Clinician's Handbook for Obsessive-Compulsive Disorder: Inference-Based Therapy (First Edition), by Kieron O'Connor and Frederick Aardema (Eds.). Hoboken, NJ: Wiley-Blackwell. 2012, 333 pagesDOI: 10.1037/a0037378The availability of a variety of cognitive-based approaches for treating anxiety disorders and related problems is important, as they enhance the number of possible options available to both therapists and clients or patients. This book presents an Inference- Based Therapy (IBT) program, which is a cognitive approach to treating obsessive-compulsive disorder (OCD). Based on extensive theoretical and intervention-based research on this topic, the au- thors have provided a detailed description of the treatment and each of its components, accompanied by a range of useful tools for both therapists and clients. Specifically, each chapter contains a description of the session content for therapists to review including examples, tips for how to know when the client is ready to proceed to the following session, and materials for clients, such as work- sheets, exercise sheets, training cards (highlighting important learning points), quizzes on session material, and even OCD- related cartoons. The cartoons add variety and a lighthearted tone to the book; but with some creative thinking, the authors may wish to consider a revised set of cartoons for use in future editions that could also serve to enhance content, understanding, or both.The book begins with an overview of the treatment and the theory on which it is based, namely the notion that doubt always results from inferential confusion. Inferential confu- sion encompasses distrust of one's senses or common sense, as well as being overly invested in unlikely possibilities. A summary of the stages of treatment is provided as well as information about appropriate assessment tools, most of which are included in the book. Following this introduction, the book is separated into three main sections of the treatment protocol, followed by a number of case examples and associated clinical data.The first treatment section, Education and Foundation, is com- posed of four sessions that provide the background and ground- work to build on as therapy progresses. The sessions focus on identifying the sequence (including triggers, doubts, consequences of doubts, and compulsions) to see that doubt is central to OCD, understanding that the reasoning behind doubt seems logical but is out of context, seeing how the reasoning behind doubt creates a convincing obsessional story and identi- fying the client's own story, and recognizing the self that clients fear they will become (i.e., common themes behind the client's doubts). This portion of the treatment really aims to help clients understand the role doubt plays in their OCD, and to better understand how their functions and is maintained. It is described clearly and lays an excellent framework for the rest of the treatment protocol.The second treatment section, Intervention, consists of four sessions that aim to establish the notion that doubts are based in imagination only, do not reflect reality, and that crossing into this imaginary world needs to be reduced. The sessions focus on exploring in further detail the notion that obsessions and doubts are based in imagination rather than reality and have no evidence in the here and now, increasing understanding that doubt is com- pletely irrelevant to reality and goes against the senses, under- standing that pulls clients into a when they cross over from reality into imagination and the importance of recognizing when they are entering this bubble, and working to reduce how strongly the client is being pulled into this OCD bubble by using the senses to dismiss doubts. Thus, this section has a strong focus on clients being able to recognize what evidence is actually based in the here and now, and how to begin trying to recognize the imaginary nature of doubts before getting pulled into an from which it is difficult to break free. …
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