by improper brain chemistry, and that those with OCD are not at fault for causing their own disorder. They go on to explain several treatment options. The authors state that the most effective form of treatment is cognitive-behavioral therapy (CBT) along with medication. In order to treat OCD, the form of CBT utilized is known as exposure and ritual (or response) prevention. In the later chapters The OCD Workbook attempts to teach the reader the basics of exposure and response prevention and outlines an approach that may be used to alleviate most of the symptoms of OCD. They discuss types of medication often used to treat OCD, as well as dosage. Since high dosages of medication are often necessary to treat OCD, they also include potential side effects, and how to manage these side effects. Hyman and Pedrick emphasize that it is extremely important to consult one’s doctor before making any decisions regarding changes or discontinuing of medication.
Part II of the book, chapters 4 through 8, outline this step-by-step, exposure and response prevention approach. The authors refer to this section as the “heart of the book.” It is this part that can best be used as a supplement to psychotherapy. The start of this section discusses strategies in preparing oneself and one’s family for the work that is mandatory in order to see substantial change. Since the client will need support from those around him, this section can be very valuable when starting a cognitive-behavioral program.
Often during CBT, therapists assign outside homework so that the client continues to work on the strategies that were discussed in therapy outside of the session. The authors describe a self-directed program for helping to alleviate the symptoms of OCD. However, due to the many questions that the reader may have while attempting to complete the program, this approach should be closely supervised by a psychotherapist. Depending on the stage of psychotherapy, the therapist can assign a specific passage from the book. For example, at the beginning of therapy, the therapist may ask the client to read the section on exposure and response prevention (p. 33), in order that the client understand what will be happening in treatment. As treatment progresses, the therapist may assign a more active activity, such as having the client write down his or her obsessions and compulsions that he or she needs to work on (pp. 53-57). These assignments helps the client to focus on what change is needed outside of therapy, and helps the psychotherapist to focus on certain behaviors in therapy.
After identifying one’s obsessions and compulsions, The OCD Workbook suggests activities that may be done in order to alleviate symptoms. They discuss both in vivo (live) exposure, as well as imaginal exposure to help a person arouse the anxiety that if often present in their lives. Following the arousal, they provide a table where one records the amount of anxiety that is present in terms of SUDS (subjective unites of distress scale). A score of zero indicates no anxiety, where as a score of 100 indicates the “most anxiety-provoking situation you have ever experienced in your life” (p.61). The authors state that with repeated exposure, one’s SUDS score will lower to acceptable levels.
However, people with OCD often perform compulsive rituals in order to alleviate their anxiety. The OCD Handbook provides tables where one records the compulsion that he or she had previously performed upon becoming anxious. Then, the reader attempts to withhold the compulsion for a specific amount of time in order to extinguish the compulsive activity (ex. washers on pg 67). In this activity, the person is forced to withhold the compulsion in effort to train their mind that the anxiety can abate without the ritualistic behavior.
Part III deals with specific types of OCD, as well as maintaining one’s gains following the self-directed program. Chapters 9 through 12 give examples of pure obsessions, scrupulosity, hyperresponsibility, and hoarding. Each chapter defines a specific type of OCD and provides a self-directed program in order to eliminate the client’s OCD. Hyman and Pedrick present their section on relapses in such a way that if relapses occur, the reader does not feel like he or she did something wrong. Relapses are seen not as a letdown, but simply a step on the road to recovery. They claim that relapses are inevitable, however, with their strategies, they can be dealt with and eliminated. Also discussed are disorders that are comorbid with OCD. Since disorders such as depression and Tourette’s syndrome can complicate treatment for OCD, the authors provide examples of how these disorders are treated. The psychotherapist can assign specific chapters to his or her client if the client is dealing with a comorbid problem. This will help the client learn more about his or her disorder between sessions, and allow the psychotherapist to discuss the client’s new knowledge with the client in the following session.
Finally, in part IV, the authors discuss where one can go to seek out further treatment for OCD. They discuss the need for one’s family’s support as well as where to seek professional assistance. They also provide a list of questions that one could ask a potential psychotherapist. They give sample answers that they feel show that the psychotherapist is competent to treat OCD. Hyman and Pedrick emphasize that experience is a must when treating OCD. They recommend seeing a psychotherapist that has dealt with numerous cases of OCD in his or her practice as well as one that is flexible with their schedule. A client with OCD may need assistance at other times besides simply when his or her appointment is scheduled.
The greatest strengths of The OCD Workbook are its ease of use and the ability for the workbook to be utilized by people with many different forms of OCD. The workbook provides straightforward instructions from start to end of treatment. It outlines how one begins by listing all the thoughts and behaviors that need to be examined. It moves on to a day-by-day approach to challenging one’s beliefs and limiting one’s compulsive ritualistic behaviors. Each chapter ends with key ideas that were learned in that chapter, so that before going on the reader makes sure that he or she has completed all of the activities in the prior chapter.
The workbook ends with directions on how to maintain the gains that the reader has made during the weeks that he or she has completed the program. The final goal is for the reader to have changed what the authors call “faulty beliefs.” People with OCD often feel that a situation will cause harm to them or other people. Therefore, they perform ritualistic activities to alleviate their concern. In most cases there is no possibility of danger. Therefore, the authors describe a process known as “cognitive restructuring,” where the reader begins to understand that while there is a chance of danger in many situations, that chance is usually miniscule and consequently should not cause great anxiety.
This workbook is broad in its focus of obsessive-compulsive disorder. Different sections of the book appeal to those suffering with different forms of OCD. This is clearly outlined at the start of the book so that once the reader understands what type of OCD he or she has; he or she can simply turn to the corresponding section and follow the self-directed program. Furthermore, the authors indicate that the book should be used in conjunction with psychotherapy. This shows that the authors realize that attempting to alleviate one’s OCD symptoms can be extremely difficult and one would be aided by the support of a trained clinician.
This workbook is clear in defining OCD and suggesting a program to help one alleviate the symptoms of the disorder. The passages throughout the text give the reader a chance to read about other people that have suffered just as the reader has suffered. The exercises are explained succinctly and clearly. The OCD Workbook would be an invaluable resource as a supplement to psychotherapy in the fight against OCD. Psychotherapists may assign the client chapters to read on the disorder or simply a chart to complete before their next meeting. Once integrated into therapy, this book would help the client understand what was happening inside of therapy and see the steps that can be taken in order to ease his or her suffering.