By Aureen Pinto Wagner, Ph.D.

Reviewed by Lee Fitzgibbons, Ph.D.
Anxiety Solutions of Northern New England
Bethlehem, NH

"Worried No More: Help and Hope for Anxious Children" by Aureen Pinto Wagner, Ph.D., is a welcome addition to the list of books produced for concerned parents and school personnel and for clinicians unfamiliar with Cognitive Behavior Therapy (CBT). It is a "must read" for these targeted audiences because the book is accurate, clear and easily understood. It provides the practical answers and strategies that parents/teachers/counselors are looking for.

"Worried No More" provides general information to bring the targeted audience up to speed on different anxiety problems. In it, Dr. Pinto Wagner discusses in general terms CBT and medications. These general chapters are easily understood, to-the-point and jargon free. She provides guidance on how to discriminate between normal anxiety from problem anxiety. She discusses warning symptoms and possible differences in presentation due to developmental age.

In my opinion, the most elegant chapter of the book is the one devoted to discussing the causes of anxiety disorders in children. Dr. Pinto Wagner explains the maintenance factors in incredibly clear and understandable language. She handles particularly well the delicate issue of parental reactions and responses that can accidentally and inadvertently strengthen an anxiety problem.

Another section the author covers with expert ease is her explanation of habituation and how and why Exposure and Response Prevention (E&RP) works. Because having this understanding is the first step towards success, these explanations alone make the book worth buying. Additionally, the book has many handy tables that simplify concepts for the reader. One that stands out is a nifty little table that highlights the differences between normal anxiety and problem anxiety. Other highlights of the book are sections that focus specifically on what parents and school personnel can do to help alleviate a child's anxiety.

The school chapter is particularly useful. In it, Dr. Pinto Wagner urges the school to respect and honor the knowledge and expertise of the parents. She also urges parents to understand the limited resources of schools and to assume that most school personnel want to be helpful. By focusing on the unique responsibilities of all the parties involved, the author shows how parents and teachers can build a team that truly works together for the best interest of the child they are trying to help. It has been my experience that school personnel and parents often initially look at each other as adversaries. Dr. Pinto Wagner provides useful guidance to help foster teamwork and specific actions the team can take to help the child.

There is also a chapter devoted to specific interventions that might be useful for a variety of anxiety disorders in children. The chapter presents many useful ideas. I hope that parents do not assume that armed with this book they can replace a clinician. Possibly to guard against this assumption, Dr. Wagner provides a list of questions to help parents find a good clinician.

I was very impressed with the "Worry Hill Memory Card" that Dr. Pinto Wagner devised and included in the book. Young children will be able to use this mnemonic device to keep in mind that, although the early part of an exposure exercise is hard work and involves feeling fear, when they get used to doing it, it will be as easy as coasting down a hill on a bike. This "Card" is a gem and the metaphor is a useful analogy for any parent or therapist. Overall, I give this book a hearty thumbs up!!

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 What to Do When Your Child Has Obsessive-Compulsive Disorder: Strategies And Solutions

By Aureen Pinto Wagner, Ph.D.

Reviewed by Lori J. Kasmen, Psy.D.
Anxiety and Agoraphobia Treatment Center, Bala Cynwyd, PA.

Reading Dr. Aureen Pinto Wagner's newest book, "What To Do When Your Child Has Obsessive-Compulsive Disorder: Strategies And Solutions," is like having the opportunity to speak with a caring expert who patiently and generously shares knowledge based on scientific research and wisdom based on clinical experience. Although there are other books that cover the basics of childhood OCD, the clarity, compassion and sensitivity with which Dr. Pinto Wagner presents information make this comprehensive source a must-read for parents, school personnel and professionals.

Throughout the book, Dr. Pinto Wagner's writing is to-the-point and jargon free, easily understood by the lay-person. Numerous quotes and vignettes from affected children and their families will surely help those who do not live with the disorder understand its impact on daily life. Several tables including "Suggested Questions About Medications" and "Suggested Questions to Ask A Therapist" provide an invaluable quick reference guide. "Frequently Asked Questions" at the end of each chapter offer the reader further clarification of important topics.

The book is organized in two parts:

What To Do Book Part 1 provides the "Essential Facts" about OCD including the steps to recognize, assess and get treatment for OCD. This part of the book may be particularly useful for parents whose children are newly diagnosed or in the early stages of treatment. Dr. Pinto Wagner provides a clear explanation of the difference between normal fears and OCD and outlines common obsessions and compulsions. She demystifies the evaluation and diagnostic process by walking parents through it step by step, offering solutions to potential hurdles that may arise as good treatment is sought.

In Chapter 5, Dr. Pinto Wagner eloquently explains the treatment of OCD, using her metaphor of the "Worry Hill" to outline the relationship among exposure/ritual prevention (E&RP), habituation and eventual mastery of OCD. In my experience, these metaphors are easily understood by parents, teens and even young children. The "Worry Hill" metaphor is elaborated upon with easy-to-remember mnemonics such as RIDE (to describe the child's tasks in facing OCD) and RALLY (to describe a parent's role in supporting their child during E&RP). This chapter alone makes the book worthwhile because an understanding of treatment is one of the important first steps toward recovery.

Part 2 of the book, entitled "What to Do," lays out the "Master Plan" for overcoming OCD. The author's humanity shines through in this section oft he book because she recognizes the multiple challenges of coping with a difficult disorder amidst the busy reality of everyday life. She appropriately encourages families to simplify their lives and urges parents to take care of themselves so that they can most effectively cope with and lead the charge against OCD. Although parents are certainly the experts on their children, one concern underlying any treatment-oriented book is that parents will surrender their important role as mom or dad to take on the role of "therapist." Dr. Pinto Wagner addresses this delicate issue in her book by clearly explaining the importance of approaching the journey toward recovery with the help of a good clinician, outlining the necessary and unique roles of the therapist, the parents and the child.

One of the most significant sections in Part 2 is Chapter 9, which discusses a child's readiness for treatment. Ensuring that a child is adequately prepared and ready to tackle the challenge of the journey is an essential aspect of successful treatment; the importance of which cannot be overstated. Any parent wants a suffering child to get well as quickly as possible, but, as Dr. Pinto Wagner explains with clarity, beginning E&RP before a child is ready can have adverse effects. Other highlights of this chapter include child-friendly explanations of OCD and CBT and strategies to deal with the reluctant child.

After reading Dr. Pinto Wagner's book, I think many parents will feel as though they have had a face-to-face conversation with an expert, who patiently answered their questions and comprehensively addressed their concerns. Armed with this book, parents will have the knowledge to obtain good treatment and the sense of hope to support their child in the journey toward mastery over OCD.

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Treatment Of OCD In Children And Adolescents: A Cognitive-Behavioral Therapy Manual

By Aureen Pinto Wagner, Ph.D.

Reviewd by Martin Franklin, Ph.D.
UPenn School of Medicine
Philadelphia, PA

One of the most serious problems facing the mental health field today is that cognitive-behavioral treatments (CBT) for pediatric and adult mental illnesses remain difficult to find outside academic research settings despite strong evidence for their efficacy.

Moreover, even when they are accessed, the treatments as delivered in some clinical contexts often do not resemble the carefully constructed and theoretically driven manuals used in randomized controlled trials (RCTs); and thus, the efficacy of these treatments may be attenuated. This unfortunate situation is certainly evident in the treatment of OCD, where many patients who are ostensibly receiving CBT do not receive an adequate theoretical rationale for the chosen treatment procedures, are given insufficient guidance in constructing and working through a hierarchy of feared thoughts and situations, are provided with vague instructions regarding response prevention, and are not carefully educated about the importance of identifying and refraining from mental rituals, among other acts of omission and commission. Indeed, on more than a few occasions in over a decade devoted to clinical practice and research on the treatment of adult and pediatric OCD, I have interviewed patients who, in the context of their CBT treatment, were asked to snap a rubber band on their wrist every time they experienced an obsession in order to drive away feared thoughts and images. This approach is more likely to induce rather than reduce obsessional distress; and, in the wake of this sort of frustration, I have often wished that the tried and true procedures of exposure and response prevention could be disseminated more readily to mental health professionals who encounter OCD patients in their clinical practices.

It is also imperative that CBT materials designed for dissemination should be made as accessible and easy-to-use as possible, since one of the major barriers to their use in real-world clinical settings appears to be the time and labor intensity of translating research-oriented manuals for use with OCD patients in general, but with children and adolescents especially.

Aureen Pinto Wagner's newest volume, "Treatment of OCD in Children and Adolescents: A Cognitive-Behavioral Therapy Manual," addresses many of these critical needs and has the potential to improve significantly the delivery of CBT for pediatric OCD in the community. Her extensive clinical experience and previous work in creating materials for children and adolescents with OCD and for their families are clearly evident in this therapist manual, which may be used in concert with these other books. The most obvious and immediate advance is that this manual provides therapist and patient forms on CD ROM, an attractive and sturdy version of the "Feelings Thermometer" which children and adolescents will be asked to use during and between treatment sessions, and sufficient detail in the description of treatment procedures that are clearly the product of the author's wealth of experience and knowledge in treating children and adolescents with OCD.

Improvision of these materials goes a long way towards promoting compliance with treatment procedures and keeping therapist, patient, and parent on the same page as the therapy progresses. The thought and care that went into their creation also sets an obvious tone about treatment for the patient. It says to him that the serious use of these handsome materials is important in helping him to achieve his goal of reducing OCD symptoms.

The manual is divided into fourteen chapters, the first four of which are devoted to the nature and maintenance of OCD symptoms, a description of the theoretical rationale for CBT procedures, and a discussion of the particular challenges of using CBT with children and adolescents. In this latter section, the author discusses treatment readiness issues, which often arise in the very early stages of assessment and thus are essential to address immediately. She also reminds us that OCD affects and is affected by family issues, and that it is important to properly prepare the family to assist the child and the therapist before CBT is implemented. Her suggestions about how best to accomplish this are likely to be especially helpful. Throughout these chapters and, indeed, in the volume more broadly, Dr. Wagner cites the scientific literature to support her assertions. She is also liberal with clinical pearls and cogent examples gathered through her extensive experience with pediatric OCD.

The heart of the volume is devoted to what Dr. Wagner refers to as the "Four Phases:"

1.     Biopsychosocial Assessment and Treatment Plan;
2.     Building Treatment Readiness;
3.     The RIDE Up and Down the "Worry Hill;" and
4.     After the RIDE. The cultivation of treatment readiness is appropriately emphasized throughout the volume.

It is made clear to therapists that effective treatment cannot proceed until the child is fully on board with the plan and has explicitly agreed to go forward. In placing this strong emphasis here, the volume goes above and beyond many of the excellent CBT manuals that have preceded it. In doing so, it makes a very important contribution to the growing clinical literature on pediatric OCD.

Child-friendly metaphors are used in the service of conveying these important points; and the protocol devotes two to four 50 minute sessions to this essential work. Stabilization is the first step, and involves psychoeducation about OCD as a biopsychosocial illness and presents an opportunity for children and families to speak about OCD's impact upon the family. The second stage, labeled "Communication," describes the maintenance factors of OCD in greater detail and prepares everyone for the third stage, Persuasion, in which the therapist encourages children and families to see the necessity, possibility, and power of change. The techniques of motivational interviewing (e.g., consideration of the pros and cons of living with OCD) are liberally used. Each is used in the service of encouraging the child to commit to the treatment program.

The last stage, referred to as "Collaboration," is designed to clarify how the treatment will be done and to install the child as the team's leader. This arrangement is intended to minimize the temptation to push harder at first than the child is willing to go and to promote the child's active participation in the process. The material in these sections is presented in a clear, logical, and concise fashion. The fact that several sessions are explicitly devoted to "Collaboration" emphasizes its importance to therapists and families, each of whom might be tempted to move ahead quickly in view of the negative impact OCD has had on the child and family system. Dr. Wagner emphasizes throughout the book that this is both understandable and unwise. In doing so, I believe has done a considerable service for children and adolescents who will be treated using these materials.

Assuming that the preparation has gone well and the implementation of E&RP is now at hand, Dr. Wagner uses the term "RIDE up and down the Worry Hill" to guide the implementation of E&RP and to track progress. RIDE is anacronym for: Rename the thought; Insist that YOU are in charge; Defy it by doing the opposite, and Enjoy your success by rewarding yourself. The first two steps can be conceptualized as preparatory because these steps are designed to encourage the child to do what needs to be done, which is to resist OCD's demands to avoid situations and thoughts and/or to engage in compulsions.

The final step reminds the child to reinforce his/herself for successful use of the steps. And, throughout the volume, families are vigorously encouraged to do so as well. Several cards are provided with the manual for the child to use during and after his/her exposure practices. Here again, the formality and attractiveness of the presentation is designed to convey a message about its importance and thereby promote compliance.

The RIDE acronym helps to break down E&RP into concrete, finite steps that structure and clarify the treatment process. The purpose is to foster endurance of the anxiety until habituation takes place. This latter point is a critical one, and therapists using the RIDE protocol must remain alert to whether or not children understand that the first two steps are not intended to reduce obsessional distress, but rather to encourage the child to tolerate the anxiety associated with planned and unplanned E&RP tasks. Dr. Wagner's specific examples of how the RIDE cards should be used underscore this important point; but, nevertheless, it bears repeating throughout the treatment.

Dr. Wagner's "Phase 4" section discusses preparing the patient and family for the transition, maintenance visits, booster sessions, realistic expectations, and strategies for managing the inevitable slips that will arise. This is an important concept that when totally internalized will go a long way in preventing "abstinence violation effects" or panicking when common problems do indeed arise.

One of the real difficulties in creating a treatment manual for pediatric OCD is the heterogeneity of patient presentations limits the degree to which general rules and examples can be provided. In Chapter 12, Dr. Wagner addresses this issue by providing more specific information about various OCD subtypes, such as, patients with reassurance rituals that involve family members, mental rituals associated with "bad thoughts," "hoarding," etc. Her examples of how to use the "Fear Ladder" and "RIDE cards" to work with these particular presentations are especially helpful. It behooves the clinician to read this chapter carefully before beginning CBT with any child or adolescent with OCD.

In Chapters 13 and 14, Dr. Wagner also addresses typical problems that sometimes occur in the context of E&RP, such as, limit setting, appropriate use of rewards and punishment, managing explosive behavior, and treatment reluctance that occurs during treatment. The citations at the end of the volume are thorough and up-to-date. They provide a guide for readers who encounter OCD more frequently and/or wish to create a subspecialty practice. Dr. Wagner also provides a list of support organizations that will be helpful for the practicing clinician to have at the ready.

Clearly, my review conveys a great deal of enthusiasm for the purpose and content of this manual and the accompanying materials. I strongly believe that it fills a critical gap in the armamentarium of practicing clinicians who treat OCD. It distills information about the nature and treatment of OCD in a clear and logical manner. And, the author is to be lauded for paying particular attention to the practical constraints that make CBT for pediatric OCD sometimes difficult to learn and deliver in clinical settings.

Of course, there are always tradeoffs that have to be made when writing such a book. Dr. Wagner's conscious choice to emphasize ease of use occasionally comes at the expense of providing more detailed information about the theoretical framework on which E&RP is built and about current controversies in the field (e.g., whether the habituation model that is strongly emphasized here is sufficient to explain changes in OCD symptoms and how best to integrate informal cognitive techniques, including the discussion of objective risk and responsibility) about E&RP.

That said, I think Dr. Wagner's newest volume is a significant advance that will assist clinicians interested in providing high-quality CBT in a manner that is consistent with the constraints of clinical practice. Clinical researchers interested in dissemination of CBT for pediatric OCD should also take heed: Herein lies a manual that can be readily tested in clinical settings, perhaps with and without expert supervision, in order for us to learn whether CBT for pediatric OCD can be successfully disseminated well beyond the academic research context.

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The Habit Change Workbook 

By James Claiborn & Cherry Pedrick

Reviewed by Tamar Chansky, Ph.D.
Children's Center for OCD & Anxiety
Plymouth Meeting, PA

Habit Change Workbook     What's worse than having a bad habit? Not knowing what to do about it. This will no longer be a problem as habit sufferers now have somewhere to turn -- a wonderful new toolbox, wrapped up in a beautiful package -- "The Habit Change Workbook."

In this exceptional book, Claiborn and Pedrick bring a warmth, optimism and clarity to a subject which has been largely ignored in the self-help literature. So comprehensive and thoughtful is this book, that the authors do everything they can to ensure success short of stopping the habit for you. A very clear and inspiring book, these authors have created a safe place for the millions who are suffering with habits that have great consequences for their lives, shame, embarrassment, financial ruin, and relationship problems to name a few. The clear message in the Workbook is that we are all creatures of habit ... keep the good ones ... here's how to change the bad ones.

Embedded in the easy-to-read, visually inviting format, are the cutting edge cognitive-behavioral principles which have a documented track record for successfully treating a variety of maladaptive habits including nail biting, hair-pulling, overspending, and overeating. Habit sufferers have heard, "just stop it" from everyone including themselves! Claiborn and Pedrick show a deep compassion for the frustration that goes along with unsuccessful attempts to control a habit. The system they present takes into account both the complexity of habits (how they are interwoven into our lives) and the need for simplicity in order to stick to the changes.

The layout of the book is very pleasant with highlighted reminders and key ideas sprinkled throughout. The book is organized into three sections:

    * The first is an introduction to the "anatomy" of habits; how they develop and how they are reinforced.
    * Next, the reader is walked through the elements of Habit Reversal -- the state of the art intervention -- including the process of assessment and self-monitoring, triggers, consequences and beliefs that support bad habits, and the development of good "competing responses" to block the bad habits. The explanation of automatic thoughts and beliefs is exceptional.
    * The last section contains separate chapters with detailed instructions for many of the most common habits. The reader can easily flip through and find a clear, easy to follow complete behavioral plan for how to proceed in changing their particular problem area.

One of the great strengths of the book is the worksheets. With each section of the book, the authors include unusual and interesting exercises to be completed on the worksheets provided. Of tremendous help is that sample worksheets have been "filled out" by a typical hair-puller, or skin-picker, nail-biter. Not only does this encourage folks to complete the forms, but it provides a mini-support group for the reader because the thoughts and feelings they see in black and white, are the very ones that they have been too afraid to share.

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Obsessive-Compulsive Disorder: Help for Children and Adolescents

By Mitzi Waltz

Review by Aureen Pinto Wagner, Ph.D.
Rochester, NY

Most parents of children with OCD are introduced to the disorder with a similar script: This strange, bizarre illness comes on with brutal force, taking control of their child in baffling and frightening ways. The child is distraught, the parents are caught off guard, and feel helpless as they watch their child become a different person. Parents desperately seek help in understanding this disorder, looking anywhere and everywhere for direction about the right treatments, and the myriad of parenting, social, academic, health care, financial and support problems that OCD forces upon them.

This book will change this script so that parents do not have to spend countless hours piecing together fragments of information about OCD. This well-written book is a comprehensive one-stop shop that covers diagnosis, causes and treatments, alternative and holistic approaches, insurance, healthcare and school issues for children with OCD. As a childhood OCD sufferer herself, and the parent of two children with OCD, Ms. Waltz brings to the book the unique perspective of a parent living with OCD. As a journalist, author and editor, Ms. Waltz provides a well-researched and consolidated fund of information for "beginner" OCD parents in an easy-to-read style.

Of particular value to parents, I believe, is Ms. Waltz' coverage of practical issues pertaining to advocacy and support for children with OCD. Her chapters on insurance, public health and financial aid programs, and school accommodations will help many parents navigate through the murky logistical waters encountered in these areas.

She also covers extensively the details of various medications for OCD, and with appropriate cautions, discusses the wide range of natural, herbal and holistic approaches about which parents are often eager to learn, but do not find satisfactory answers easily. In addition, she provides a lengthy appendix of resources that includes books, organizations, agencies, treatment centers, and web sites that is a wealth of information at the fingertips.

Ms. Waltz also discusses health care in some English-speaking countries outside the USA, which may be a good starting point for readers outside the USA. This is a book for the "smart consumer" .

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The Imp of The Mind   

By Lee Baer, Ph.D.

Reviewed by James Claiborn, Ph.D.
Portland, ME

 Dr. Lee Baer's name is well known in OCD circles. He is the author of an excellent self-help book "Getting Control" and author of numerous research articles, chapters and co-editor of important books on OCD. He has also been involved in teaching many therapists the fundamentals of behavioral treatment of OCD. Now he has added to his long list of accomplishments authorship of another book on OCD. "The Imp of the Mind" is the latest effort. He takes the title from a literary reference to Edgar Allen Poe's "Imp of the Perverse" and makes connections to important literature through out the book. The imp he writes about is the source of the horrible thoughts and obsessions that plague the OCD victim.

The book begins by describing the bad thoughts that can range from everyday experiences to horrifying obsessions. Dr. Baer admits to having his own troubling images when he drives behind a pickup truck with a dog in the back. He also makes it clear that like most people with out OCD these experiences are part of everyday life but don't cause us misery because we don't get caught up in our reaction to them. He gives clinical examples of obsessions from people he has treated and explains about the common types of intrusive thoughts and images. He explains how troublesome thoughts are those that are linked to what is most important to the individual. Dr. Baer makes it understandable why we would try to suppress these thoughts and why that effort not only doesn't work it worsens the problem.

The book includes a clear discussion of the problem of post partum depression and the research showing that women with this disorder have a very high rate of having harm obsessions about their children. Dr. Baer makes it clear however that thoughts of harming children are not restricted to women with post partum depression. Children are the focus of harm obsessions because they are seen as less able to defend themselves.

S. J. Rachman, another psychologist who has written extensively about OCD, often notes that no one has obsessions about harming someone like "Arnold Schwarzenegger." This is because he seems quite capable of defending himself. People who have harm obsessions will always be uncertain about the thoughts and the possible connection to action. People with OCD are often terrified by the idea that they might want to do the things they obsess about or might lose control and act out their violent thoughts. While absolute assurance is impossible, Dr. Baer gently and effectively writes about this fear and puts it in clear perspective. He includes case material that illustrates the difference between obsessions and thoughts which do warrant concern. He includes material to help explain the diagnostic questions involved in making this discrimination. One of the most interesting chapters to me was focused on explanatory models of bad thoughts. Dr. Baer discusses a number of possible models including ideas about the evolutionary significance of obsessions and Freudian theory about why obsessions might occur. While final conclusions cannot be reached the openness to a variety of explanations is unique and refreshing.

The second part of the book presents ideas about dealing with the troubling thoughts. Baer begins with a description of exposure-based therapy a tried and proven method of dealing with obsessions. The clear descriptions of exposure including suggestions on how to use audio tape are likely to be helpful to professionals who are new to treating OCD as well as being a self-help guide. There is an extensive discussion of cognitive therapy as an alternative to exposure treatment for bad thoughts. This is the new frontier in treatment of OCD and may offer hope for those who have not responded will to exposure treatments or who cannot bring themselves to do the exposure work. Dr. Baer describes some of the techniques used in cognitive therapy and explains the cognitive model of OCD. Unlike exposure therapy, it is not really practical to do the cognitive work as a self-help project.

The book addresses the sensitive problem of religious obsessions. Although the standard exposure therapy is still recommended, consultation with clergy or other experts in the individuals religion is recommended and is the standard of practice. It is clear that religious obsessions are simply another example of OCD focusing on what is most important to the individual in its grip.

Although this is a book about bad thoughts and treating them with cognitive behavioral therapy it includes important information about drug treatment of OCD and bad thoughts. Many more people with OCD will find it easier to get reasonable treatment in the form of medications than will be able to find competent cognitive behavioral therapy. If they can know what to expect from medication and apply the exposure methods described in the book most people should be able to make important gains in controlling their OCD.

I am pleased to be in a position to review this book. While it isn't as dramatic as the release of a "Harry Potter" story, I expect that many will want to get a copy as soon as possible. I have been telling patients and therapists to be on the lookout for this little book. I would advise anyone with intrusive thoughts of harm or similar obsessions to read this book and follow the plan.

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Tormenting Thoughts and
Secret Rituals    

By Ian Osborn, M.D.

Review by Fred Penzel, Ph.D.
Western Suffolk Psych. Services
Huntington, NY

Lately, it is not unusual for a physician who treats OCD to write a book about the disorder. The number grows yearly. What is unusual, is for that physician to be an OCD sufferer. What is also unusual, is for that book to not read like a technical manual, but as a well-crafted and highly readable blend of historical knowledge, philosophy, keen personal observations about a wide variety of cases, and allot of therapeutic expertise. Dr. Ian Osborn's "Tormenting Thoughts And Secret Rituals" is the best book for OC sufferers to come along in quite a few years.

One of the most appealing features of Dr. Osborn's book is that he does not merely offer us some type of slick repackaging the usual things we have all heard, but instead reaches out to his readers on a more personal level. This allows the humanity and intelligence he no doubt shows to his own patients, to be shared with the reader. This is not simply an expert giving advice, but someone who has suffered personally.

The book, which begins with Dr. Osborn's personal views on, and experiences with OCD, goes on to cover all the bases. It gives a great deal of information on types of OCD, diagnosing the disorder, and its treatment via medications and behavioral therapy. It also reviews such topics as group therapy, family issues, underlying biological causes, OC spectrum disorders, and a historical rundown of OCD treatment.

One aspect of the book that I found particularly fascinating was its descriptions of the famous historical figures who may well have suffered from OCD, including John Bunyan, St. Ignatius of Loyola, Samuel Johnson, Martin Luther, Winston Churchill, and Howard Hughes. Understanding that even some of history's great suffered from the disorder can go a long way toward destigmatizing sufferers. (Perhaps it could even be the start of an OCD "Hall Of Fame.")

Dr. Osborn's approach is clean and structured. I appreciated the fact that it is not overloaded with jargon. He lays out "Six Steps To Conquering OCD," and in addition, offers ten practical strategies that have been distilled from six years of group treatments he has conducted. These are all very helpful and easy to follow.

There is only one real criticism I can make of this book. While it probably seemed like a good idea to list every known American and Canadian support group for OCD in the back of the book, this information is subject to frequent changes, and could quickly go out of date. It is good to know that such groups exist, but it could also be the source of much frustration, trying to track down listed contact people who are no longer holding that job, or groups that have long since disbanded or moved their locations. It would probably be better to just mention that sufferers should contact the Obsessive Compulsive Foundation, which maintains a list of support groups around the world. [Click Here.]

All in all, I would rate this a nice compact volume that is well organized and contains a really good balance of everything a useful book on OCD should contain. Best of all, it isn't simply practical: it reads well. I wish that more writers of the caliber of Dr. Osborn would produce self-help books. I have been recommending this book to my patients ever since it was released, and shall continue to do so.

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Freeing Your Child from Obsessive-Compulsive Disorder: A Powerful Program For Parents Of Children And Adolescents

By Tamar E. Chansky, Ph.D.

Review by Bruce M. Hyman, Ph.D. and Cherry Pedrick, RN

With the publication of Dr. Tamar Chansky's new book (now available in paperback), parents finally have a road map for helping their children deal with OCD. Dr. Chansky's experience as founder and director of the Children's Center for OCD and Anxiety shines through every page. Her book displays both a thorough understanding of OCD as well as deep compassion for the children and families afflicted by this disorder.

Part One defines OCD and reviews the diagnosis and treatment options. Dr. Chansky briefly discusses other disorders that sometimes coexist in children with OCD. "Chapter 2: Cracking the Code, Visualizing the Secret Mechanisms of OCD" is a valuable resource for anyone trying to understand OCD. Eight "lessons" explain how children -- and adults -- with OCD get stuck in a "brain trap" and how they can get unstuck. Each lesson is designed to help parents discuss OCD with their children in simple, creative word pictures.

Part Two offers clear strategies to help parents fulfill their roles in the battle with OCD. Parents want to protect their children from pain and suffering while also fostering independence. This is especially challenging for parents of children with OCD. Dr. Chansky expertly guides parents along this difficult path. Chapter 10 discusses the importance of parents taking care of themselves. Powerful strategies are presented for dealing with feelings of anger, sadness, guilt, and shame, overcoming dysfunctional beliefs about OCD, finding outlets for feelings of isolation, dealing with stress, and knowing your limitations.

Part Three discusses the many forms of OCD. Dr. Chansky does not hold back: bad thoughts, worries about harm, scrupulosity, and sexuality thoughts are covered, as well as contamination, checking, repeating, redoing, evenness, ordering, symmetry, numbers, hoarding, and obsessive slowness. And what about brothers, sisters, grandparents, and other relatives? Chapter 15 helps parents decide when and how to involve others in the struggle with OCD. This chapter also helps parents decide how much to involve their child's school. Teachers will also find valuable insight here. The appendix provides lists of valuable resources and sample assessment instruments for OCD.

Throughout "Freeing Your Child from Obsessive-Compulsive Disorder" are quotes from children and parents that help the reader relate to the struggle with OCD. We would like to have seen more help for parents who also have OCD. This presents a particular challenge, but then, this could be the subject of another fine book. Tamar Chansky has produced a comprehensive resource no parent of a child with OCD should be without.

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Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And Staying Well

By Fred Penzel, Ph.D.

Reviewed by Patricia Perrin, Ph.D.
OCD & Anxiety Treatment Center
Bellaire, TX

Dr. Penzel's book is a comprehensive, scholarly, yet highly readable resource on treatment of obsessive-compulsive disorder (OCD) and its spectrum disorders, as well as a labor of love.

Fred Penzel, Ph.D. is one of the most experienced psychologists and behavior therapists treating obsessive-compulsive spectrum disorders (OCSD's) today. Dr. Penzel chooses to focus on OCD and four disorders considered in the field to be part of the OCD spectrum, excluding others (e.g., Tourette's Disorder and hypochondriasis). He aims to reach as many sufferers of OCD, body dysmorphic disorder (BDD) (imagined ugliness), Trichotillomania (TTM) (compulsive hair-pulling), compulsive skin picking, and nail biting as possible, with practical tools, in order to provide hope and a path to recovery. Simultaneously, he provides the clinician a fly-on-the-wall view of how he treats OCSD's. He shares tried and true ways of communicating the rationale for treatment, how behavior therapy works, how to motivate individuals to undertake treatment, how to recognize the effectiveness of treatment, and how to prevent relapse. He comes up with gems, for example, in treating obsessions, "If you want to think about it less, think about it more", and in describing the effect of behavior therapy, when a real shift occurs, "It's like a spell has lifted."

Dr. Penzel uses the term OCSD's to refer to OCD and a group of disorders not currently classified together in traditional diagnostic schemes (i.e., the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]). This grouping is currently considered in the field to make sense, since these disorders share characteristics ranging from compulsive to impulsive. They also have similarities in their neurobiological etiology, and in their responsiveness to behavior therapy and, particularly, to serotonergic medications. Considering these disorders together should have implications for understanding and treatment of OCSD's.

Dr. Penzel describes how to implement two types of behavior therapy. Exposure and response prevention (E&RP) is used to treat OCD and BDD, and habit reversal training (HRT) is used for TTM, skin picking, and nail biting. Dr. Penzel's 18 years of experience are clearly demonstrated in his creative and plentiful examples of how to approach obsessions, compulsions, and impulsions. (He uses "impulsion" to refer to an urge or a call to action which seemingly cannot be ignored, and is acted on if it is gratifying, like grooming impulsions, but not acted on if it is repulsive, as in aggressive impulsions. Unlike compulsions, they do not serve to reduce anxiety.)

The longest chapter, on self-help, and the chapter on treating children are particularly useful in describing the specifics of implementing E&RP and HRT. Here the reader will be treated to detailed outlines of how to do E&RP for compulsions, obsessions, and impulsions, including examples of hierarchies of each and examples of specific exposures. HRT is detailed, starting with a preliminary step of destigmatizing oneself, followed by the traditional awareness training, breathing and relaxation training, competing response training, and a welcome section on augmenting HRT. The latter includes lists of suggestions specific to the different types of inputs that influence an individual's TTM, skin picking, or nail biting. Relapse prevention is addressed for all the disorders discussed.

The chapter on children will assist parents and clinicians with early identification of symptoms of OCSD's. Dr. Penzel alerts the reader to the role of Pediatric Autoimmune Neurological Disorders Associated with Streptococcal infections (PANDAS), which can trigger the onset of OCD and tic disorders. Finally, he tells how to tailor behavior therapies for children, e.g., by adding rewards to maintain motivation.

I have been reluctant to use the term "recovery" in discussing relapse prevention with patients, in order not to imply that OCSD's are addictions. Dr. Penzel's chapter on recovery and acceptance has prompted me to revise that position. He suggests that since it is rare that one's symptoms go away permanently, one must accept that "OCSD's are a potential you will always carry with you." Maintaining one's recovery, therefore, requires a) accepting what cannot be changed, e.g., having an OCSD, having setbacks, and experiencing anxiety, while b) changing what we can, e.g., doing exposures, blocking compulsions, using competing responses, increasing tolerance, and dispensing with perfectionism.

Dr. Penzel reminds therapists, who often become obsessed with change, that we must accept that not everything can be changed. Tweaking failed behavioral techniques alone may not be enough to succeed. Helping patients remove blocks to acceptance, e.g., perfectionism, overcontrol, and an excessive need for certainty, can completely shift the patient's awareness, and that may constitute the real change.

Dr. Penzel also includes in this book a thorough review of medication and alternative remedies, a chapter about family members, an entire chapter on obsessions, and one on compulsions. He also differentiates OCD from obsessive-compulsive personality disorder and discusses common disorders accompanying OCSD's.

There is an outstanding chapter on the biological and environmental causes of and contributing factors to OCSD's. Finally, Dr. Penzel includes a list of helpful resources, evaluation instruments that can help in assessing OCSD's, and an 18-page glossary of terms.

This book may seem excessively long, about 400 pages, but it doubles as an encyclopedia of OCSD's and a treatment guide. If you are a sufferer of OCSD's or a clinician, I believe you will find this book enlightening, uplifting, and potentially life changing.

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The OCD Workbook: Your Guide To Breaking Free from Obsessive Compulsive Disorder

By Bruce Hyman, Ph.D. and Cherry Pedrick, R.N.

Reviewed by Ian Osborn, M.D.
Albuquerque, NM

The OCD Workbook is the most helpful presentation of behavior therapy for OCD that has been published in quite a few years. Cherry Pedrick, an R.N who has herself suffered OCD, and Bruce Hyman, Ph.D., a psychologist and social worker who specializes in treating the disorder, make a great team. Their book flows smoothly along with a wonderfully compassionate tone while providing an excellent blend of clinical and theoretical material.

The book is divided into four sections. Part One presents an easily digestible review of OCD's diagnosis, proven causes, and effective treatments. Part Two, the heart of the book, discusses cognitive-behavior treatment in detail, including instructions for self-directed treatment programs. Part Three deals with OCD spectrum disorders and childhood problems. Part Four finishes with a discussion of how family members, support groups, and various types of therapists can help. I found Part Two's presentation of behavior therapy to be exceptional. Clearly written, easy to follow, and yet very complete; it is the best introduction to behavior therapy for OCD that I have yet read. For every major subtype of disorder there is an outline for a complete therapy program.

Have a problem with "hit and run obsessions?" Pedrick and Hyman provide worksheets for assessing the symptoms, monitoring obsessions and compulsions, constructing a situations hierarchy, and then executing exposure and response prevention. All for that one specific problem and with examples of every form filled out! Likewise, step-by-step instructions are provided for the treatment of common contamination, harm, sexual, religious and orderliness obsessions. Pedrick and Hyman do not neglect the hard to treat cases. Pure obsessions, obsessional slowness, and hoarding are also tackled in an easy-to-understand manner with case studies included.

One of the main strengths of The OCD Workbook is the inclusion of a number of different approaches to behavior therapy. For those OCD sufferers who are "psyched up" to make an all-out effort, the book provides a "fast track." For those more fearful, there is a gradual method to follow that still gets results. Recently developed behavior therapy techniques including ritual delay and imaginal exposure are presented in a reader-friendly manner.

I particularly enjoyed the layout of the book. We do not have to wade through one lengthy paragraph after another. Rather, every page is divided into manageable sections with clear headings. Lists, highlights, sidebars, and set-off examples make the book ultra-easy to follow and a pleasure to read. A quibble is the lack of an index.

The OCD Workbook falls short only in trying to cover too much. Non-behavior treatments such as medications are dealt with superficially. Similarly, discussions of disorders that are associated with OCD such as depression, ADHD and Trichotillomania are not detailed enough to satisfy most readers.

All in all, The OCD Workbook is a wonderful addition to our resources. I am already using it with some of my patients. The discussion of behavior therapy is so clear and complete that it is equally helpful for both therapists conducting treatment and OCD sufferers taking on the disorder by themselves.

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  Everything in Its Place

By Marc Summers, with Dr. Eric Hollander

Reviewed by Janis D. McClure

Not gloom or doom, but hope and laughter are found in this incredibly entertaining new book by Marc Summers, with Eric Hollander, MD.

As past vice-president of an affiliate of the national Obsessive-Compulsive Foundation, Inc. (The Obsessive-Compulsive Foundation of Jacksonville, Inc.), I have the fortune or being able to be kept abreast of a vast number of new writings on the topic of Obsessive-Compulsive Disorder (OCD) and related illnesses. I am excited to say that Everything In Its Place is the most fresh, enlightening and entertaining book about Obsessive-Compulsive Disorder written in years.

Mr. Summers does a remarkable and difficult task in this book. Through the telling of his private life and career in the entertainment business, he keeps us enchanted on each page. As he writes about the different stages in his life and how Obsessive-Compulsive Disorder impacted each of them, he not only teaches us about the illness, but also purely entertains us. He makes us shed tears of sadness for his plight, while also has us producing tears of laughter -- often on the same page.

This book is a uniquely wonderful tale that can help those of us with Obsessive-Compulsive Disorder to better cope, as well as teach those who care about someone who is afflicted by the illness to better understand OCD's devastation. At the same time, Mr. Summers gives hope for the future. Probably the best statement I can make about this book is that, if someone is not reading for the knowledge of OCD it provides, one should read it for pure entertainment. It is an easy book to read and it keeps a person glued to each page.

Everything In Its Place is a one-of-a-kind book that I highly recommend to all to read and I believe it should be on the top of every best-sellers' list.

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Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty

By Jonathan Grayson, Ph.D.

Reviewed by Lee Fitzgibbons, Ph.D.
Anxiety Solutions of Northern New England
Bethlehem, NH

A recent visit to the OCF Bookstore at the 11th Annual OCF Conference showed me that there is no shortage of books available for OCD sufferers and treatment providers. Judging from the file of books I purchased and the comparable piles I saw being purchased by others present, I can safely surmise that sufferers, family members and treatment providers read them all. (Dare I say, compulsively?) Most of these books are competent, informative, and helpful in some way. But generally, reading them frequently provokes the thoughts - "I know that," "I've heard this before," "This is nothing new," and sometimes even "That's not quite right." These will probably NOT be your thoughts on reading Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty by Jonathan Grayson, Ph.D. Put simply: the book is a gift. It speaks to people with OCD through the voice of someone who knows intimately the world they walk in: not from a professional's authoritative perspective, but as someone who has walked with many through the difficult terrain.

The book is designed to help individuals develop an effective exposure and response prevention (ERP) program. One would expect that a book with this goal would tediously exhaust the respective exposure and response prevention exercises that might be needed. While the book does cover the basics (OCD basics, CBT basics, medication basics, and what is needed for ERP to occur (it is not a tedious manual or cookbook. Dr Grayson discusses all the major OC domains with a real understanding of the real experience and underlying concerns. He also provides concrete suggestions for potential exposure exercises and response preventions rules. However, the book goes much further.

Dr. Grayson rightly assumes that anyone can design an ERP program and so focuses more on the greater challenger. The challenge and the art of CBT for OCD is not designing effective exercises but getting someone to actually do them. This necessarily means that the main challenge of a self-help book is that the person needing to do the persuading is the same person that needs to be persuaded, namely, the reader. In meeting this challenge, this book offers new ideas and new twists on old ides. This book is the distillation of twenty-five years of Dr. Grayson's experience. Dr. Grayson offers strategies to the reader to enable him or her to push forward and take the necessary steps needed to journey to freedom.

What are some of the highlights that grabbed or inspired me? The first was Dr. Grayson's discussion of treatment readiness. Dr. Grayson asserts that many people fail CBT because they engage in the therapeutic process before they have clearly signed on to the therapeutic goal. Too often, the real and necessary goal of therapy is not explained to the treatment seeker and may not even be understood by the treatment provider. Dr Grayson suggests that whether or not someone is really ready to sign on to treatment boils down to whether or not they can affirmatively answer one question. The question is: "Are you willing to learn to live with uncertainty?" When individuals engage in therapy without signing on to this goal, they frequently want their OCD to go away while clinging to the fantasy that they can have or should have certainty. Dr Grayson helps clarify why answering "Yea" is so difficult: say "yes" requires mourning, moving from denial to acceptance, losing a cherished fantasy. Dr. Grayson urges each reader to grapple with this question before starting to develop a program. Because without answering "yea" to this question, there can be no lasting progress. He revisits the question throughout the book, translating its specific meaning of the question for him or herself.

Another highlight is his discussion of the "C" in CBT for OCD. Often, sufferers and professionals can get bogged down in professional disputes, such as; this technique is good; that technique is not. Dr Grayson's discussion of cognitive tools clearly explains how and why cognitive techniques are essential to treatment and how they can be used to help bring an individual to the starting gate and support his/her continued effort. Furthermore, he clearly explains how cognitive techniques can be misused by treatment providers and sufferers alike. This discussion alone makes the book worth reading. Dr Grayson is thoughtfully challenging the accepted use of some cognitive strategies. Rather that belittling or tossing out these strategies, he is arguing that they are needed but that they need to be used somewhat differently in the treatment of OCD. His discussion could provide grist for potential researchers and does raise issues for clinicians who may not be having as much success as they wish. For the sufferer seeking help, Dr. Grayson clearly shows how to use these cognitive tools, correctly providing a clear roadmap that will allow him/her to sidestep pitfalls.

One of the most innovative and exciting things about this book is that Dr. Grayson's uses imagery scripts extensively and provides actual script text with recommendations of how to tweak the scripts to personalize them. The use of imagery scripts is not new. Good treatment often incorporates the use of imagery in order to provide extended exposure to feared consequences. However, Dr. Grayson's use of imagery scripts far exceeds the norms for treatment. He points out that OCD is like a successful company that has a major advertising campaign operating in the sufferer's mind: it has been monopolizing the air time for years. He suggests that a useful technique is to purposely launch a counter campaign. To that end, he recommends listening to therapy tapes as much as possible so that anti-OCD thing (the product of all that good cognitive work) can become as pervasive as OCD thoughts have been. In essence, he is advocating combative self-brainwashing! To this purpose he utilizes scripts to build motivation, to learn how to talk back to OCD, to find ways to resist ritual, to explain why rituals are futile, and to learn to accept uncertainty. He provides examples of scripts to tape for nearly every type of OC problem, balancing elements of exposure and feared consequences with anti-OCD thoughts.

The book is truly packed with wisdom and clinical clarity. Upon finishing it, I felt a strong desire to begin reading parts again: not to satisfy a compulsive urge, but because there was so much worth digesting that I wanted a second round. That rarely happens. I cannot say that I did not have any "that's not quite right" thoughts. (After all, nothing is 100%.) But such thoughts were pretty rare. So, for individuals looking to help free themselves from OCD, for clinicians looking to improve their clinical understanding and expertise, for researchers wanting to come up with some provocative new areas to investigate and for all those people with stacks of books from the OCF Bookstore, my suggestion is read Dr. Grayson's Freedom from Obsessive Compulsive Disorder. Not only does it give you the first question that has to be asked for treatment to be successful, but it also suggests some very good techniques and exercises for when the answer is "yes."

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Helping Your Child with OCD: A Workbook for Parents and Children with Obsessive-Compulsive Disorders


By Lee Fitzgibbons, Ph.D. and Cherry Pedrick, RN

Reviewed by Barbara Van Noppen, Ph.D.
Providence, R.I.

Helping Your Child with OCD is cleverly organized in three parts:

1)     Does my Child have OCD?
2)     Selecting Treatment and Seeking Help, and
3)     What the Parent Can Do.

In Part 1, Fitzgibbons and Pedrick provide a descriptive overview of OCD. The diagnostic criteria and an explanation of the cycle of OCD from a cognitive-behavioral perspective and presented. The cognitive theme of intolerance of uncertainty is highlighted. This is followed by demographic statistics on the prevalence of OCD in children and theories of etiology, including information about PANDAS- related OCD. Seven cases of childhood OCD (children ranging in age from 7-16 years) are described to convey the different forms of OCD and how they affect children and parents functioning.

The authors recommend that parents begin by "unmasking OCD," i.e., "bring the OCD out in the open without shame or fear." Since these are common feelings for parents, the authors provide relevant descriptions of the various presentations of OCD so that parents can identify their child's symptoms and begin the unmasking process. Worksheets in the book help parents to identify what is OCD and what is not, a frustrating dilemma for parents. Part 1 concludes with an exquisitely sensitive section on the impact of OCD. The authors lay out the many forms of interference caused by OCD for both children and family. Though the impact of OCD on a child is extremely distressing for parents to acknowledge, the authors provide hope that there is effective treatment to promote recovery from OCD.

Part II, Selecting Treatment and Seeking Help, is a thorough two-chapter overview of treatment options and what they involve. The authors outline medication strategies, cognitive-behavioral therapy and the combination of both. Techniques such as exposure and response prevention and cognitive restructuring are described in a "user-friendly" way. Tips on finding a qualified psychiatrist and therapist are provided.

The last part of the book, What the Parent Can Do, is the heart of the workbook. It is in this section that questions about parents' roles and responsibilities are addressed. The authors prepare families for what can be a long journey of recovery from OCD. An emphasis is on changing negative or overly involved attitudes to constructive partnership-like ones. The authors stress that it is not a parents job to fix or solve the OCD. Parents can empower and support their child in his/her treatment to learn strategies to manage their symptoms. Helpful suggestions are made for parents to become advocates for their children in schools. In addition, the authors underscore the importance of parents taking time to care for themselves and families working together to normalize routines. This section is very goal oriented, providing numerous worksheets for families to use to outline goals, establish timelines, create privileges, develop family contracts, and brainstorm about expectations and limits. The book concludes with an extensive resource guide and list of publications of interest to children and teens, parents, educators, and therapists.

In short, this book is an invaluable resource. The authors' presentation of information is simultaneously frank and direct while empathetic and compassionate. The practical suggestions and worksheets help families to support and implement CBT techniques in the home. Many thanks to Lee Fitzgibbons and Cherry Pedrick for their contribution to the OCD community, which includes persons afflicted with OCD and the professionals who are always looking for therapeutic resources to help improve the quality of lives.