Cognitive Behaviour Therapy for Obsessive-compulsive Disorder
In the nineteen- fifties psychologists interested in abnormal behaviour began studying obsessive- compulsive problems. In the early stages, attention was focussed on intense repetitive handwashing, which the affected people felt compelled to carry out to remove feelings of contamination. This evidently irrational, abnormal behaviour became the most notable manifestation of a psychological disorder. In succeeding years interest expanded to include compulsive checking and repetitive doubting.
During this period the prevailing ‘school’ of psychology was Behaviourism, in which exclusive attention was paid to observable behaviour. Compulsive handwashing was certainly that, and psychologists made reasonable progress in developing a technique for reducing this observable problem. It was found that repeated prolonged exposure to the stimuli (contaminants) that set off the washing steadily decreased the compulsive urges providing that the patient was prevented from executing the washing. However, obsessions— recurrent, disturbing intrusive thoughts and images— were outside the scope of a behaviourist approach.
In the nineteen- eighties cognitive ideas were infused into abnormal psychology, and in 1985 Paul Salkovskis presented a cognitive analysis of obsessive- compulsive disorder (OCD) that transformed our understanding of the disorder. It laid the basis for a significant improvement in therapy— behaviour therapy for OCD grew into cognitive behaviour therapy (CBT for OCD). Among other advances, it prepared the ground for an understanding of obsessions— not observable behaviours. In addition, Salkovskis drew attention to the seriously inflated sense of responsibility that afflicts so many patients with OCD.
Unlike most of the other anxiety disorders, there are several different manifestations of OCD. A valuable component of the book is the rich supply of clinical material, and it includes five cases that illustrate some of the varying forms of the disorder: compulsive checking, contamination fears, ruminations, ‘not just- right’ feelings, and religious obsessions. Mental contamination is a recent addition and includes some surprising variations, such as a fear of morphing, visual contamination, and self- contamination.
Several of the techniques for treating OCDs that are described and explained in this book were devised by Professor Salkovskis, who combines his basic research with an active clinical practice. He is an eminent authority on OCD and other anxiety disorders. The book consists of four sections: a comprehensive account of the disorder, assessment, treatment, and outlook. Given the imprimatur of Paul Salkovskis, it is authoritative, insightful, and comprehensive.
S. J. Rachman
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