“Overcoming Obsessive Compulsive Disorder” Book Review

This practical and informative book provides a wealth of knowledge and guidance on understanding and treating obsessive-compulsive disorder (OCD) using cognitive-behavioral therapy (CBT) techniques. Authors David Veale and Rob Willson are experts in managing anxiety disorders, and their expertise shines through.

A major highlight is the authors’ ERASE conceptualization model outlining the key factors that drive OCD – events, reactions, avoidance, safety behaviors, and expectations. This framework dissects how OCD develops and persists, providing a crystal clear picture for both therapists and clients. The authors then use the ERASE model to guide detailed assessment and tailor treatment using exposure and response prevention.

The book covers the entire OCD therapy process – from diagnosis and case conceptualization to planning exposure exercises, managing resistance, and preventing relapse. Examples of client forms, worksheets, and exercises make it easy to implement the CBT techniques discussed. The authors write in an empathetic yet optimistic tone, validating the agony OCD causes while providing hope.

While focusing on OCD, the ERASE model and CBT strategies can be applied to anxiety disorders. The chapters are thoroughly referenced for those interested in the research foundations. Some sections get technical, making portions complex for general readers. However, overall this is an indispensable guide for therapists and an insightful resource for clients with OCD. The authors distill decades of expertise into an immensely helpful volume.

Here is a brief overview of the ERASE conceptualization model of anxiety:

• E – Events/Experiences: This refers to the external events or experiences that initially triggered the anxiety. These could include traumatic events, significant life changes, interpersonal issues, etc. Identifying the initial trigger can help uncover the root cause of the anxiety.
• R – Reactions: This refers to the cognitive, emotional, physical, and behavioral reactions the person has to the anxiety-provoking event or trigger. Common reactions include worrying thoughts, avoidance behaviors, muscle tension, restlessness, etc. Examining the reactions provides insights into how anxiety manifests.
• A – Avoidance: This refers to the avoidance behaviors the person engages in to minimize contact with anxiety triggers and reduce anxiety. Avoidance provides temporary relief but reinforces anxiety in the long term. Examples include avoiding social situations, procrastination, substance use, etc.
• S – Safety Behaviors: These are subtle, less obvious behaviors the person uses to prevent feared consequences. Like avoidance, safety behaviors reinforce anxiety. Examples include always having a water bottle to prevent panic attack symptoms, sitting near exits, etc.
• E – Expectations: This refers to the negative, irrational expectations and beliefs the person holds about themselves, others, and the world around them. Examples include “I’m inadequate”, “Others are judging me”, and “The world is dangerous”. Addressing unrealistic expectations is key.

The ERASE model helps identify factors that contribute to and maintain anxiety from a cognitive-behavioral perspective. It provides a framework for assessment and treatment planning. The goal is to increase awareness of maladaptive responses and replace them with more adaptive coping strategies.

The ERASE model for conceptualizing anxiety was originally proposed by psychologists David Veale and Rob Willson in their 2007 book “Overcoming Obsessive Compulsive Disorder”.

Key details:

• David Veale is a South African-born British psychologist known for his work on cognitive-behavioral therapy (CBT) for anxiety disorders, especially obsessive-compulsive disorder (OCD).
• Rob Willson is a British psychologist who also specializes in CBT for anxiety and OCD.
• Veale and Willson developed the ERASE framework as a way to understand the development and persistence of obsessive-compulsive symptoms. However, they noted it could be applied to conceptualize many forms of anxiety.
• The model aims to identify key components that cause and maintain anxiety so they can be effectively targeted in CBT treatment.
• Their book provides practical guidance on using ERASE to assess OCD clients and implement exposure and response prevention techniques.
• Since its proposal, the ERASE model has been widely adopted by CBT therapists and found useful for explaining anxiety to clients during cognitive restructuring.