Breaking Free From OCD:A CBT Guide for young people and their families

This book is intended for young people who suffer from Obsessive Compulsive Disorder (OCD) and everyone trying to help and support them. Whether the OCD is in a mild form or has escalated to totally debilitating, the books has much to offer. It is written by four experts in the field who all specialise in OCD and children/young adults. It is written in a very approachable, non-threatening tone without being patronising or over-simplified.

Each of the 18 chapters has a similar format with general information, a summary, and notes for parents. The introduction gently introduces OCD as the authors are well aware that some young people may be reluctant to admit they have a problem and resistant to take any action. It is easy to read, absorb and understand with definitions introduced slowly, clearly and repeated at intervals, along with real examples to perhaps identify with. The authors are careful to ensure that the reader understands that OCD has many guises from obsessive, intrusive and unwanted thoughts through to a need to check something such as a locked door multiple times.

Chapter 2 is dedicated to listing some of the symptoms which might be apparent in someone with OCD, being careful to keep the list low key, for to be too graphic might lead a vulnerable individual to develop a new obesession/fear/compulsion. The sufferer is reassured that they are not mad, or bad and it is explained that bad thoughts cannot make something bad happen. There is a short questionnaire to help assess whether OCD may be the problem. The chapter is summarised and then there is a short section for parents and carers with further information on OCD.

The third chapter is reassuring and explains that the condition is treatable and the types of help on offer. It should be declared that the authors are heavily biased in favour of CBT and one has been involved in the NICE guideline development. Whilst I accept that CBT has much to offer, I feel that much of the research is flawed, poorly designed and used as evidence based when it may be less effective than claimed. I have grave concerns by clinicians' apparent easy acceptance CBT research without looking for potential weaknesses in design and conclusions. This chapter explains where to go for help and what assessments and treatments might be offered

Chapter 4 explains a little about CBT but I felt it was perhaps too sketchy although it is covered in much more depth later in the book.

Chapter five begins to guide the young person into looking at how their OCD works because until they understand it, they cannot conquer it.

In Chapter 6 the real work begins in setting time aside to confront the OCD and it becomes clear that it will not improve without quite a lot of work and commitment. They explain that it is rarely a linear process and that support from parents/carers is essential and that another person's problem-solving may help to keep them on track as fear tends to distort things and affect clear thinking. Anyone overcoming OCD needs an advocate, someone/something to help motivate them and they need to review and monitor how things are progressing. The following chapters guide the young person through a series of exercises designed to help them see what they are doing and to work at challenging their behaviour, and gradually exposing themselves to their fears until the anxiety dies down. There are many worksheets which help to organise the activities and document how an exercise went. Chapter 13 is classic CBT of how to challenge faulty thinking and is something which is of use to everyone, as we often hold beliefs which fail to stand up to logic. There are charts to help identify the OCD problem that is to be worked on, the beliefs held, how to test the validity of this belief etc. The very act of treating one's problem as a science experiment helps to turn the problem into something the individual is controlling and it becomes an interesting exercise as well as being therapeutic.

There is no doubt that following the advice in this book is very demanding and time consuming and most young people will need a considerable amount of support to carry it through and organise themselves. However, with the right support most young people should be able to make considerable progress, although the more severe cases may need medication to lessen the severity of the symptoms before being able to take up the challenge. The skills acquired can be used throughout the whole of a person's life and not just for those with OCD ,so anyone following the book will develop life skills which will transfer outside of OCD management.

I can see very little, if any, explanation about the biological/genetic/epigenetic predispositions to anxiety and OCD and feel that a little about the physical influences is part of being educated and being fully informed. This knowledge also helps to remove the guilt which individuals and families can experience and to break down much of the prejudice about mental illness ie. OCD being seen as the families or individuals' fault. To some extent CBT plays into this prejudice, as it claims our thoughts cause the illness and fails to acknowledge that the illness and flawed biochemistry can cause the thoughts. It is important that views and beliefs about mental health are not skewed and that the various potential causes are known about, albeit briefly, for this audience.

I would not hesitate to recommend this book to anyone dealing with a young person with OCD. It is easy to read and follow but I feel few young people could manage to follow through without considerable support, organisation and encouragement.