New Book on OCD

[Guest InsaneIain]

Don't know if anybody else is aware of it but a new book has just been published entitled "Overcoming Obsessive Compulsive Disorder". Dr David Veale is one of the authors and although I haven't read it yet I'm sure it will be of some benefit to everyone. I'll post my thoughts on here when I've read it.

[Ashley]

I have read it and it offers nothing new and is quite negative. My full review will appear shortly.

I would certainly not recommend it.

[Guest InsaneIain]

It seems to me that there are two schools of thought on OCD these days- the exposure and response prevention techniques as championed by Salkovskis & the like (old school) & the 4 steps theory as pioneered by Schwartz (new school). Personally, I won't rule out either & try to keep an open mind about the problem (as much as is possible in any case)! What I will do is read every book I can find on the disorder as I believe that what works for one sufferer may not work for another.

[Ashley]

I am in complete agreement with you Iain but my gut instinct with this book and judging by the fact it offers nothing new to the field of self-help books, is that this book was published for the sake of it because of the authors status within the OCD community.

Of course like you say we all have different opinions on things, but I found it negative, dismissive and all the way through it uses Americanised English which I found annoying. I also found the way OCD case studies use the names of 'OCD Professionals' rather cheesy. I actually question some of the 'facts' used in this book.

It also keeps referring to the other books in the series, 'how to overcome depression', 'how to overcome low self esteem' etc, so I cant help get the feeling this was just released for the sake of it to complete the series and maybe for another reason.

If I was going to spend £10 of my money I would put these books above it in the list:

- Obsessive Compulsive Disorder: Practical, tried-and-tested strategies to overcome OCD by Dr Frederick Toates, Olga Coschug-Toates.

- OCD Workbook by Bruce M. Hyman and Cherry Pedrick.

- Getting Control by Lee Baer.

- Brain Lock by Jeffrey Schwartz

- Obsessive-Compulsive Disorder: The Facts by Padmal de Silva, Stanley Rachman.

- Imp of the Mind by Lee Baer.

But this is just my opinion, others may disagree. Let me know what you think after you have read it, be good to get a few opinions.

[Ashley]

Talking of new books, not read this yet myself but I will be getting copies shortly.

Loving Someone with OCD - Help for You and Your Family

By Karen Landsman, Kathleen Rupertus & Cherry Pedrick

New Harbinger Publications

People who suffer from mental illness rarely do so alone. Their families and loved ones face their own set of unique challenges - problems that deserve their own resources and sources of support. This is the first book written specifically for the loved ones of people with obsessive-compulsive disorder (OCD). It helps readers examine how OCD affects their lives and offers a straightforward system for building a healthier, more constructive relationship with OCD sufferers.

[Guest InsaneIain]

Appreciate your honesty mate, we all have our own opinions. I've read all but the first two of these I think and I must say the approach that Schwartz puts forward is now almost universally recognised as the treatment of choice for the disorder. Personally I find it very hard to put the 4 steps into practice but having said that I've held down a job for the past decade and am happily married so I guess you could say that I'm controlling my OCD to some extent, although I still obsess and carry out compulsions.

[Ashley]

I've read all but the first two of these I think

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Oh wow, you have to read Obsessive Compulsive Disorder: Practical, tried-and-tested strategies to overcome OCD by Fred Toates, I will be getting copies in our shop shortly.

It's unique because Dr Toates also used to suffer with OCD and is a real life story, not just a self help book.

I love this book.

[Guest InsaneIain]

I may have read it- I have read one of his books but it was some years ago and I think that this is a more recent publication.

[Guest Dennis912]

I was scared by Imp of the mind, it was alittle to harsh for me to handle.

[Guest David Veale]

Dear Ashley

I’m sorry you didn’t like our book. Our feedback so far has been very positive from other indiviudals with OCD so we will take on board any specific comments you have for the next edition and answer “the facts that you question”. We haven’t referenced the book because it’s not an academic textbook. Of course there are many things that are not known in OCD and where we present an opinion, we have tried to say so. I agree with you about the awfulness ofthe Americanised English but unfortunately the publisher won’t do a separate text for USA readers. Originally we were told it would be edited to mid-Atlantic but in practice we discovered this means American! Still at least this is the same as all the other books you mention.

Our motivation for us approaching the publisher, Robison was because we thought we had something new to say about the psychological understanding and cognitive model of OCD which is developed from Paul Salkovskis. This has not been previously published in an easily accessible format and Paul himself acknowledges this in the foreword that he hasn’t had the time to write such a book. All the other books you mention are standard texts on OCD – most cover exposure but none have really explained the cognitive model in a practical way. Some are more theoretical like Padmal’s book and not sufficiently practical. I assure you it’s not published “for the sake of it”. Writing a book (for me and my co-author) takes many hours in the evenings and weekends and I can think many better ways of enjoying myself – however I am interested in improving the lot of OCD (and BDD) sufferers and have done this through my research and helping the charity OCD Action. I get about 35p for each book sold and at an hourly rate, I assure there are far easier ways for me to pay my mortgage! We do refer to the other books in the Robinson series and many others not in the series because we want to pass on our recommendations that we give to our own patients. People with OCD have other problems whether it be low self-esteem, depression etc. It has nothing to do with the publisher and many other self help books will give recommendations so I am not sure what this niggle is about.

Let's be clear about one very important thing - there is no evidence that Jeffrey’s Schwartz “method” is better than standard approaches – it is not another school of thought and contrary to what “InsaneIan” says it is definitely “not universally recognised” by others as the treatment of choice. I’ve never heard of another credible therapist who uses it. There are no presentations at scientific meetings or journals or workshops where Jeffrey presents the approach he uses in his book. He uses CBT and he has not conducted any randomised controlled trials (which is the accepted method in the scientific community) to demonstrate it’s superiority over standard CBT. In the book we do refer to his approach as we believe it may be counter-productive because in our view there is not enough emphasis by Jeffrey on the “doing” aspects and testing out beliefs in behavioural experiments. Research across all anxiety disorders demonstrates that this is the most powerful way of overcoming OCD and other anxiety disorders. We think that Jeffrey’s approach may sometimes be counter-productive because it may encourage new mental rituals (like giving yourself a form of reassurance). As you may know the problem is not the intrusive thoughts or urges (which are entirely normal) but the “thoughts about the thoughts” and the way you respond to them. Hence we provide a detailed discussion on the meaning that is attached about intrusive thoughts such as “thought action fusion” and “magical thinking”. OCD is a problem of misinterpreting normal thoughts and ideas or urges as evidence that you are for example, dangerous or harm will occur and believing that you are able to preventing harm from occurring. First cognitive therapy hardly ever involves just talking, it means following it up with action to test out your prediction. In many respects mindfulmness medcitation fits neatly with contemporary theory of how to manage intrusive thoughts, images, doubts and urges. Mindfulness practice involves learning to be fully present in the current moment, but without passing judgment on that which you are experiencing. The application of this approach to overcoming OCD is obvious, since at the heart of the problem lies extreme judgments placed on the intrusive thoughts, images, doubts, and urges (i.e. the meanings and misinterpretations that give rise to obsessions). As yet there are no scientific studies on mindfulness medaition in OCD, but theoretically it fits. Mindfulness means acknowledging the intrusive thoughts and urges but not engaging with them and refocusing attention. A useful analogy is to imagine the intrusive ideas as cars on a road. When you have OCD, you focus on particular cars and respond by either trying to stop them or push them to one side. Alternatively you may try to flag the car down, get into the driving seat and try to park it (that is analysing the idea and sort it out until you feel “right”). Of course, often there is no place to park a car and as soon as you have parked one car another one comes along. Being “mindful” means being on the pavement, acknowledging the cars and the traffic but just noticing them and then walking along the pavement (that is doing something else) and refocusing one’s attention on other parts of the environment (such as talking to the person beside you and noticing other people passing you and the sights and smells of the flowers on the verge). In other words intrusive ideas have no other meaning than passing traffic – they are “just” thoughts and images and part of the rich tapestry of human existence. OCD is a problem of misinterpreting normal thoughts and ideas and believing that you are able to preventing harm from occurring. As you know Jeffrey Schwartz has written discussed his approach in various books and a four step method in response to the obsessions and compulsions which consists of: 1) Relabel 2) Reattribute 3) Refocus 4) Revalue. The method is part of an elaborate biological explanation for OCD which in our view goes beyond the data available and is not accepted by scientists in teh OCD comminity. The four step approach has not been evaluated in a controlled trial – for example there have been no comparisons of individuals with OCD who receive a standard treatment like CBT against the four step method. If you read the draft NICE guidelines on treating OCD, there is no reference to it because there are no controlled studies on his approach. Furthermore there is indeed a danger that the method teaches a sophisticated mental ritual especially in individuals with intrusive thoughts. We have noticed in a number of our patients that it may distract a person from following through with the exposure and testing out their beliefs in a behavioural experiment. The most powerful way of changing beliefs is to act against them and to test them out. An example in our book is Naomi who had had intrusive doubts about being in a parallel world and that her family and friends around her were “false”. I chose Naomi’s story because she had personally tried the “Schwartz method” to no avail. She found it difficult to articulate the “awfulness” of being in a parallel world and intellectually to her the idea of being in a parallel world was absurd. However the idea made her extremely anxious and she was highly handicapped as she had a number of elaborate and complex rituals to avoid remaining in a parallel world. She had been taught to relabel and reattribute the idea of being in parallel world as “just an OCD thought”. She did this religiously so it became a safety behaviour and reassured her. She remained very handicapped as she had difficulty in resisting any of her rituals. She was not asked by the therapist to do any exposure or behavioural experiment to the idea of staying in a parallel world.

We think therefore a problem with “relabelling and “reattributing” ideas is that it is a mental activity that involves engaging with the thought and giving it more attention without following it through with an action. Any exposure or behavioural experiment has been avoided. Following standard CBT and Paul Salkovskis’s model, we would try to engage Naomi with two theories to test out. Theory “A” is that Naomi has a problem of being in a parallel world and she has to do everything she can to get her self back to the real world before any harm occurs. Theory “B” is that she worries excessively about being in a parallel world and being out of control and that her various rituals and safety behaviours increase her worries. A behavioural experiment involves testing out which theory best explains the phenomenon. In Naomi’s case, this involved exposure to deliberately trying to be in a parallel world and staying there without any safety behaviours or rituals. She eventually agreed to try this and realized that her experience best fitted with Theory B as her worries decreased when she stopped trying to escape from the idea of being in a parallel world. This was more effective than intellectually trying to relabel and reattribute the thought and convincing herself that it was just an OCD thought. You can teach a parrot to say “It’s just an OCD thought” but it doesn’t mean anything to the parrot unless you follow it through with action and do the exposure to prove to yourself that it is just an idea. “Relabelling” and “reatributtion” is a standard part of cognitive therapy. However the timing is important –the cognitive aspoect needs to be done before an intrusive a thought pops up when you are trying to understand the processes that maintain OCD. Relabelling should not occur at the time an intrusive thought occurs as it can become a mental ritual. We would argue that it’s important to acknowledge an intrusive thought when it occurs (and not to suppress it’s appearance) but not to mentally engage or put any meaning to it (for example reassuring yourself that it is “just an OCD thought” or “just an obsession”). There is a danger that relabelling can become a ritual by itself because it is anxiety reducing. Trying to be an impartial observer of intrusive thoughts and urges, not engaging with them and acting against them with a different behaviour is just good CBT and has nothing to do with Jeffrey Schwartz. We would add that acting against the thoughts and urges is best done with exposure and a behavioural experiment to test out one’s theories and see whether the data best fits which theory. (Theory A or B as above)

Anyway we think the book has a place in the OCD community and I hope that your antagonism is nothing to with the fact that I was disappointed that you set up a new charity. As you know I thought there are already too many charities with at least four national ones in anxiety disorders in the UK each of which has many members with OCD, as well as OCD Action. However this is history and I understand your reasons for setting up OCD UK. As you know my view was that other fields such as Eating Disorders or Autism are more successful in focussing members, funding, grants, publicity etc in one direction. Any way I hope you are keeping well and keep up your excellent bulletin board. Best wishes

David Veale (co-author of Overcoming OCD published by Robinson)

Consultant Psychiatrist, The Priory Hospital North London and Hon Senior Lecturer, Royal Free & University College Medical School London

[Guest Brainstrain]

I was scared by Imp of the mind, it was alittle to harsh for me to handle.

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Me too!

Brainstrain

[Guest Brainstrain]

Hi David

Just to say that I am soooo glad that Ashie set up this charity as I have looked at many of the others and this is the one that offers the most practical help and support to sufferers, I don't know where I would be without it. Talking to other non-judgemental fellow sufferers has been for me, better help than any counsellor because it makes you not feel alone and for me that was half the battle, feeling I was the only one having these terrible thoughts. If OCD uk didn't exist it wouldn't have been advertised on a programme, I would never have realised what was actually wrong with me and would still be in the depths of despair so personally I have a hell of a lot to thank OCD UK for, that as far as I am aware no other OCD charity has done for me.

Brainstrain

[photog]

Hi David

Just to say that I am soooo glad that Ashie set up this charity as I have looked at many of the others and this is the one that offers the most practical help and support to sufferers, I don't know where I would be without it. Talking to other non-judgemental fellow sufferers has been for me, better help than any counsellor because it makes you not feel alone and for me that was half the battle, feeling I was the only one having these terrible thoughts.  If OCD uk didn't exist it wouldn't have been advertised on a programme, I would never have realised what was actually wrong with me and would still be in the depths of despair so personally I have a hell of a lot to thank OCD UK for, that as far as I am aware no other OCD charity has done for me.

Brainstrain

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As a mere carer i totally agree with the last comments after seeing and talking to Dr Swarze (not spelt that right) my wife is reading about the four steps and she seems to be getting her teeth into and we are having some good conversations on a subject that she doesn't talk about. Ashly Please Keep Up The Good Work there may be other charities out there but none has dynamic as OCD UK after many years of suffering for both of us we now can both go online and talk to sufferers and carers alike and speaking to people who know the depths of despair this condition can cause Thanks again ashly

ed

[Guest Smudger]

Anyway we think the book has a place in the OCD community and I hope that your antagonism is nothing to with the fact that I was disappointed that you set up a new charity. As you know I thought there are already too many charities with at least four national ones in anxiety disorders in the UK each of which has many members with OCD, as well as OCD Action. However this is history and I understand your reasons for setting up OCD UK. As you know my view was that other fields such as Eating Disorders or Autism are more successful in focussing members, funding, grants, publicity etc in one direction. Any way I hope you are keeping well and keep up your excellent bulletin board.

34675[/snapback]

I'm a little confused as to how there can be 'too many charities'? I may be missing something vital here, but for something as common yet little known as OCD surely the more attention the condition gets, the better? There may be other charities out there, but I've yet to find one as welcoming and dedicated as this. Not saying they don't exist, but I've never heard of them and would hate to think what would have become of me were it not for OCD UK. OCD UK is a life line for many people-for some it is their only life line, and I would imagine they, like myself, are extremely grateful for the hard work of Ashley and everyone else involved in this charity.

I personally am registered with 4 different OCD sites, and this is the only one I continue to use. Why? Because of the fantastic and friendly people. Because of the continued hard work and dedication of people like Ashley to push OCD out into full view of the public so that they don't need to suffer alone anymore. Because of the effort to provide the information and understanding that OCD sufferers need.

I just don't understand why you were opposed to this charity? It would either fail and dissapear, or succeed and help a great many people, and thankfully the latter occured. If it weren't for this charity, I have no doubt that I would be in a very bad place.

[Caramoole]

Fortunately OCD-UK is open minded enough to consider and allow all opinion to appear on its bulletin boards without moderation or censorship, in an effort to offer a balanced view on OCD and the current and varied opinions and treatment options avaiable. That in itself is refreshing.

I haven't read the book in question, so am not in a position to comment. I have read 'Brainlock' and think that in many cases it offers good, effective and practical advice, I have not personally found that it avoids exposure. Of all the books I've read I find 'Imp of the Mind' extremely effective in explaining what exactly occurs with purely obsessional thinking, that in itself to many is a God send.

As for OCD-UK being one too many charity, I can only disagree whole heartedly. I too have looked at many of the OCD charities and found that this one stands head and shoulders above the others, perhaps because it is run by sufferers and ex-sufferers who truly understand the condition at grass root level, unlike professionals who have studied the model.

[Guest David Veale]

>I just don't understand why you were opposed to this charity? It would either fail and dissapear, or succeed and help a great many people, and thankfully the latter occured. If it weren't for this charity, I have no doubt that I would be in a very bad place.

Oh dear! I'm not opposed. I'm sorry it was a comment at the end of long post and I was tired! I strongly believe in the power of self help and mutual support. I'm very pleased that OCD-UK has helped you. I think it will succeed because Ashley is so dedicated and good luck to you - although if ashley went under a bus, I suspect it would struggle. I believe that all the charities are fighting over the same members, grants, publicity etc and because of stigma and all sort of issues there's a very limited pot. My pipedream is therefore that the OCD Community will join up as one and if you put all your energy together you'll be bigger and better than all the individual charities put together. It's just a comment on strategy and getting OCD on the map. My comment was only a response to the book review which I though was biased because of history - and if you look in my book, we list OCD UK in the appendix as a resource for sufferers. Please forgive me Mr Smudger - judge me on my actions not my thoughts!

David Veale

[Caramoole]

I'm very pleased that OCD-UK has helped you. I think it will succeed because Ashley is so dedicated and good luck to you - although if ashley went under a bus, I suspect it would struggle.

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Ashley is indeed very dedicated and a driving force. As a moderator and administrator myself, I find your comment condesending but unsurprising!

OCD-UK has a dedicated committee, administration and moderation team who are all working as a united force to promote the awareness and treatment of OCD and doing it extremely well. It is beyond doubt that Ashley is doing a sterling job at the moment but with the foundadtion he has built, the support that he has encouraged, the team that has been developed, OCD-UK would not struggle (sorry Ashley, I hope you accept that in the manner it was meant)

I know little of the politics between the various charities (and much less care) but one thing about OCD-UK is that it has no allegiance to any other party, no financial gain to be made through its operation and that alone makes it honest and unbiased.

[Guest Smudger]

>I just don't understand why you were opposed to this charity? It would either fail and dissapear, or succeed and help a great many people, and thankfully the latter occured. If it weren't for this charity, I have no doubt that I would be in a very bad place.

Oh dear! I'm not opposed. I'm sorry it was a comment at the end of long post and I was tired! I strongly believe in the power of self help and mutual support. I'm very pleased that OCD-UK has helped you. I think it will succeed because Ashley is so dedicated and good luck to you - although if ashley went under a bus, I suspect it would struggle. I believe that all the charities are fighting over the same members, grants, publicity etc and because of stigma and all sort of issues there's a very limited pot. My pipedream is therefore that the OCD Community will join up as one and if you put all your energy together you'll be bigger and better than all the individual charities put together. It's just a comment on strategy and getting OCD on the map. My comment was only a response to the book review which I though was biased because of history - and if you look in my book, we list OCD UK in the appendix as a resource for sufferers. Please forgive me Mr Smudger - judge me on my actions not my thoughts!

Incidentally I'm currently helping the Anxiety Disoders Conference www.anxietyconference.org.uk for November in London on speakers and content in OCD so please let us know what topics you want to see covered.   

David Veale

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Thanks for clearing that up David.

I still think that for the level of exposure OCD currently gets, that more is better in terms of the number of charities. The more there are, the more chance there is of people encountering the help they need, and there is more chance the government will see how seriously the condition affects people, and on what scale. Also, just because a charity exists doesn't actually mean it will be effective or even properly run-if that weren't the case I wouldn't have had need to come here.

The efforts of OCD UK have been responsible for raising a great deal of awareness that wouldn't have otherwise occured . That's hundreds, maybe thousands, of people who could very possibly still be carrying their OCD around like the guilty secret they felt it was, had we not been here. While the pot is still small I feel it vital that we show there is a need for a bigger one by encouraging the growth of sites such as this and others, so that sufferers have too much choice of where they can get help, rather than too little.

Just my thoughts.

[Guest David Veale]

I'm very pleased that OCD-UK has helped you. I think it will succeed because Ashley is so dedicated and good luck to you - although if ashley went under a bus, I suspect it would struggle.

34702[/snapback]

but one thing about OCD-UK is that it has no allegiance to any other party, no financial gain to be made through its operation and that alone makes it honest and unbiased.

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A small point - none of the other registered charities I was referring to (i.e. OCD Action, Anxiety Disorders Conference, FSTF, TOP, NPS ,NP etc) have allegiance to any party and have no fiancial gain to be made through their operation. The policy of a charity is made by their governing body, which is different from the view expressed by individuals on a bulletin board. This post started with a book review and I regret questioning the bias of Ashley's comments.I would prefer to argue the case for the best way of getting better!

David Veale

[Guest InsaneIain]

It seems I opened a real can of worms with this topic. I am a member of both charities and I've got to say that in the six months that I've belonged to OCD-UK I've had a lot more support than that offered by OCD Action. However, as a sufferer I like to keep an open mind about the treatment options available and would not dismiss either the 4 step theory proposed by Schwartz or the traditional exposure & response prevention approach favoured by Salkovskis. I do stand by what I say about "Brainlock" though- every other sufferer I have spoken to regards it as being the seminal book on OCD too and while I have been inspired by both Salkovskis and Schwartz at previous conferences, when the latter described the gnawing sensation at the pit of your stomach at the recent Scottish conference I felt that he was the first non-sufferer I'd ever met who truly understood the condition.

Whatever your views or allegiances, I believe we should be uniting to fight a common cause, not driving wedges between each other.

[Guest waul46]

I think that combining both OCD UK and OCD Action would be a step in the right direction as they both serve the same purpose and having one main charity that focuses on raising awareness and keeps up to date on the latest research ect is the way to go! The OCfoundation of america is a good example!

I think Ashely has done so much to help the suffreres of OCD and so too has Dr Veale so basically we are all on the same side here! I actually recommend not reading too many OCD books because most good books are so similar theres no point in re reading the same advice however good it is! Better to read one good book and follow through with its advice! While classic CBT has helped me ease my symptoms as has medication I still feel Swchartz's 4 steps have value! Many readers swear by his methods and I find that refocusing really does help! However isn't this just distraction rather than an amazing thing discovered by Dr Swchartz?! As a paramedic in training I have certainly found that the high intesity work in helping others and keeping on your toes all day really helps shift attention away from OCD! Also this is not reassurance, this is real life! surely its healthy to focus on other things apart from your OCD to live a productive life! I think that both schools of thought have filled in important points which the other has left out! Also much of these ideas overlap! For example where Dr Veale says do not engage with thoughts and where Dr Swchartz says use mindfullness are essentialy the same thing!

I have both critisism and praise for Swchartz's work but he does in his latest CD recommend classic CBT for more severe OCD problems. Personaly I use classic techniques when the OCD is bad and when i'm at home but I also use 4 steps when i'm at work! So basically I say its not this or that or that only one method works! I say try everything, keep what works for you and discard what doesn't!

best wishes all ,warren

[Guest harmony]

Hi David Veale

I have never read your book, if you would like my opinion please send me a copy free of charge, I will read it and past it on to anybody else who wishes to read it, my opinion will be not bias at all, I am looking for overall infomation

[Guest harmony]

I am not going to get involved just yet, but I am sure David Veale is very active in OCD, but I am unsure if he is involved in the NICE guidelines? In fact I am not sure if he does any NHS work. Full stop?