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Stop Obsessing! How to Overcome Your Obsessions and Compulsions
By Edna B. Foa & Reid Wilson. New York: Bantam Books, 1991. 247 pp. $12.95 (paper).
Stop Obsessing! How to Overcome Your Obsessions and Compulsions is a useful book that serves as a practical guide for those who suffer from Obsessive Compulsive Disorder (OCD). The reader is informed about the nature of the disease and provided with insight into the reasoning behind the disturbing thoughts and behavior they may be experiencing. This book is useful for adolescents and adults who experience mild to severe forms of OCD. Since OCD can take various forms, this text specifically addresses several types of the disorder. A workbook format is provided throughout the book in order to guide the reader through the learning process. While this text may be useful in the therapeutic process, the authors grossly undervalue the benefits of therapy and psychotropic medication. Therefore, the psychotherapist may want to use the text as a guide for therapeutic assignments rather than as an assigned reading. The content will be further examined in terms of how it can be integrated into psychotherapy, as well as the strengths and limitations of the information provided.
As an adjunct to cognitive behavioral therapy, a psychotherapist may use this text in order to reinforce the skills learned and practiced in treatment sessions. The book is divided into three parts, which can effectively correspond with the beginning, middle and advanced stages of therapy. A primary goal is to help the reader clearly identify the problem by using a checklist of symptoms. A psychotherapist can use this extensive list of symptoms as a way to help the client share distressing thoughts and feelings that are often difficult to express. Using this type of format to identify the problem may lessen the shame that is often associated with OCD. Along with the realization that others have had similar thoughts and feelings, a sense of hope may begin to develop. As the reader is educated about the cycle that perpetuates OCD this book may serve as a psychoeducational resource to complement early stages of treatment.
In order to change habitual thinking patterns, it is essential for the client to work outside of therapy. The psychotherapist may assign exercises that promote change in real life contexts. This book explains the seven most common types of OCD through depicting the situations that provokes distress, the thoughts that are being played while under distress, the dreaded consequences that one is trying to avoid, and the typical rituals that may result. Understanding the wide range of experiences that comprise OCD may serve as a means to normalize the client’s experience. One of the assignments requires the reader to list disturbing thoughts, the factors that instigate their distress, the consequences they fear, the situations they avoid, and rituals they engage in to cope with their anxiety. In the early stages of psychotherapy, this book may help clients gain a better understanding of the distress they have been feeling in preparation for the next phase which involves implementing change.
The second section of the book deals with how to obstruct the sequence of symptoms associated with OCD. In conjunction with psychotherapy, the exercises offered in this section can help break old patterns of thinking and behavior. This section clearly illustrates a fundamental construct of cognitive behavioral psychotherapy, which explains how redefining obstacles influences an individual’s ability to take control of the situation. Concise examples of how thoughts control feelings are provided with specific new thoughts that can be used to replace maladaptive thinking. This section is especially important as it can serve as a written reference for those who are implementing change.
Several important techniques used to prevent obsessions are covered in this section including instructions on how to go about delaying obsessions, how to vary obsessions in order to start gaining control over them, relaxation techniques, and how to integrate supportive statements into one’s daily life. In addition, the reader is instructed to set aside time each day specifically to worry during this time. The reader is taught that obsessions are time-consuming because a significant amount of time is often spent trying to prevent oneself from worrying. When one is instructed to simply worry without thinking about anything else, worrying becomes more difficult. Another method of desensitization involves tape recording obsessive thoughts and replaying the tape for at least forty-five minutes daily. Similar techniques offered to reduce one’s compulsions include holding off the compulsion until a later time, slowing down one’s movements during rituals, and changing a part of the ritual. Other exercises include adding a consequence to the ritual and eventually choosing not to ritualize. All of these exercises can be used to reinforce what is learned in treatment and to provide guidelines to practice each technique.
The third section of the book is designed to work as a three-week program for those afflicted with both worries and obsessions or those who were not able to reduce their worries or obsessions using the first two sections. This section includes valuable exercises in imagery practice, exposure, ritual prevention, and habituation. The exercises are divided into the type of OCD including, “. . . washers, checkers, repeaters, hoarders, orderers, and thinking ritualizers” (p.124). This section may help psychotherapists provide appropriate homework assignments that specifically address the client’s distinct form of OCD.
The strengths of this book include the easy-to-read format, the real life stories included throughout, and the ability of the book to help those afflicted with various forms of OCD. The practical assignments allow the reader to put the information learned into action. The concepts discussed are presented in simple terms, which enable readers of all levels to utilize the information. Flow charts and tables are used to illustrate the key components of the disease and definitions of terms are provided as needed. Compelling stories taken from the authors’ counseling practices are used to explain how techniques have been implemented. The stories included add an interesting element to the text and provide hope and insight for those who can identify with the people described. The authors clearly address the varying degrees of severity that are associated with OCD and inform the reader to use the book according to how they are affected by the disorder. They indicate one part of the book for those who are working on overcoming worries or obsessions, another for those who are also affected by compulsions, and a third part for those who spend more than two hours daily ritualizing.
A major limitation of this text is evident, as the value of seeking professional treatment for OCD is substantially underestimated. In fact, the authors encourage only those with severe cases of the disorder to seek mental health services. According to the authors, the severe situations that warrant professional help include individuals who deny that their compulsions are used to lower anxiety or those who experience compulsions that are completely involuntary. In addition, they explain that if individuals are convinced that their most anxiety producing fears are likely to occur or they engage in rituals for two or more hours per day, they should seek help from a professional. Otherwise, the authors encourage the reader to primarily request the help of a friend or family member. In support of their position, they cite researcher conducted in England, which found that OCD can be alleviated through self-help instructions and “minimal professional guidance” (p.7) and this single study is used as evidence to support their stance. In addition, the authors emphasize the importance of social support in treating this disorder and the difficulties that often accompany the stigma and shame that prevents individuals from seeking social support. This issue is essentially disregarded when the readers are advised to tell someone close to them about their disorder in order to gain the support necessary to work through the program.
The authors’ position is further complicated with their indication that OCD is often accompanied by depression. Since depression is known to limit one’s motivation and reduce the energy needed to carry out an intense program such as this text provides, it would be difficult for someone afflicted with OCD and depression to overcome these disorders without professional guidance and encouragement. In addition, the authors explain that there are very few experts in the field and imply that one needs to see a specialist in OCD in order to obtain appropriate mental health services. The authors minimize the effects of this disorder by suggesting that professional help is only necessary for those who suffer from severe symptoms.
Although the authors do not formally suggest using medication in addition to following their program, they explain that if one has already sought psychiatric treatment, they are likely to have used several medications. This chapter appears as though it was interjected as an afterthought and does not flow with the text. The information presented regarding medications is confusing and scant. Again, the authors emphasize the usefulness of their program when compared to professional treatment services.
This text is a comprehensive guide for those afflicted with various types of OCD. The exercises are easy to follow and provide a great reference for both psychotherapists and patients either in or out of psychotherapy. It is valuable in that it contains employable exercises that can be tailored to meet individual needs. In addition, it provides passages, which may illicit insight into one’s own behavior, and supplies illustrations to explain the processes examined. However, the lack of emphasis on the utility of professional treatment is a limitation. But, when used in conjunction with psychotherapy, this book may serve as a valuable adjunct for individuals suffering from OCD. The assignments, exercises, and case presentations can each be easily integrated into the psychotherapy process. The psychotherapist can integrate the appropriate sections into the treatment process as is appropriate, in support of the treatment being provided.