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The treatment of obsessions
  1. A Speckens

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    By S Rachman. Published by Oxford University Press, Oxford, 2003, pp 158, £22.95. ISBN 0-19-851537-5

    This practical manual on the cognitive behavioural treatment of obsessive compulsive disorder (OCD) was recently published in the Cognitive behaviour therapy science and practice series, edited by David Clark, Christopher Fairburn, and Steven Hollon. The author is an authority in the field of OCD who has laid the foundations of the behaviour theory of OCD and has remained doing important research on the development and treatment of the disorder ever since.

    Although this book shows that he has moved towards including more cognitive elements in his treatment approach, his behavioural background shows in the lack of a coherent, developmental, cognitive behavioural formulation. As a consequence, the presented treatment techniques tend to remain patchy and arbitrary. The verbal and behavioural challenging of the meaning of obsessions could be described in more detail.

    In his introduction, the author states that although considerable progress has been made in treating compulsive behaviour, this was not accompanied by comparable progress in dealing with obsessions. Although the book is aimed at filling this gap of treating “patients with pure obsessions”, many of the examples in the book are of patients with compulsive behaviours and most of the techniques are equally applicable in obsessive patients with or without compulsions. The book has been clearly written, but there is considerable overlap and repetition between the different chapters. Although the author sometimes attempts to define the terms he is using, a better demarcation of concepts as intrusive thoughts, obsessions, preoccupation, and rumination; compulsions, neutralisation, safety behaviour, and avoidance; and exposure and behavioural experiments would be very helpful.

    Having said that, the book offers a wealth of ideas to use in the treatment of OCD and includes a lot of practical examples and case illustrations. The author has generously made available some of the interviews, questionnaires, and information material he has used with patients. I am sure this book will prove a very helpful adjunct for all therapists who are involved in the treatment of patients with OCD.

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