Cognitive-Behavioral Therapy for OCD [Hardcover]

David A. Clark Phd (Author)

Book Description

ISBN-10: 1572309636 | ISBN-13: 978-1572309630 | Publication Date: November 14, 2003 | Edition: 1

This authoritative book reviews current cognitive-behavioral models of OCD and delineates an innovative, theoretically and empirically grounded approach to assessment and treatment. Leading scientist-practitioner David A. Clark first elaborates and refines existing theories of obsessions and compulsions. He then spells out effective strategies for assessing client needs, developing a clear case formulation, implementing an array of cognitive and behavioral interventions, and troubleshooting potential difficulties. Illustrated with extensive clinical material, the volume is practical and user-friendly. Reproducible appendices feature over a dozen rating scales, client handouts, and homework tasks.

Editorial Reviews

Review

"This is an outstanding book. Clark has undertaken the considerable task of reviewing all of the key literature on OCD, from early behavioral research to current cognitive theories and tactics. Coverage of definitions, diagnostic criteria, epidemiology, and assessment is balanced and up to date. Naturally, the book is particularly strong on the subject of obsessions, as Clark has made a significant research contribution here and is an accepted authority. Well organized and comprehensive, the book is bolstered by many tables and summaries. It may well become a standard reference and is likely to be required reading in clinical graduate programs."--S. Rachman, PhD, University of British Columbia

"This book fills an important gap in the treatment literature. The coverage is detailed and thorough, providing a good balance of theory, research, and step-by-step clinical suggestions. Clark's expertise and experience, both as a scientist and a clinician, are evident in this extremely well-written work. Students learning to apply evidence-based strategies to the treatment of OCD will find this to be an invaluable resource."--Martin M. Antony, PhD, Ryerson University, Toronto

"This very readable and wonderfully detailed volume provides up-to-date and comprehensive coverage of the phenomenology of OCD, as well as the theoretical and research basis for understanding this complicated condition. Initial chapters provide a wealth of information on diagnostic distinctions and set the stage for knowledgeably applying the treatment techniques contained in the second half of the book. These strategies are clearly presented with numerous examples and helpful tables, handouts, and therapy forms. Especially useful is the detailed presentation of the subtleties of effective cognitive and behavioral interventions. Overall, this is a truly excellent handbook that should be on the shelves of practicing clinicians, academic instructors, and advanced graduate students interested in the psychopathology and treatment of OCD."--Gail Steketee, PhD, Boston University School of Social Work

"This volume is exciting reading for anyone interested in recent developments in cognitive-behavioral theories and therapies of obsessive-compulsive disorders. David A. Clark has written a cohesive, comprehensive book that is scholarly yet at the same time contains much of value for the clinician. Provided is a much-needed, theoretically and empirically guided CBT treatment manual for obsessional disorders. Highly recommended!"--Paul M.G. Emmelkamp, PhD, University of Amsterdam

About the Author

David A. Clark, PhD, is a professor in the Department of Psychology, University of New Brunswick, Canada. He received his doctorate from the Institute of Psychiatry, University of London, England. Dr. Clark has published widely on cognitive theory and therapy of depression and OCD, and is a founding fellow of the Academy of Cognitive Therapy. With Aaron T. Beck, Dr. Clark recently developed the Clark-Beck Obsessive-Compulsive Inventory, which assesses self-reported severity of obsessive and compulsive symptoms. He has received a number of research grants to study the cognitive basis of emotional disorders, the most recent being a Canadian federal grant to investigate intentional control of unwanted intrusive thoughts. He is also a founding member of the Obsessive Compulsive Cognitions Working Group, an international research group devoted to the study of the cognitive aspects of OCD, and serves as an associate editor of Cognitive Therapy and Research.

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Product Details

• Hardcover: 324 pages
• Publisher: The Guilford Press; 1 edition (November 14, 2003)
• Language: English
• ISBN-10: 1572309636
• ISBN-13: 978-1572309630
• Product Dimensions: 8.8 x 6.3 x 1.2 inches
• Shipping Weight: 1.3 pounds (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #2,082,567 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

5.0 out of 5 stars Excellent, December 26, 2009

By 

Stephen Kaplan (Dix Hills, NY) - See all my reviews
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This review is from: Cognitive-Behavioral Therapy for OCD (Hardcover)

I found this book to be well-written and well researched. I pretty much stopped doing therapy with OCD years ago because I found strict behavior therapy to be inadequate for most cases. Clark proves the value of cognitive-behavioral approach, backing it up with empirical findings. His treatment of the literature is objective--presenting both positive and negative findings and attempting to make sense out of it. Started using Clark's approach recently and found it to be helpful. I'm sure there are ongoing refinements since he wrote this book, but if you are treating OCD I would consider this book to be a must-read.

3 of 7 people found the following review helpful:

3.0 out of 5 stars Paradigm Shift in the Study and Therapy of Primary Mental Disorders, January 13, 2009

By 

Altan Loker (Istanbul, Turkey) - See all my reviews

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This review is from: Cognitive-Behavioral Therapy for OCD (Paperback)

Clark's book must be read by anyone who is interested in the etiology and psychotherapy of OCD because it is full of much valuable research and clinical findings and therapy strategies based on them. But Clark also explains that the current understanding of the etiology of this disorder and the results of its treatment are not sufficiently satisfactory, as exemplified by his statements quoted in the next paragraph. It is shown in this review of his book that the research results and the therapy strategies based on them constitute a mixture of rights and wrongs because an invalid hypothesis is used in research, which causes the misinterpretation of the results of research. Therefore, a new research hypothesis is generated and is used in the interpretation and evaluation of existing research findings and therapy strategies that are currently based on the misinterpretations of those findings.

"Yet there are many inconsistent findings that leave us with more questions than answers" (p. 115). "It is entirely possible that the faulty appraisals and beliefs noted by Rachman, Salkovskis, and others is a consequence, rather than a cause, of obsessive-compulsive symptoms" (p. 115). "At present too few studies have investigated the therapeutic ingredients of CBT [Cognitive-Behavioral Therapy] to draw firm conclusions about the mechanisms in this new treatment approach" (p. 281). "Despite the advances in our understanding of the cognitive basis of obsessions and compulsions, further research is needed ." (p. 282). "Together, cognitive theory, research, and practice clearly have much to offer in the treatment of OCD. Yet the present discussion reveals many important gaps in our theories and research of this disorder. The treatment innovations that characterize the new cognitive-behavioral therapy of OCD have yet to receive empirical verification. Moreover, the application of cognitive and behavioral interventions to obsessions and compulsions continues to present extraordinary challenges to even the most experienced practitioners" (p. 284).

In reality, psychologists have done much better in the study of OCD than they did in the study of mental disorders in general. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), it is said:

"DSM-IV . . . distinguishes those mental disorders that are due to a general medical condition from those that are substance induced and those that have no specified etiology. The term primary mental disorder is used as a shorthand to indicate those mental disorders that are not due to a general medical condition and that are not substance induced" (p. 165).

This means that the etiologies of primary mental disorders are not known, as more clearly expressed in DSM-III-R thus: "For most of the DSM-III-R disorders, however, the etiology is unknown" (p. xxiii), the exceptions being organically caused and drug induced mental disorders. This evaluation covers OCD too and makes it a primary mental disorder because it is considered a psychological-behavioral disorder, not an organic one. Consequently, the causes of the unsatisfactory results of OCD research and therapy need to be looked for in the study and therapy of mental disorders in general. And because scientific investigation consists of framing a hypothesis and testing it, the basic hypothesis and the general method of testing used in the study of mental disorders need to be scrutinized. This is important especially because therapy can be sufficiently effective only if it is based on the correct understanding of etiology.

I showed elsewhere that the hypotheses that made possible the construction of the grand theories of physics have been generated by likening the studied phenomenon to a better known one on the grounds that they have some observed common features and then assuming that the former shares also some other observed features of the latter although this is not obvious. This assumption constitutes a hypothesis that needs to be tested empirically. This is how hypotheses are generated in physics and gave birth to grand theories. This is also how all hypotheses are generated, although not always fully consciously. The definition of mental disorder given in DSM exposes the general hypothesis that is used in the study and therapy of mental disorders:

"Each of the mental disorders is conceptualized as a clinically significant [i.e., harmful] behavioral or psychological syndrome or pat¬tern . . . . Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biologi¬cal dysfunction in the individual."

This means that symptoms are considered harmful manifestations of dysfunction, and this amounts to saying, "Something is wrong here." The problem is to discover what is wrong, or what the dysfunction is. The basic hypothesis that is currently used in the study and therapy of mental disorders based on the idea of "something is wrong" is that symptoms are not only caused by dysfunctions and constitute manifestations of those dysfunctions but are themselves harmful dysfunctions. Concerning OCD, biological dysfunction is ruled out because this disorder is not known to be organically caused and is therefore a primary mental disorder caused by psychological-behavioral dysfunction which needs to be discovered. Consequently, researchers look for psychological-behavioral dysfunctions and interpret their findings as such. Some of the "dysfunctions" that they discovered are intrusive thoughts, inflated responsibility, dysfunctional assumptions, thought-action fusion, moral perfectionism, preexisting dysfunctional cognitive beliefs and biases, anxiety proneness, faulty appraisals, ironic monitoring process, and so forth. Compulsive behaviors are readily observed symptoms of OCD.

In reality, considering the symptoms of primary mental disorders, including OCD, as dysfunctional is a self-contradictory thought. The reason is that, if all hypotheses are generated as explained above, psychologists must have likened the symptoms of primary mental disorders to some better-known symptoms, which appear to be the symptoms of organic illnesses interpreted without making any research. In fact, many symptoms of organic illnesses are seen as, and are, harmful manifestations of organic dysfunctions, and this fits the idea of "Something is wrong here." But there are also symptoms of organic illnesses that do not constitute dysfunctions, because they are found to have self-protective functions. For example, the rise in the body temperature caused by infections has self-protective function: it facilitates the fight against the microbes in many ways, including the hindering of their reproduction. Pain is a very common symptom of organic illnesses and has a self-protective function: it warns consciousness about an organic dysfunction. Ordinary pain too warns consciousness about a harm suffered by a part of the body. Pain can do even more than warning consciousness for realizing self-protection. For example, pain caused by a cracked leg bone prevents walking and thus facilitates the mending of the crack in the bone. In fact, this is what a doctor does to a leg with a cracked bone.

There are also symptoms that are not caused by any organic defect and have self-protective functions. For example, fear warns consciousness about a danger and prepares the organism mentally and physiologically to cope with the danger. Fear has this function both when it is a symptom of mental disorder, e.g., phobia, and an ordinary mental response. Freud found through linguistic analysis that anxiety is a "danger signal," a particular type of fear that prepares the person to detect and cope with dangers about which sufficient information is not available. Clark too mentions this function of anxiety: "The central function of anxiety is `to facilitate the detection of danger or threat in potentially threatening environments' (M. V. Eysenck, 1992)" (p. 82).

Now, because hypotheses are generated by likening a studied phenomenon to a better known one on the grounds that they have some common features, it makes more sense to liken all symptoms of primary mental disorders, including the symptoms of OCD, to some symptoms of some primary disorders that have functions, instead of likening them to the non-functional symptoms of some organic illnesses. This makes more sense because (a) a particular symptom of a primary mental disorder has, or can be expected to have, more common features with the symptoms of other primary mental disorders than with the symptoms of organic illnesses, (b) the results of research and therapy based on the dysfunction hypothesis have not been satisfactory, (c) some symptoms of organic illnesses have self-protective functions, (d) some symptoms of primary mental disorders too are functional, (e) many automatic responses are seen to be functional, and symptoms too are, or can be considered, automatic responses, and (f) automatic responses are, or can be considered, as created by evolution which is directed to realize self-protection, success, and survival.

A definition of the symptoms of primary mental disorders, including OCD, based on the above-mentioned facts and the fact that consciousness too seeks to realize self-protection can be formulated as follows: The symptoms of primary mental disorders are automatic responses which have self-protective functions and are produced when consciousness fails to realize sufficient self-protection for any reason. This definition of symptoms can be used as the basic hypothesis in the research and therapy of all primary mental disorders, and it is used below in interpreting and evaluating the research and therapy results related in Clark's book.

Compulsive behaviors, intrusive thoughts, inflated... Read more ›