Draws on the author's work at the Philadelphia Anxiety and Agoraphobia Treatment Center to discuss the exercises and activities that have enabled his patients to make breakthroughs in coping with their disorders, outlining a self-guided version of the program that blends multiple treatment avenues and focuses on relapse prevention and recovery. 17,500 first printing.
This book was helpful, but also triggering. Proceed with caution and be prepared to have lots of exposure therapy shoved down your throat. You have to really be ready for it.
True story: My mother-in-law had just left after a lengthy visit, and I was trying to get back into doing my own housework again. My mother-in-law is extremely helpful, but putting your house in someone else’s hands always comes at a price as things will not necessarily be done the way you would do them. Grateful as I was for her help, I found myself growing increasingly irritable as I searched for items that had been “put away” in unexpected places, found hidden dirt in areas she didn’t know to clean, etc. My mounting inner grumbling finally found a voice when I picked up a bottle of cleanser which had not been closed tightly and it exploded all over me. “Dammit!” I yelled. “Why? Why would someone put this bottle back open?” The student who helps me clean my house approached me a few minutes later and asked me politely if everything was all right. I sheepishly mumbled an excuse. It was then that I remembered that “Freedom from Obsessive Compulsive Disorder” had been lying open on my night table.
Thank G-d, I actually don’t have OCD (my house would surely be a heck of a lot cleaner if I did, so probably my cleaner didn’t jump to the obvious conclusion). It is one nasty disease. As a psychologist new to the field, I picked up this book in an effort to learn more and found it quite informative. It’s written for laypeople, clear and jargon-free, and seems to make a lot of sense.
I remember reading that traditional “talk therapy” is ineffective for OCD but had only vague ideas of what the treatment of choice, “exposure and response prevention,” actually looked like in practice. “Freedom from Obsessive Compulsive Disorder,” after providing helpful information about OCD in general, the role of medication, and other relevant issues, outlines a self-guided program of exposure and response prevention for OCD sufferers. Needless to say, it’s also quite useful for therapists seeking a road map for helping OCD clients.
(The following is a general summary of what I learned from this book. If you’re not interested in learning about OCD therapy, you may as well stop reading. If you are seriously interested in learning about and practicing OCD therapy, be forewarned that reading my summary is not a substitute for reading the book. If you’re mildly curious about OCD therapy but don’t expect to ever try it with a client or on yourself, feel free to read on.)
According to the book, therapy for OCD clients consists of three general processes:
1. Deciding to live with uncertainty 2. Exposure 3. Response prevention
Deciding to live with uncertainty is the theme that underlies recovering from OCD. Instead of obsessing and/or ritualizing in an effort to neutralize uncertainty (e.g., Did I just contaminate myself? Am I really sure the stove is turned off?), the goal is to learn how to live with the discomfort that anxiety creates. Choosing to live with uncertainty means abandoning OCD rituals in favor of making peace with the fact that one can never truly be sure.
Exposure begins with the client creating a hierarchy of anxiety-provoking situations that stimulate the urge to ritualize, ranked in order of intensity. The client also lists the response rituals frequently used that will now be off-limits. The client then commits to spending 1-2 hours per day engaged in “active exposure,” i.e., deliberately placing themselves in the feared situations. The client uses the fear hierarchy to start active exposure with the easier situations and gradually work their way up. In the beginning, if the deliberate exposure is too scary, they should devote the hour to “safe steps,” i.e., exposure-related tasks such as writing and listening to therapy scripts (supportive messages about the need to perform exposure tasks) and/or approaching the exposure situation even if they can’t actually enter into it. Aside from the scheduled active exposure, the client also engages in passive exposure (i.e., non-avoidance of the anxiety-provoking situation) throughout the day.
Response prevention ideally means going whole hog – all rituals should stop once the client commits to following the program. It’s not usually realistic to go halfway. If the client is too overwhelmed by stopping all the rituals, though, they can work according to their fear hierarchy and commit to following rituals only in the more feared situations at first, gradually working their way up the hierarchy. The client uses a variety of tools to prevent themselves from engaging in the compulsive ritual during the exposure situation. One is therapy scripts that they compose and record for listening to on headphones. They listen to these scripts as much as possible during the scheduled active exposure sessions, and even throughout the day during passive exposure situations. They also keep a log of their successes during these sessions, even small ones. If a client feels overwhelmed and compelled to ritualize, they can use distraction and refocusing – choosing a delay that they are sure they can tolerate, even if it’s only five minutes, and following through on that delay by making sure to engage in some other activity such as listening to their therapy scripts. Once that delay is over, ideally they should try for another delay; even if this is impossible, they should record their success in delaying this long. Clients should post helpful reminders around the house, particularly in target areas (e.g., toothpicks taped to the sink knobs to remind themselves not to compulsively wash their hands; script cards or more subtle “dot” stickers).
This is very general; the book offers specific guidelines as well for confronting particular feared situations and preventing the accompanying rituals. The book also offers sample fear hierarchies and therapy scripts to address a variety of different OCD situations.
Finally, the book reviews other diagnoses on the “OCD spectrum” for which the book’s guidelines are relevant although they may need some tweaking (e.g., generalized anxiety disorder, hypochondriasis) and discusses maintenance once the recovery program has been successful.
I highly recommend this book to OCD clients and to their therapists. You may want to avoid displaying it in potentially embarrassing situations, though.
This book was a really fantastic way to help me understand OCD. I learned a LOT of coping mechanisms and I felt validated without the author reassuring the crazy parts of my brain. The only thing I will say is most of the chapters are about contamination OCD. And while I do have that, my OCD is more focused on less common things and I wish there was more information on that. Overall, I HIGHLY recommend reading this book if you have OCD.
Ok very cool and insightful read. I spent years thinking my incessant and irrational “what if” doubts were simply a result of my active imagination!!!!! I thought my inability to trust any one or thing was a character flaw!!!! My compulsions weren’t harming me because i liked doing it!!!! My self flagellating attachment to outcome was because i was career driven!!!! My entirely fictional mental narratives that made me physically sick and suicidal was just a little bit of anxiety!!!!! Haha. This book is triggering and made me cry a lot but thats expected when im hit with that double whammy realization that the seemingly inescapable ruminating horrors that plague me daily are actually simultaneously my only comfort and a compulsive addiction…. that I have the power to stop. Ouchie! Dr. Grayson really lets you know that you have to abandon every coping mechanism that gives you any crumb of (perceived) relief and re learn how to navigate the world if you ever want to feel real and present joy. Easy peasy. He is very blunt and direct, at times a little emotionless. A lot of it is hard to hear but once you accept it, his techniques are pretty awesome. I feel seen and understood. Well structured for rereads. I like his example of the woman who really didn’t want to and had a deep fear of living in a world where her daughter could die; because of course no one wants to live in that world. And he tells her well it doesn’t matter what you want, you already live in that world. Im like … face crack. There will always be a what if. This book does not teach you how to stop thinking what ifs and he makes it clear that trying to stop thoughts is also impossible. He outlines a solid way to learn how to live and breathe with uncertainty instead of letting it destroy your life. Recommend this book to anyone who has been told that they just have anxiety/depression but feel an insatiable need for control and an unwavering sense of doom at all times lol.
There was a glitch in my library app that caused me to lose my place, but I made it through the entire book/worksheet part into part of the appendices that were catered to specific kings of ocd. This, like another reviewer said, is a very good but very triggering book. Ideally one would use this in tandem with a specialized therapy and/or iop program like I did. But, healthcare isn't attainable for everyone. If this is all you've got, it's definitely a useful tool. Just take your time. You've basically got to walk a delicate line between bravery and damage and it sucks. It REALLY sucks. But it's worth it even for a little freedom.
4.5 stars Hard to rate this one but giving it 5 stars because LIFE CHANGING. This is a book for sufferers from Obsessive Compulsive Disorder and also has super helpful information about related Anxiety Disorders: Generalized Anxiety, Body Dysphormic Disorder, Obsessive Compulsive Personality. Even if you do not have a "Diorder" but are "merely" Perfectionistic (which is most physicians and successful pre-medical students), this book is extremely relevant. I learned a lot about myself and am using this information to attempt to overcome some obsessive thought patterns of my own and a bad habit or two. Wish me luck!
This is The Bible for families and friends of sufferers from OCD, to help them understand the disorder, and is The Book for Psychiatrists and Psychotherapists to understand OCD and treat their patients with Exposure and Response Prevention (ERP). What was difficult? Lots of dry checklists and worksheets which are tedious to read through (though no doubt helpful), and the part about designing your treatment program was hard to visualize. I think if I were suffering from OCD, I would definitely need a therapist to walk me through it, and I would need medication to control the anxiety while doing ERP. Great news is that you can control OCD in 15 sessions and once you are done with ERP treatment you can taper off medication. The best parts for me were Part 1 explaining what OCD is, Part 4 after recovery, and Chapter 13 related disorders to OCD.
Some stuff in here is really weird--the things people obsess about are very interesting and to me surprising--and the part about having patients rub hands on a Dumpster and then eating without washing literally blew my mind. This is part of the treatment--you have to go overboard to stop ritualizing. I am just so glad there is an effective treatment for this debilitating disorder.
Highly recommend for anyone with an interest in OCD or related disorders for any reason.
This book focuses primarily on contamination OCD, but explores applicable goals and exposures for other kinds. Before assigning this book, a caution should be given to clients that it may be triggering and ERP therapy should only be used for those ready to accept uncertainty and WANT to change. The author’s sample therapy scripts can be useful to help clients build their own.
during the worst flare up of ocd i’ve experienced, this book educated me about treatment more than any other resource. it’s something i’m sure i’ll come back to again and again
In his manual Freedom from Obsessive-Compulsive Disorder, guru Dr. Jonathan Grayson expresses, “In a sense, your rituals show a lack of faith...Many of you have focused so much on following rules that you have forgotten to think about the nature of your faith. If this is important to you, treatment will not only help you overcome OCD but also may help you strengthen your faith...I often suggest...that they believe in two Gods...on the one hand, they have a loving and forgiving God who cares about their souls and well-being, and, on the other hand, they have a stern and exacting God who will damn them for the slightest misstep.”
Do I, too, worship two gods? A be ye holy (perfect, clean, pure) therefore as I am holy God and a God who spit on a blind man’s eyes, who wrote in the sand, who shared a drink from the same vessel as an “unclean” Samaritan woman at a well, who was anointed with the perfume and tears of a prostitute, who bathed his friends’ dirt encrusted feet, who inhaled his first breaths from the cradle of a feeding trough and who exhaled his final breath from the nail pierced hands and spear slashed side and thorn crowned brow of the cross, by whose stripes I am healed? A God who invited the grubby little fingers and feet of children come unto me? If He was unafraid of contaminating himself with the fingerprints of humanity and unashamed of the scars that remained on His divinity, will I not accept the grace to be holy and wholly unafraid and unashamed that he offers me? Just know this: when you’re down to your last straw and you’ve come to the end of yourself, God is waiting to surprise you inside a cupboard door. He holds a box full of straws with which to taste and see that He is good and He is God.
Grayson goes on to affirm the positive use of faith in treatment. “However, rather than ask for relief, I would suggest something different. I’m reminded of Terry Anderson, a reporter who was held captive by Iranians during the years Carter was president. He was held captive for months. He hadn’t been a religious man prior to his captivity. During his imprisonment, his captors gave him a Bible. He read it and overtime developed a deep faith and prayed every day. In his prayers, he never asked for freedom. Instead, he simply prayed for the strength to keep his newfound faith. If religion is important to you, then I would suggest that you pray for the strength to cope with the anxiety that is part of your treatment...At least you won’t be praying to be OCDemon.”
“Miracles come in many forms, but they are usually unexpected. The big ones are obvious, but sometimes the important ones aren’t. Finding treatment can feel like a miracle. Finding that it can work for you can be a miracle. And that brings us to the question. Often to find a miracle, you may have to take a risk, a leap of faith. Have you taken any such leaps in the past two weeks, and if so what were the results? Did you experience a small miracle?” God is the ultimate miracle maker, but sometimes He empowers us to walk with Him on the water if we will step out of our comfort boats and fix our eyes on Him in faith!
This man knows what he's talking about, and is very compassionate towards those who suffer from OCD. My copy was borrowed from the library, so I didn't fill out the exercises. Now, I want to buy it so I can do so! I highly recommend this book to those who know well the intense battle associated with coping with OCD.
If you could read one book on treating or self-treating OCD, this is it. Grayson is so clear, insightful, loads of helpful scripts and treatment planning, and truly clarifies what an OCD sufferer's experience is like.
A captivating and well-researched book on OCD that I would recommend to anyone suffering from obsessive thoughts and/or compulsive behaviors that demand too much attention from their life. 4/5 stars.
Great book for those out there struggling. There is a path forward and help is just around the corner. Don't let ocd dictate your life. You can be the maker of your life.
This book is for anyone who suffers from OCD or for anyone who has family or friends that suffer from this disease. This book provides the reader with new understanding about obsessive compulsive disorder. Grayson describes the reasons - both biological and environmental - which lead to the disease and what it feels to the person who suffers from it. OCD is rooted in the inability to deal with uncertainty. Coping with uncertainty is the way to manage the disease. Grayson gives truly helpful exercises which help the sufferer to cope. One of my favorite ways is the "Ten-minute at a time" approach to anxiety. OCD makes me feel like my anxiety will never end and so I use rituals to try to manage that anxiety but what Grayson suggest I do is - instead of ritualizing - cope with the fact of my anxiety (regardless of how painful it is) for ten minutes at a time. There are a bunch of little gems - AKA exercises - in this book which help me to manage my OCD. Whenever I suffer a relapse I return to this book and find healing and solace.
I always thought of OCD as being obsessively clean and washing hands repeatedly. It actually covers a wide range of obsessive thoughts and behaviors meant to relieve anxiety but ultimately perpetuating it with repetition. My OCD helped me to create structure in a chaotic childhood and really served me well throughout school, college, law school and practicing law … until I became a mother. With the help of a fantastic exposure therapist, I’ve learned to not only understand the behaviors, but to also expose myself to my fears, the behaviors in response to my fears, and learn to live with much less anxiety. This has been enormously helpful as I navigate and learn to embrace “a life of uncertainty” - especially with a toddler! This book coupled with a great exposure therapist will change your life.
I appreciate the way this book is structured. The author includes step-by-step instructions for engaging in ERP for each category of OCD including sample therapy scripts and hierarchy examples. Dr. Grayson has obviously worked extensively with OCD and is knowledgeable on evidence based treatment. I am rating this book 4.5 stars due to several of his examples having body shaming language and tend to be unnecessarily gendered (examples about going on a diet, etc). On that note, I do want to acknowledge that this book (at least the version I read) was published in 2003.
This is an exhaustive review on OCD and it’s behaviors. I had to switch to the audible version of the book halfway through because of how tedious it was. I don’t believe that I could have read the whole thing throughout and been fine. Definitely need to work with individuals before reading or most of this book will not make sense. It is a great reference book involving scripts to overcome obsessive thoughts.
Excellent book on treatment of obsessive-compulsive disorders. It greatly helped me understand basics of Exposure and Response Prevention Therapy, the nature of CBT, anxiety disorders, and, of course, OCD. Highly recommend this book to anyone suffering from anxiety disorders, or any therapist thinking of treating a patient/client who has an anxiety disorder. OCD treatment is one area where CBT is a highly effective treatment and can save peoples' lives.
One of the toughest books I’ve ever read. I understand more about my own OCD, but with that comes even more fear and uncertainty - but that’s the point of this book. Understanding ERP and how to do it is a life long struggle, but this book does a great job of laying it out. My only wish would be that he spend more time on mental obsessions and other OCD behavior like trich.
A must read for anyone who struggles with OCD, families of a person with OCD, therapists, and anyone who wants to learn how OCD manifests and how it is treated. As an expert in OCD treatment, Jonathon Grayson knows what he's talking about.
Jk. But a lot of good insights and some new epiphanies while reading this. Unfortunately a lot of the examples were so hyper specific and not relevant to me it made it difficult to relate or be engaged while reading.
But the methods and the whole structure of the book is very chaotic and a disaster. Nothing new besides the checklists. This book emphasize acceptance of uncertainty, but how? ERP. But ERP is nothing new and I can hardly see how is it related to acceptance of uncertainty.
An insightful book! It highlights the time-consuming nature of OCD as a result of obsessions and compulsions. Most importantly, it provides steps to create a personalized plan to confront the fears associated with the thoughts and reduce compulsions.
A good basic book on understanding what OCD is and the steps to gain back freedom.
Only negative was that I felt like some of the case examples were quite hyper-specific. But I would still recommend this book to anyone for their first book on understanding OCD.
I read this over a long time, partially because there was a lot to think about but also because the complex topic would have been more understandable with more concise writing. despite that, the book taught me some things about myself and about some people I've been close to in my life.