Clinician's Handbook for Obsessive Compulsive Disorder

This book is the first to bring together new research to offer a hands-on clinical guide to treating people with all types of obsessive compulsive disorder (OCD) using an inference-based therapy (IBT).

• Provides clinical examples from the full range of OCD subtypes
• Coverage integrates theory and application
• Decribes case management in detail - from initial assessment to terminating therapy and follow-up
• Shows how IBT can also be generalized and applied to other serious psychiatric disorders

List of Cartoons vii

About the Authors ix

Acknowledgements xi

Introduction xiii

Chapter One: Overview of the IBT Programme 1

Chapter Two: IBT: Evaluation Tools 9

Part I: Education and Foundation 21

Chapter Three: When OCD Begins 23

Chapter Four: The ‘Logic’ behind OCD 43

Chapter Five: The Obsessional Story 57

Chapter Six: The Vulnerable Self-Theme 73

Part II: Intervention 89

Chapter Seven: OCD Doubt is 100% Imaginary 91

Chapter Eight: OCD Doubt is 100% Irrelevant 115

Chapter Nine: The OCD Bubble 129

Chapter Ten: Reality Sensing 143

Part III: Consolidation 157

Chapter Eleven: A Different Story 159

Chapter Twelve: Tricks and Cheats of the OCD Con Artist 175

Chapter Thirteen: The Real Self 189

Chapter Fourteen: Knowing and Doing: Moving On and Preventing Relapse 205

Chapter Fifteen: Trouble-Shooting 221

Case Illustrations 231

Case Illustrations: Clinical Data 257

Answers to Common Queries from Clients 277

Therapist Queries 283

Quiz Answers Sheet 289

Appendix 1: Inferential Confusion Questionnaire (ICQ-EV) 291

Appendix 2: IBT Clinical Scales 293

Appendix 3: Therapy Evaluation Form and Scale 299

Appendix 4: Avoidance and Situational Profile Scale 307

Appendix 5: Diary 311

Bibliography: Key IBA Publications and Other References 321

Index 325

Dr Kieron O'Connor is currently the Director of the Centre for Research on Tic and Obsessional Disorders at the Fernand Seguin Research Center, Louis H. Lafontaine hospital affiliated with University of Montreal. He is also affiliated with the University of Quebec in Outaouais. His research focuses on improving understanding and treatment of people suffering from obsessive-compulsive spectrum and related disorders. The current IBT program is a product of this research. Dr O'Connor's publications include Behavioural Management of Tic Disorders (Wiley, 2005), and Beyond Reasonable Doubt: Reasoning Process in Obsessive Compulsive Disorder (with F. Aardema & M. C. Pélissier; Wiley, 2005).

Dr Frederick Aardema is a Clinical Researcher at the Fernand Seguin Research Center, Louis H. Lafontaine hospital affiliated with the University of Montreal. He played a vital role in the development of the inference based approach to the treatment of OCD and his work on reasoning led to the development of an innovative theoretical approach to pure obsessional ruminations. Dr Aardema has published widely on obsessive-compulsive and related disorders. His books include Beyond Reasonable Doubt: Reasoning Process in Obsessive Compulsive Disorder (with K. P. O'Connor & M. C. Pélissier, Wiley, 2005).

It is refreshing to have a new approach to therapy for OCD explained so clearly, with due regard to the theoretical subtlety of the Inference-Based Approach (IBA) approach. This book is a game-changer in this area of work and is a model of what careful research and evaluation can yield. Richard S. Hallam, Visiting Professor of Clinical Psychology, University of Greenwich, UK

The Inference-Based Approach (IBA) to the treatment of Obsessive-Compulsive Disorders presents a new and useful way to provide an evidence-based intervention for OCD. This approach is compatible with standard cognitive-behaviour therapy, but it adds a fresh perspective with new emphases for clinicians and clients alike. You will no doubt find it to be most interesting, and highly useful. Adam S. Radomsky, Associate Professor of Psychology, Concordia University, Canada

This is an excellent handbook on the Inference-Based Approach, the most viable and promising approach to OCD of the past ten years. Based on firm research, the book is highly practical. The authors provide clear guidelines as to how therapists should deal with the underlying thoughts of OCD patients. A must for clinicians and students. Paul Emmelkamp, Academy Professor, University of Amsterdam, Netherlands

This book is the first to compile and present the latest clinical strategies and offer a hands-on clinical guide to inference based therapy (IBT) for individuals with all types of obsessive compulsive disorder (OCD).

Recent findings have shown that OCD is primarily a reasoning problem whereby people erroneously infer that there is a reason to doubt themselves despite their senses and common sense saying otherwise. In the IBT model, the obsessional doubt is considered the source of OCD and the starting point for therapy. Inference-based therapy (IBT) offers an economical model effective for all OCD subtypes and is designed to help the person regain confidence in a realistic appreciation of events and move away from an imaginary doubt.

Using cartoons and illustrations, as well as clinical examples from the full range of OCD subtypes, this book is a fully interactive manual for clinicians, practitioners, and students. The book integrates theory and application, and pays special attention to the therapeutic process, detailing all steps from meeting the client and explaining the approach, right through to terminating therapy and preventing relapse.