tl;dr: Contains three good methods to deal with OCD: mindfullness
meditation, cognitive behavioral therapy (CBT), and exposure with
response prevention. Book does good job of explaining OCD, including
classes of OCD with tailored help approaches for each type. Also
talks about a number of factors that can aggravate OCD. I STRONGLY
recommend this book to people with OCD and those that want to
understand/help those with OCD.
There is a lot to like about this book. First, the book does an
excellent job explaining what OCD is, and why it effects people the
way it does. It talks about how everyone has a number of random
thoughts that pop into their head and most people just don't pay
attention to the odd/unlikely ones. OCD people tend to notice them
and actually give them weight; i.e. if one had this thought, it must
mean something and be important. They have to DO something about it.
Depending on what type(s) of OCD you have, most such thoughts you will
ignore if they don't fall within your "obsessions" (things that you worry
about). The compulsive part are the actions/rituals they undertake
to try to handle the "problem/worry."
The authors explain how doing the compulsions actually make things
worse, not better, using pavlovian conditioning. Basically, the
"obsession" makes the person uncomfortable (say they are afraid they
forgot to turn the stove off at night), so they do the compulsion (say
they go and check the stove again a number of times) which relieves
the discomfort for a while. When it comes back, the fact the
compulsion made them feel better last time, makes them want to do so
again, reinforcing that doing the compulsion is "good." As the
compulsion becomes less effective overtime, the person is compelled to
do "bigger" compulsions to get their "reward." Of course, the more
one does compulsions because of the thoughts that cause the
discomfort, the more attention you pay to them and the message to your
brain is that these thoughts are "important" and that the brain
should pay more attention, and the cycle reinforces itself!
A key point the book makes is that people doing compulsions are
seeking certainty that they will address or prevent the "concern" that
they are obsessing about. For example, if a person touches something
they think might be "unclean" they might wash their hands
excessively trying to be certain their hands are clean. The problem
is, we can never be 100% certain about anything so the OCD has set an
impossible task. The OCD then works to make one less sure the more they do
compulsions, requiring the compulsions to become more involved
over time. A key concept in reducing OCD is learning to accept
uncertainty.
The book suggests three ways to deal with OCD: mindfullness
meditation, cognitive behavioral therapy (CBT), and exposure with
response prevention (ERP).
mindfullness meditation: this is a simple form of meditation where you
might simply sit with your eyes closed, and focus on your
breathing. If a thought pops into your mind, just recognize it
("thought") but do not follow it or concentrate on it, but gently
redirect your attention back to your breathing. This is useful for
OCD since when an obsession related thought pops in to one's head,
instead of paying attention to it and doing compulsions, the idea is
to use meditation to recognize it as just another thought, and then
go back to what they were doing. The ability to do this is a skill,
and doing meditation is a way to develop and strengthen this skill.
CBT: the idea here is that we don't experience the world directly, but
through a mental filter that "interprets" the world and attaches
meaning. For example, if someone cuts us off in traffic we don't just
not the fact but we might think the person was a jerk, or "that's the
100th time" that's happened." The problem is that we often attach
meaning that are either guesses, biases, or exaggerations. These are
referred to by CBT as "cognitive distortions" and typically lists
several common ones that people tend to do. The idea being that we
learn to recognize when we are doing a distortion and correct
ourselves with a more accurate assessment. This book gives several of
the more common ones, but goes on to explain how they particularly
relate to OCD. In the later chapters on types of OCD, they discuss
distortions that are common for that type, and suggests ways to
counter them.
Some relevant distortions are all or nothing thinking (i.e. a person is
either "dirty" or clean, and can't be somewhere in between),
catastrophizing (i.e. I touched something unclean and I will become ill
unless I wash immediately), emotional reasoning (i.e. because the thought
popped in to my head, it must be important), mind reading (you see
someone do or say something and you assume you know why they did it),
to mention a few. They are explained well, with OCD related examples.
The idea with CBT is that when an obsession related thought pops in to
one's head, OCD tries to distort it and drive you to compulsions. By
applying CBT, one can put the thought into a more rational view, and
reduce one's desire to counter with a compulsion.
ERP: As discussed above, doing compulsions reinforces the desire to
do compulsions as well as the "importance" of the obsessions. The
books approach cumulates in using meditation, CBT, and ERP to
experience the obsession related thoughts and not do the
compulsions. They start off with reducing them, with the aim to
eventually eliminate them. With things such as hand washing that one
normally does, eliminate means reducing down to a "normal" (the
amount a "regular" person would do) level.
The idea is to experience the thought, endure the discomfort, but without
doing the compulsions; that over time this will break the feedback
loop, and the obsession and the compulsions will become less strong
over time. The book describes several ways to do this exposure in a
graduated way, including methods where exposure would not be safe to
physically do (i.e. creating scenarios in your head where you would
encounter things that you obsessive about and "experience" how that
makes you feel without being in the actual situation).
The book also makes the point that avoidance of what you are worried
about reinforces the worry. When you avoid the thing, your mind
doesn't say "you are safe," it says you just avoided something
"dangerous." This reinforces the worry, making things worse
(increases your discomfort in the future). They offer other
strategies instead.
The second part of the book discusses ten different types of OCD (many
quite general that encompass a number of related subtypes) such as
contamination, checking, just right, and harm OCD. They first
describe the type and then give some example fears and compulsions
that are often associated with the type. The idea is that if you
realize you are doing something because of OCD, you have a better
chance of doing something about the behavior. They then talk about
how to use meditation, CBT, and ERP for that specific type.
The one type of OCD that surprised me the most was "relationship OCD"
(ROCD). As OCD demands "certainty," it's easy to see how it would sow
a great deal of doubt in a person about their relationship; that it would
cause them to question things and demand that one answer questions that
they have no chance of answering correctly with the information
available.
It's also easy to see how cognitive distortions can play havoc as
well. For example, "all or nothing" or "mind reading". Mind reading is
particularly problematic as it means we assume we know why the other
person did what they did. However, people are very complex, and we
are shaped a lot by our experiences. It is very likely the reason
they did things was a function of their past that you don't know about.
At best, you might be partly right. That's ok. Problems start when a
person assumes they must be correct, doesn't check that they are, and
takes action based on their assumptions.