Book Review
Obsessive–Compulsive Disorder 
Cognitive-Behavioral Therapy for OCD David A Clark. New York (NY): Guilford Publications; 2003. 324 p. US$35.00
Reviewer
rating*: Excellent
Review by: Arun Ravindran, MB, PhD, FRCPC, FRCPsyc
Toronto, Ontario
Cognitive-behavioural therapy (CBT) is now recognized as a highly effective form of psychological treatment for obsessive–compulsive disorder (OCD). Although several recent publications on OCD had specific chapters on CBT, there is a definite need for a single, comprehensive volume that provides current information on the underlying theories, research, and clinical perspectives on this topic. This book by David Clark, a clinician–researcher and professor of psychology at the University of New Brunswick, admirably fulfills this need.
The volume is divided into 3 parts: the nature of OCD, CBT, and the research and practice of CBT. The first part provides a succinct overview of diagnosis, psychopathology, and relevant phenomenology of OCD. In the second part, the initial chapters on behavioural perspectives, psychology and information processing, and cognitive appraisal provide the history, the psychological substrates, and descriptions of the previous models of psychopathology and intervention. Logically, this is followed by a more detailed examination of the obsessive thought process, and the author proposes a novel model of obsessions. Referred to as the cognitive control model of obsessions, it suggests that unwanted intrusive thoughts persist if they are personally significant, ego dystonic, or threatening because of anticipated negative consequences. This, together with a heightened sense of responsibility, is said to lead to greater thought-control efforts, resulting in compulsions and neutralizations. Thus OCD patients not only try too hard to control the obsessions but also care too much about the results of incomplete thought control. The message to clinicians is that modification of dysfunctional thoughts, beliefs, and appraisals are critical in treating obsessions.
I found the second section the most enjoyable to read. It reflects the author’s extensive first-hand experience in both behavioural and cognitive schools from their early days through their evolution to their current states. Complex information is presented in a simple, easy-to-understand, and lucid manner. The arguments for the validity of the proposed model are cogent, and the synthesis of information is well done.
Part 3, which occupies half the volume, is an extensive treatment manual. It begins with the steps of a cognitive behavioural assessment of OCD, using the appropriate assessment tools and methods to arrive at a comprehensive formulation that becomes the foundation for the intervention. Clark describes different therapeutic approaches, with information on behavioural components, cognitive strategies, and explanations to enhance and tailor the treatment to individual patients. Clark suggests that interventions affecting primary and secondary appraisal of the obsession and its control (as proposed in the cognitive control theory of obsessions) are likely more effective than those that focus on the narrower definition of cognitive dysfunction. He then elaborates on maintenance treatment and relapse prevention using cognitive behavioural strategies.
The final chapter examines the empirical status and proposes future directions for research and clinical development. Clark points out the lack of empirical verification of the main treatment forms as an important deficiency that needs to be addressed by clinical research.
The book is concise and well written, with a succinct summary of each chapter. It is easy to read, comprehend, and remember. Clinicians will enjoy the clinical examples and researchers will appreciate the description of the behavioural theories and models. The bibliography is current, appropriate, and comprehensive.
This book will appeal to a wide audience, including health care professionals, researchers, and students working in the area of OCD. This comprehensive volume on the evolving area of CBT and OCD should be made available in all psychiatric libraries. I recommend it highly.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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