Overcoming Obsessive Thoughts

We all occasionally think thoughts that are completely out of character. We imagine, for example, that we might swerve our car into oncoming traffic or take the kitchen knife we're using to prepare dinner and use it to harm someone we love. Many of us simply ignore thoughts like these, but some of us return to them again and again in our minds: What if I cause an accident? What if I hurt some I care about?

Christine Purdon, Ph.D., C.Psych., is associate professor of psychology at the University of Waterloo in Waterloo, ON David A. Clark, Ph.D., L.Psych., is professor of psychology at the University of New Brunswick in Fredericton, NB

Acknowledgments

ix

INTRODUCTION

Overview of OCD

1

(6)

Who Are We?

Is This Book for You?

Will This Book Help You?

What's Ahead

Using This Book

Pacing and Timing

CHAPTER 1 Our Treatment Approach

7

(6)

Medication and OCD

Cognitive Behavioral Therapy and OCD

Same Thought, Different Reaction

The Difference Is in the Interpretation

What Does CBT Do?

The Behavioral Part

CHAPTER 2 Do You Have Obsessions and Compulsions?

13

(20)

Some Faces of OCD

What Are Obsessions?

Repugnant Obsessions

Are Your Thoughts Obsessions?

"Normal" Obsessions

Can Obsessions Turn Ugly?

Scrupulosity: A Special Case of Religious Obsessions

Compulsions and Neutralizing

Examples of Compulsions and Neutralizing

Thought Control and Avoidance

CHAPTER 3 The Making of an Obsession

33

(12)

Why Do You Have Obsessions and Compulsions?

Engaging Obsessional Thoughts

Thinking About Thoughts

The Cognitive Behavioral Model

A Treatment Rationale

CHAPTER 4 Establishing Your Symptom Profile

45

(10)

Your Own OCD Symptoms

Establishing Your Symptom Profile: The Behavioral Component

Establishing Your Symptom Profile: The Cognitive Component

CHAPTER 5 Why Does Your OCD Persist?

55

(4)

Why Does Your OCD Persist?

Behavioral Factors

Putting It All Together

CHAPTER 6 Are You Ready to Make Changes?

59

(8)

Change Can Be Difficult

Concealment of Obsessions

Overvalued Ideation

Concerns About Overcoming OCD

Addressing Specific Fears and Concerns About Overcoming OCD

Costs of OCD: Do They Outweigh Your Concerns?

Weighing and Balancing

CHAPTER 7 The Paradox of Mental Control

67

(10)

Introduction

Attention and Thoughts

Deliberate

Attempts to Control Thoughts

Research on Mental Control

Why the Paradox?

Factors Influencing the Success of Mental Control

Consequences of Failed Mental Control

Effectiveness of Mental Control Strategies

Thwarting the Paradox

CHAPTER 8 Overcoming Obsessions with Themes of Harm, Violence, and Sex

77

(16)

Violent and Sexual Obsessions

What Are Your Appraisals?

Thought-Action Fusion

Making Use of This Information

Taking the Plunge: Exposure

CHAPTER 9 Religious Obsessions and Compulsions

93

(24)

Introduction

Religious Diversity

Does Religion Cause OCD?

Religious Devotion: How Much Is Too Much?

Faulty Appraisals and Beliefs

Challenging Appraisals

Religious Counseling and OCD Treatment

Taking the Plunge: Exposure

CHAPTER 10 Taking the Risk: Phasing Out Coping Strategies

117

(24)

Rationale for Phasing Out Coping Strategies

Taking It One Step at a Time: The Exposure Ladder

Is It Dangerous to Experience This Level of Distress?

Doing Exposure Exercises

Keys to Successful Exposure

How Tos of Exposure

Troubleshooting

Exposure Exercises and Your Family

Quitting Cold Turkey

CHAPTER 11 Maintaining Your Gains

141

(16)

Reviewing Your Gains

Strategies for Maintaining Gains

Managing the Return of Symptoms

Coping with Stress

Stress Management

References

157

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Overcoming Obsessive Thoughts

Summary

Author Biography

Table of Contents

Supplemental Materials