Getting Over OCD: A 10-Step Workbook for Taking Back Your Lifeby Jonathan S. Abramowitz
Just imagine: No more obsessional thoughts and compulsive behaviors. No more planning your day around avoiding certain situations. You can get over OCDand join the thousands of people who are living freer, happier lives thanks to the clinically proven strategies in this book. Noted OCD specialist Dr. Jonathan Abramowitz provides the information,/i>
Just imagine: No more obsessional thoughts and compulsive behaviors. No more planning your day around avoiding certain situations. You can get over OCDand join the thousands of people who are living freer, happier lives thanks to the clinically proven strategies in this book. Noted OCD specialist Dr. Jonathan Abramowitz provides the information, support, and practical tools you need to:
*Understand your obsessions, compulsions, and rituals
*Develop a customized action plan
*Take gradual steps to safely confrontand masterthe situations you avoid
*Find relief from intrusive thoughts, no matter how distressing
*Overcome compulsion urges
*Reduce anxiety and improve your relationships
Based on cognitive-behavioral therapy, the most effective treatment for OCD, the workbook’s carefully sequenced exercises are illustrated with detailed examples. Ready to get over OCD? Your journey starts here.
Association for Behavioral and Cognitive Therapies (ABCT) Self-Help Book of Merit
"A top clinician has drawn on his extensive research to produce this first-rate self-help book. The techniques and steps clearly outlined here can help you significantly decrease your OCD symptoms. Dr. Abramowitz offers himself as your coach, and his positive, encouraging style will serve you well."Michael A. Jenike, MD, Department of Psychiatry, Harvard Medical School
Read an Excerpt
Getting Over OCD
A 10-Step Workbook for Taking Back Your Life
By Jonathan S. Abramowitz
The Guilford PressCopyright © 2009 The Guilford Press
All rights reserved.
Learning about the Symptoms, Causes, and Treatments
Let's get one thing perfectly straight right up front: OCD is a real psychological disorder that can be truly debilitating to its sufferers and their loved ones. It's not something you're making up or indulging yourself in. You didn't ask for it—although how you respond to this "enemy" is definitely the key to getting it out of your life.
The best way of thinking about the symptoms of OCD is as a set of unwanted thinking, feeling, and behaving patterns that are very stressful, unproductive, and difficult to control without help. The thinking patterns involve senseless, unwanted, and often very unpleasant thoughts, images, and impulses—called obsessions—that intrude into your mind even though you don't want them there. These kinds of mental intrusions provoke feelings of anxiety or discomfort, along with fear and uncertainty that something bad or harmful might happen. In turn, the anxious feeling patterns trigger the urge to do something to reduce the anxiety and deal with the obsessional thoughts. Rituals (sometimes called compulsive rituals) and avoidance strategies are the kinds of behavior patterns people with OCD get into to try to cope with obsessional thoughts, restore a sense of safety and certainty, and reduce anxiety.
There are two critical take-home messages here:
2.Compulsive rituals and avoidance are attempts to reduce anxiety.
Although compulsive rituals and avoidance behaviors occasionally succeed in reducing obsessional fear and uncertainty in the short term, these strategies tend to backfire in the long run. This is because obsessions always return; so you just find yourself doing more and more of the same rituals and avoidance behaviors. Over time, these thinking, feeling, and behaving patterns intensify to the point that people end up spending too much energy on avoidance and rituals (which backfire anyway) so that their work, school, social, and leisure activities get disrupted.
According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, now in its fourth edition (DSM-IV-TR), OCD is classified as an anxiety disorder, defined by the presence of recurrent obsessions or compulsive rituals that are severe enough to be time-consuming—taking up at least 1 hour a day—and that cause significant personal distress or interference with daily activities. Other psychological problems classified as anxiety disorders include phobias (irrational fears of things like animals, storms, the dark, and enclosed spaces), social anxiety disorder (fear of social embarrassment and speaking in front of groups), panic disorder (recurrent attacks of intense fear and dread), agoraphobia (fear of going out by yourself into crowds), posttraumatic stress disorder (PTSD; anxiety, flashbacks, and nightmares about traumatic personal events), and generalized anxiety disorder (excessive worrying about everyday matters such as relationships, finances, work, school, and health). Although these other problems often occur along with OCD, they are not the topic of this workbook.
What Is Not OCD?
The treatment strategies in this workbook are very effective for OCD, but they are designed specifically to help with the problems that fit the description you just read. Unfortunately, many people (including some professionals) confuse other disorders that involve repetitive thinking and behavior with OCD. So, in addition to learning what OCD is, it is important to learn about what it isn't. If you think you might have either of the following types of disorders instead of OCD, this is not the workbook for you.
Obsessive–Compulsive Spectrum Disorders
Check off any of the following "obsessive" and "compulsive" problems that you have trouble with:
 Repetitive hair pulling (for example, trichotillomania)
 Tics or Tourette's syndrome (for example, sudden facial movements such as eye blinking, unwanted vocalizations such as throat clearing or grunting, sudden muscle movements in different parts of the body)
 Repetitive skin picking or nail biting
 Compulsive gambling
 Compulsive sexual behavior (for example, excessive pornography use or masturbation that interferes with relationships or functioning)
 Compulsive stealing
 Self-injury behavior (for example, cutting)
 Compulsive shopping, buying, and hoarding
 Unnecessary fixation with a part of your appearance (for example, body dysmorphic disorder)
 Excessive preoccupation with having a serious illness (for example, hypochondriasis/health anxiety)
If one or more of these are a problem for you, then you might have a so-called obsessive–compulsive spectrum disorder. These spectrum disorders have some overlapping features with OCD—thoughts that are repetitious and behaviors that are difficult to resist—yet they do not involve the same thinking, feeling, and behaving patterns shown in the diagram on the facing page. Therefore they require their own treatment approach. I recommend consulting with a mental health professional if your symptoms seem to fit better into this category.
Obsessive–Compulsive Personality Disorder
Place a check mark next to any of the personality traits in this list that describe you:
 I am preoccupied with details and rules.
 I insist that people do things my way, and I can get angry or very upset if they don't.
 My perfectionism interferes with my getting things done.
 I am stingy and not very generous; I have a hard time sharing my things with other people.
 I am excessively devoted to work and productivity.
 I am generally rigid and stubborn.
 I am overly conscientious and rigid when it comes to ethics and morality.
 I cannot throw away even worthless or worn-out things such as clothes, books, or papers.
If you're like most people, you probably checked a few of those boxes. But if you have at least four of these characteristics, and they cause difficulties in your life, you might have a problem called obsessive–compulsive personality disorder or OCPD. OCPD is different from OCD (I always tell my patients and students that it's a shame the two conditions have such similar names). It doesn't share the same thinking, feelings, and behaving patterns as OCD, nor does it respond to the treatment techniques used in this workbook.
What Is It Like to Have OCD?
OCD is a very heterogeneous disorder. What it's like to have OCD for one person can be very different from what it's like for another, as the following four individuals illustrate. Underlying their widely variable symptoms, however, you'll undoubtedly begin to spot the thinking, feeling, and behavior patterns just described. Can you recognize how these patterns are related to one another in the following stories?
Brittain: The Mistakes That Were Never Made
"Mysymptoms began soon after I started college and began living away from home for the first time. Whenever I would finish a paper for class, or had to pay a bill, or fill out an important form, I would get these doubts in my head that maybe I had made a mistake—a serious one. For example, 'What if I underpaid my telephone bill?' or 'What if I copied the invoice number incorrectly from the statement?' Thoughts of my telephone service being cut off kept running through my mind. I also had images of collection agencies showing up at my door and coming after me.
"So, to make sure I never made any mistakes, I made myself reread everything I wrote before handing or sending it in. But my rechecking got out of hand after a while. I would get stuck reading over my bank checks to make sure the amount and invoice numbers were correct. Even after checking them several times over, I still had doubts. Sometimes, after I had finally put the check into the envelope, sealed it, and was on my way to the mailbox, I would have to reopen the envelope just to make sure I didn't make any mistakes. The whole process would start again. Of course, my rational mind knew this was completely senseless—I never made any of the mistakes I was so scared of. Still, checking gave me reassurance. I felt like I would go on obsessing forever unless I had a guarantee that everything would be okay."
Mike: The Fastidious Cable Guy
"As a cable TV installer, I was always going into different people's homes. That's when I started thinking that I could be spreading germs and other dangerous contaminants throughout the town where I live. Suppose I got germs from someone living on Elm Street and then spread them to a family on Maple Street later that day? It would be my fault if an innocent person—a child perhaps—got some terrible disease. I also worried that maybe I had stepped in dog poop or grass that had been sprayed with poisonous pesticides or fertilizer. What if I tracked that into someone's home? What if a baby lived there and crawled where I had walked? I couldn't get these obsessive thoughts out of my head. They seemed to be with me every waking moment, and they made me very worried.
"To deal with these thoughts and fears, I carefully watched where I stepped and avoided walking on grassy areas. I also scrubbed my hands and washed down my shoes with wipes before going into people's homes. Even still, I had the feeling I might be spreading contamination without realizing it. At one point, I thought of calling all the homes I had visited to make sure everyone was okay. That's when I started arranging my route so I could go home, shower, and wash my uniform in between houses. Of course, my work was suffering; but I was so scared of causing innocent people to get sick. Needless to say, I ended up losing my job at the cable company."
Stephanie: Postpartum OCD
"It all started when my son, Tyler, was born. I had always been a worrier, but having a tiny and helpless infant to take care of made me absolutely terrified! To make matters worse, I couldn't stop thinking the most awful thoughts about the worst possible things I could do to this defenseless, innocent baby. I find it hard to even talk about these thoughts, but when he would cry, I would find myself thinking about wildly shaking him. Although I knew these thoughts were senseless, they were so frightening. Sometimes when Tyler was sleeping, I would check on him just to make sure I hadn't lost control and shaken him to death.
"Changing Tyler's diaper made me have all sorts of awful sexual thoughts. The word 'penis' would come into my head every time I changed him, and I had thoughts of touching him sexually. I wondered whether he was getting sexually aroused by me changing him. Even though I was trying hard to get rid of these thoughts, theyjust kept coming back. I tried thinking about nice things instead, but the bad thoughts always won out. Why? Was I secretly a pedophile? A pervert? Was it just a matter of time before I acted on these awful ideas? I ended up having to avoid changing Tyler—my husband did it all. The poor child had to sit in dirty clothes until my husband came home from work. I also constantly asked my husband if he thought I was a bad person because of my thoughts. He would reassure me that I was still a good person. I thought becoming a parent would be a wonderful thing. Instead, it was turning out to be a terrible nightmare."
Steve: "Not Just Right" OCD
"Since my early teen years, my days have been consumed with the need to make sure that things are 'even,' 'balanced,' and 'in order.' My brain thinks about this all the time—like it's on autopilot. Even though I hate it and wish I didn't think this way, I can't seem to ignore it or put it aside. For example, odd numbers are a problem for me because I think they're unbalanced. If I come across an odd number, I have to do something in order to 'even it out.' Like, if I know I've received 23 e-mail messages today, I'll have to send myself one more just to make it 24. Balance is also a big thing. If I touch something with my left side, I have to turn around and brush up against it with my right side (with the same amount of pressure) to 'balance it out.' If I don't, I won't feel 'balanced.' My bedroom at home also has to be ordered and arranged just right. The clothes in my drawers have a certain alignment. Items on my desk must be placed a certain way. Even the way I put on clothes, shoes, eat my food, wash myself, and comb my hair has to be done just so. It's not that anything bad is going to happen if things aren't perfect, balanced, or even, but there's this overwhelming sense that things are 'not just right.' And it seems like that feeling would just go on forever and ever, and that I will lose my mind thinking about it. So, in order to get rid of that feeling, I just take the time to do these rituals. Unfortunately, they take up so much time that I can hardly get anything else done."
Did you recognize the thinking, feeling, and behaving patterns of OCD in these stories? Since the aim of CBT is to weaken these OCD patterns, an important first step is to learn how to spot the patterns in your own thoughts, emotions, and actions.
Are You Alone in This?
Anxiety disorders are the most common mental health problems. About 20% of adults—that's one in five—will have clinically severe anxiety at some point in their life. As for OCD, it affects 2–3% of the adult population—about one in every 40 people, or over six million adults in the Unites States alone. And that doesn't even count millions more people who experience occasional obsessions and rituals that don't fully meet the criteria for OCD. As we'll see, most people have obsessions and rituals at some point in their lives. You probably know other people with anxiety or OCD problems even if you don't realize it. So if you suffer from OCD, you are not alone.
Most people start to develop OCD in their late teens or early 20s, when people in many societies are becoming more independent and are faced with greater responsibilities. As you might have noticed from reading the preceding stories, responsibilities often play a role in OCD. It can be hard to pinpoint when problems with OCD begin, and it doesn't really matter if you don't remember when you first had obsessions and compulsions. What's more important to understand is that once OCD patterns develop, they're hard to get rid of on your own. So the sooner you get started, the better. And the way to start is to be aware of the kinds of thoughts, feelings, and behaviors you're experiencing that are part of OCD.
What Kinds of Ideas Does OCD Put in Your Head?
Your best friend may claim to be "obsessed" with a new car. Your son may be "obsessed" with a sports hero. Your coworker might be "obsessed" with a musical group. You might remember at one time being "obsessed" with jealousy over a new love. But these uses of the term "obsession" trivialize the thinking patterns of OCD and how they affect you. To a psychologist, obsessions and obsessional thinking are much more than just thinking a lot about something. In OCD, obsessions are persistent unwanted thoughts, impulses, doubts, or images that seem intrusive, inappropriate, senseless, and distressing. For those with OCD, obsessions are not manifestations of intense interest in something. On the contrary, they are:
Thoughts and doubts that you don't want to have,
That you try to ignore or resist (often unsuccessfully), and
That make you feel uncomfortable, anxious, or unsafe.
This is entirely different from daydreaming about a new car.
This workbook is designed to be helpful for OCD-related obsessions. You, however, might experience other kinds of repetitive negative thoughts that suggest a different problem is present—one that may require different treatment approaches. Excessive worrying, for example, is often a sign of generalized anxiety disorder (GAD). Worries, which are different from obsessions, concern real-life issues such as work and school, relationships, decisions, health, and finances (for example, "What if I lose my job and end up on the street?"). Ruminating is another form of repetitious negative thinking often mistaken for obsessing. Ruminations are signs of depression and involve repetitive thoughts about an actual negative event such as a setback, loss, or other type of problem that you can't seem to get over. If your negative thoughts seem to fit better into the categories of worry or rumination, rather than obsession, I recommend seeking a professional evaluation to determine whether you have OCD or one of these other problems.
Excerpted from Getting Over OCD by Jonathan S. Abramowitz. Copyright © 2009 The Guilford Press. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Meet the Author
Jonathan S. Abramowitz, PhD, is Professor and Associate Chair of Psychology, Research Professor of Psychiatry, and Director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill. Dr. Abramowitz founded and directed the OCD and Anxiety Disorders Program at the Mayo Clinic in Rochester, Minnesota. An award-winning researcher, he serves on the Scientific Advisory Board of the International Obsessive-Compulsive Disorder Foundation and is Editor-in-Chief of the Journal of Obsessive-Compulsive and Related Disorders. He lives in Chapel Hill with his wife and two daughters.
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