"Worried No More" provides general information to bring the targeted audience up to speed on different anxiety problems. In it, Dr. Pinto Wagner discusses in general terms CBT and medications. These general chapters are easily understood, to-the-point and jargon free. She provides guidance on how to discriminate between normal anxiety from problem anxiety. She discusses warning symptoms and possible differences in presentation due to developmental age.

In my opinion, the most elegant chapter of the book is the one devoted to discussing the causes of anxiety disorders in children. Dr. Pinto Wagner explains the maintenance factors in incredibly clear and understandable language. She handles particularly well the delicate issue of parental reactions and responses that can accidentally and inadvertently strengthen an anxiety problem.

Another section the author covers with expert ease is her explanation of habituation and how and why Exposure and Response Prevention (E&RP) works. Because having this understanding is the first step towards success, these explanations alone make the book worth buying. Additionally, the book has many handy tables that simplify concepts for the reader. One that stands out is a nifty little table that highlights the differences between normal anxiety and problem anxiety. Other highlights of the book are sections that focus specifically on what parents and school personnel can do to help alleviate a child's anxiety. The school chapter is particularly useful. In it, Dr. Pinto Wagner urges the school to respect and honor the knowledge and expertise of the parents. She also urges parents to understand the limited resources of schools and to assume that most school personnel want to be helpful. By focusing on the unique responsibilities of all the parties involved, the author shows how parents and teachers can build a team that truly works together for the best interest of the child they are trying to help. It has been my experience that school personnel and parents often initially look at each other as adversaries. Dr. Pinto Wagner provides useful guidance to help foster teamwork and specific actions the team can take to help the child.

There is also a chapter devoted to specific interventions that might be useful for a variety of anxiety disorders in children. The chapter presents many useful ideas. I hope that parents do not assume that armed with this book they can replace a clinician. Possibly to guard against this assumption, Dr. Wagner provides a list of questions to help parents find a good clinician.

I was very impressed with the "Worry Hill Memory Card" that Dr. Pinto Wagner devised and included in the book. Young children will be able to use this mnemonic device to keep in mind that, although the early part of an exposure exercise is hard work and involves feeling fear, when they get used to doing it, it will be as easy as coasting down a hill on a bike. This "Card" is a gem and the metaphor is a useful analogy for any parent or therapist.

Overall, I give this book a hearty thumbs up!!

Dr. Fitzgibbons treats children and adolescents with anxiety disorders at the Agoraphobia & Anxiety Treatment Center in Bala Cynwynd, PA.

Throughout the book, Dr. Pinto Wagner's writing is to-the-point and jargon free, easily understood by the lay-person. Numerous quotes and vignettes from affected children and their families will surely help those who do not live with the disorder understand its impact on daily life. Several tables including "Suggested Questions About Medications" and "Suggested Questions to Ask A Therapist" provide an invaluable quick reference guide. "Frequently Asked Questions" at the end of each chapter offer the reader further clarification of important topics.

Part 1 provides the "Essential Facts" about OCD including the steps to recognize, assess and get treatment for OCD. This part of the book may be particularly useful for parents whose children are newly diagnosed or in the early stages of treatment. Dr. Pinto Wagner provides a clear explanation of the difference between normal fears and OCD and outlines common obsessions and compulsions. She demystifies the evaluation and diagnostic process by walking parents through it step by step, offering solutions to potential hurdles that may arise as good treatment is sought. In Chapter 5, Dr. Pinto Wagner eloquently explains the treatment of OCD, using her metaphor of the "Worry Hill" to outline the relationship among exposure/ritual prevention (E&RP), habituation and eventual mastery of OCD. In my experience, these metaphors are easily understood by parents, teens and even young children. The "Worry Hill" metaphor is elaborated upon with easy-to-remember mnemonics such as RIDE (to describe the child's tasks in facing OCD) and RALLY (to describe a parent's role in supporting their child during E&RP). This chapter alone makes the book worthwhile because an understanding of treatment is one of the important first steps toward recovery.

Part 2 of the book, entitled "What to Do," lays out the "Master Plan" for overcoming OCD. The author's humanity shines through in this section oft he book because she recognizes the multiple challenges of coping with a difficult disorder amidst the busy reality of everyday life. She appropriately encourages families to simplify their lives and urges parents to take care of themselves so that they can most effectively cope with and lead the charge against OCD. Although parents are certainly the experts on their children, one concern underlying any treatment-oriented book is that parents will surrender their important role as mom or dad to take on the role of "therapist." Dr. Pinto Wagner addresses this delicate issue in her book by clearly explaining the importance of approaching the journey toward recovery with the help of a good clinician, outlining the necessary and unique roles of the therapist, the parents and the child.

One of the most significant sections in Part 2 is Chapter 9, which discusses a child's readiness for treatment. Ensuring that a child is adequately prepared and ready to tackle the challenge of the journey is an essential aspect of successful treatment; the importance of which cannot be overstated. Any parent wants a suffering child to get well as quickly as possible, but, as Dr. Pinto Wagner explains with clarity, beginning E&RP before a child is ready can have adverse effects. Other highlights of this chapter include child-friendly explanations of OCD and CBT and strategies to deal with the reluctant child.

After reading Dr. Pinto Wagner's book, I think many parents will feel as though they have had a face-to-face conversation with an expert, who patiently answered their questions and comprehensively addressed their concerns. Armed with this book, parents will have the knowledge to obtain good treatment and the sense of hope to support their child in the journey toward mastery over OCD.

Lori J. Kasmen, Psy.D. practices at the Anxiety and Agoraphobia Treatment Center, Bala Cynwyd, PA.

Moreover, even when they are accessed, the treatments as delivered in some clinical contexts often do not resemble the carefully constructed and theoretically driven manuals used in randomized controlled trials (RCTs); and thus, the efficacy of these treatments may be attenuated. This unfortunate situation is certainly evident in the treatment of OCD, where many patients who are ostensibly receiving CBT do not receive an adequate theoretical rationale for the chosen treatment procedures, are given insufficient guidance in constructing and working through a hierarchy of feared thoughts and situations, are provided with vague instructions regarding response prevention, and are not carefully educated about the importance of identifying and refraining from mental rituals, among other acts of omission and commission. Indeed, on more than a few occasions in over a decade devoted to clinical practice and research on the treatment of adult and pediatric OCD, I have interviewed patients who, in the context of their CBT treatment, were asked to snap a rubber band on their wrist every time they experienced an obsession in order to drive away feared thoughts and images. This approach is more likely to induce rather than reduce obsessional distress; and, in the wake of this sort of frustration, I have often wished that the tried and true procedures of exposure and response prevention could be disseminated more readily to mental health professionals who encounter OCD patients in their clinical practices.

It is also imperative that CBT materials designed for dissemination should be made as accessible and easy-to-use as possible, since one of the major barriers to their use in real-world clinical settings appears to be the time and labor intensity of translating research-oriented manuals for use with OCD patients in general, but with children and adolescents especially.

Aureen Pinto Wagner's newest volume, "Treatment of OCD in Children and Adolescents: A Cognitive-Behavioral Therapy Manual," addresses many of these critical needs and has the potential to improve significantly the delivery of CBT for pediatric OCD in the community. Her extensive clinical experience and previous work in creating materials for children and adolescents with OCD and for their families are clearly evident in this therapist manual, which may be used in concert with these other books. The most obvious and immediate advance is that this manual provides therapist and patient forms on CD ROM, an attractive and sturdy version of the "Feelings Thermometer" which children and adolescents will be asked to use during and between treatment sessions, and sufficient detail in the description of treatment procedures that are clearly the product of the author's wealth of experience and knowledge in treating children and adolescents with OCD.

The provision of these materials goes a long way towards promoting compliance with treatment procedures and keeping therapist, patient, and parent on the same page as the therapy progresses. The thought and care that went into their creation also sets an obvious tone about treatment for the patient. It says to him that the serious use of these handsome materials is important in helping him to achieve his goal of reducing OCD symptoms. The manual is divided into fourteen chapters, the first four of which are devoted to the nature and maintenance of OCD symptoms, a description of the theoretical rationale for CBT procedures, and a discussion of the particular challenges of using CBT with children and adolescents. In this latter section, the author discusses treatment readiness issues, which often arise in the very early stages of assessment and thus are essential to address immediately. She also reminds us that OCD affects and is affected by family issues, and that it is important to properly prepare the family to assist the child and the therapist before CBT is implemented. Her suggestions about how best to accomplish this are likely to be especially helpful. Throughout these chapters and, indeed, in the volume more broadly, Dr. Wagner cites the scientific literature to support her assertions. She is also liberal with clinical pearls and cogent examples gathered through her extensive experience with pediatric OCD.

1.	Biopsy-chosocial Assessment and Treatment Plan;
2.	Building Treatment Readiness;
3.	The RIDE Up and Down the "Worry Hill;" and
4.	After the RIDE. The cultivation of treatment readiness is appropriately emphasized throughout the volume.

It is made clear to therapists that effective treatment cannot proceed until the child is fully on board with the plan and has explicitly agreed to go forward. In placing this strong emphasis here, the volume goes above and beyond many of the excellent CBT manuals that have preceded it. In doing so, it makes a very important contribution to the growing clinical literature on pediatric OCD.

Child-friendly metaphors are used in the service of conveying these important points; and the protocol devotes two to four 50 minute sessions to this essential work. Stabilization is the first step, and involves psychoeducation about OCD as a biopsychosocial illness and presents an opportunity for children and families to speak about OCD's impact upon the family.

The second stage, labeled "Communication," describes the maintenance factors of OCD in greater detail and prepares everyone for the third stage, Persuasion, in which the therapist encourages children and families to see the necessity, possibility, and power of change. The techniques of motivational interviewing (e.g., consideration of the pros and cons of living with OCD) are liberally used. Each is used in the service of encouraging the child to commit to the treatment program.

The last stage, referred to as "Collaboration," is designed to clarify how the treatment will be done and to install the child as the team's leader. This arrangement is intended to minimize the temptation to push harder at first than the child is willing to go and to promote the child's active participation in the process. The material in these sections is presented in a clear, logical, and concise fashion. The fact that several sessions are explicitly devoted to "Collaboration" emphasizes its importance to therapists and families, each of whom might be tempted to move ahead quickly in view of the negative impact OCD has had on the child and family system. Dr. Wagner emphasizes throughout the book that this is both understandable and unwise. In doing so, I believe has done a considerable service for children and adolescents who will be treated using these materials.

Assuming that the preparation has gone well and the implementation of E&RP is now at hand, Dr. Wagner uses the term "RIDE up and down the Worry Hill" to guide the implementation of E&RP and to track progress. RIDE is anacronym for: Rename the thought; Insist that YOU are in charge; Defy it by doing the opposite, and Enjoy your success by rewarding yourself. The first two steps can be conceptualized as preparatory because these steps are designed to encourage the child to do what needs to be done, which is to resist OCD's demands to avoid situations and thoughts and/or to engage in compulsions.

The final step reminds the child to reinforce his/herself for successful use of the steps. And, throughout the volume, families are vigorously encouraged to do so as well. Several cards are provided with the manual for the child to use during and after his/her exposure practices. Here again, the formality and attractiveness of the presentation is designed to convey a message about its importance and thereby promote compliance.

The RIDE acronym helps to break down E&RP into concrete, finite steps that structure and clarify the treatment process. The purpose is to foster endurance of the anxiety until habituation takes place. This latter point is a critical one, and therapists using the RIDE protocol must remain alert to whether or not children understand that the first two steps are not intended to reduce obsessional distress, but rather to encourage the child to tolerate the anxiety associated with planned and unplanned E&RP tasks. Dr. Wagner's specific examples of how the RIDE cards should be used underscore this important point; but, nevertheless, it bears repeating throughout the treatment.

Dr. Wagner's "Phase 4" section discusses preparing the patient and family for the transition, maintenance visits, booster sessions, realistic expectations, and strategies for managing the inevitable slips that will arise. This is an important concept that when totally internalized will go a long way in preventing "abstinence violation effects" or panicking when common problems do indeed arise.

One of the real difficulties in creating a treatment manual for pediatric OCD is the heterogeneity of patient presentations limits the degree to which general rules and examples can be provided. In Chapter 12, Dr. Wagner addresses this issue by providing more specific information about various OCD subtypes, such as, patients with reassurance rituals that involve family members, mental rituals associated with "bad thoughts," "hoarding," etc. Her examples of how to use the "Fear Ladder" and "RIDE cards" to work with these particular presentations are especially helpful. It behooves the clinician to read this chapter carefully before beginning CBT with any child or adolescent with OCD.

In Chapters 13 and 14, Dr. Wagner also addresses typical problems that sometimes occur in the context of E&RP, such as, limit setting, appropriate use of rewards and punishment, managing explosive behavior, and treatment reluctance that occurs during treatment. The citations at the end of the volume are thorough and up-to-date. They provide a guide for readers who encounter OCD more frequently and/or wish to create a subspecialty practice. Dr. Wagner also provides a list of support organizations that will be helpful for the practicing clinician to have at the ready.

Clearly, my review conveys a great deal of enthusiasm for the purpose and content of this manual and the accompanying materials. I strongly believe that it fills a critical gap in the armamentarium of practicing clinicians who treat OCD. It distills information about the nature and treatment of OCD in a clear and logical manner. And, the author is to be lauded for paying particular attention to the practical constraints that make CBT for pediatric OCD sometimes difficult to learn and deliver in clinical settings.

Of course, there are always tradeoffs that have to be made when writing such a book. Dr. Wagner's conscious choice to emphasize ease of use occasionally comes at the expense of providing more detailed information about the theoretical framework on which E&RP is built and about current controversies in the field (e.g., whether the habituation model that is strongly emphasized here is sufficient to explain changes in OCD symptoms and how best to integrate informal cognitive techniques, including the discussion of objective risk and responsibility) about E&RP.

That said, I think Dr. Wagner's newest volume is a significant advance that will assist clinicians interested in providing high-quality CBT in a manner that is consistent with the constraints of clinical practice. Clinical researchers interested in dissemination of CBT for pediatric OCD should also take heed: Herein lies a manual that can be readily tested in clinical settings, perhaps with and without expert supervision, in order for us to learn whether CBT for pediatric OCD can be successfully disseminated well beyond the academic research context.

Martin Franklin, Ph.D. UPenn School of Medicine Philadelphia, PA

Adam wrote, shot, directed, edited and produced this insight into what it's like to deal with an OCD monster that is constantly sowing doubts in the mind. Did I complete my rituals? What are the consequences if I didn't? What can I do to put things right? He does this through an interesting dramatic technique.

The piece opens with the teenage hero obsessively practicing basketball hoops. It's clear he’s been doing this for a while today and perhaps every day. A wide variety of camera shots match the variety of attempts to get the ball through the hoop. When he thinks he’s finished, he’s confronted by another character who tells him he hasn't completed the ritual correctly and threatens him with the ultimate sanction: an early death. This would be enough to make anyone think twice about going into the house. For an obsessive-compulsive it means a return to the hoop.

It becomes clear through some expressive dialogue that the harbinger of doom is the hoop-player's alter ego. He’s a manifestation of the voice inside an OCD sufferer's head that urges them to throw more hoops, to be concerned about catching a fatal disease, to fear a collision with a pedestrian while driving. Adam is served well by his two main actors who provide convincing performances as the pleasant young man and his evil twin. It becomes clear that nobody else can see the OCD monster and thereby lies the hero's potential salvation. Somebody enters the hero's life and offers to help banish the demon.

The oblique approach to the subject works well. It's not clear at first what's happening. When viewers begin to understand what's going on and say, "Now I get it" OCD sufferers can reply, "Now you can begin to understand what I'm going through." Adam Bernard shows talent in video production and The Surface, deserves wide distribution. My only major criticism: invest in a tripod.

John Metherell produced a documentary on OCD for The Discovery Channel, which has now been seen in several European countries. It has won a Telly award and a Cine Golden Eagle. John also teaches production classes at American University in Washington, DC and Towson University in Maryland.

However, just the simple act of becoming hyperaware of thoughts or automatic functions can lead to distress and a decrease in performance. Perhaps parts of our brains are designed to function best without the intrusion of our conscious cortical inputs. The non-OCD brain may have automatic ways of keeping cognitive intrusions away; and these mechanisms might be impaired in OCD. Once we have all this thinking and obsessing going on, how does one get back to basics?

One approach to manage this dilemma is discussed in a CD containing seven lectures and an epilogue by Dr. Jeffrey Schwartz, the author of the best-selling book "Brain Lock." The lectures range from about 4 1/2 minutes to 17 minutes. The technical quality of the production is excellent with no static and distortion or audience noises. All the lectures are perfectly clear in terms of audio quality. The lectures are tightly organized and Dr. Schwartz is very lucid on the points he is making. The repetitive nature of some of Brain Lock is not evident here.

I answer questions on Internet OCD lists, and it is clear that many patients crave something more than basic exposure and response prevention (ERP) which has been the cornerstone of OCD treatment for at least three decades now. Dr. Schwartz gives patients a richer approach to treatment, and his steps will facilitate ERP (and mindfulness) for many patients who have mild to moderate OCD.

Dr. Schwartz's approach has been criticized by classical behavior therapists as just being a new way to look at exposure and response prevention. Also, his "allowing" the OCD patient to do some pleasurable activity (refocusing) rather than stay in an anxiety-provoking situation until the brain habituates has been a major source of contention. In this lecture series, he addresses these criticisms.

The first step in his process to get control of OCD is called "Relabeling." This is an activity whereby a sufferer identifies his/her obsessive thoughts, urges, and fears as being symptoms of his or her OCD. Dr. Schwartz discusses the concepts of "Mindfulness," which he describes as a function of the mind that tells you that OCD, is bothering you. OCD patients attempting mindfulness need to become "impartial spectators" of their own problematic thoughts. This allows them to view the thoughts objectively and impartially as if they were someone else's thoughts. In the lecture, Dr. Schwartz acknowledges that this can only be done initially if the OCD is not too severe. If the problems are severe, he recommends that medication and CBT be used in combination with "Mindfulness."

Step 2, "Reattribution," answers the questions: "Why don't these urges and behaviors go away? What causes them?" The answer is that they are due to OCD, which is a biochemical abnormality in the brain. This is what produces the "false messages" and causes the brain to get stuck in gear.

How do you differentiate between "Relabeling" and "Reattribution?" Reattribution reminds you of the biology of the condition. OCD is due to basal ganglia malfunctioning and may be analogous to getting stuck in physical symptoms that occur with Parkinson's disease. The orbital frontal cortex of the brain (the section above the eyes) gets hyperactive and stuck and constantly gives error feelings.

In OCD, this error detection part of the brain is stuck in gear and will not let go. Dr. Schwartz feels that this is why the feeling does not go away. It appears that medication may help this "gear shift" work better.

Classical ERP seeks mainly anxiety reduction; Mindfulness allows more clear thinking and deeper understanding of OCD symptoms. Dr. Schwartz feels that we can use medications and ERP as a means to a greater end; that is, decreasing anxiety to allow us to develop more mindfulness and more awareness. Once you can think more clearly and be more mindful, then you increase your options tremendously. You are now prepared to do "refocusing" and more adaptive behaviors.

Step 3 is "Refocusing." Here is where Dr. Schwartz introduces a new concept to counter earlier criticisms by classical behavior therapists. Their objection was that what Dr. Schwartz calls "Refocusing" is just "avoidance." Superficially, "Refocusing" sounds like avoidance. However, to Dr. Schwartz, "Refocusing" never means avoidance. That is a misunderstanding. It's not how you feel; it is what you do that counts! According to his theory as enunciated in the lecturers, "Avoidance" is the conscious decision to avoid an anxiety-provoking situation to prevent OCD symptoms (e.g., avoiding red things because they remind you of blood). Dr. Schwartz sees the act of "Avoidance" as a compulsion. "Refocusing" actually means that instead of doing a compulsion, you do something more adaptive. You don't avoid the anxiety-provoking situation. You do a good behavior instead of doing a compulsion.

"Refocusing with a Star" is when an OCD sufferer purposefully exposes himself to a feared situation, such as, the color red. That is always good. In classical ERP, that is the only thing to do.

Dr. Schwartz's "Four-Step" method gives other things to do as a response to OCD spikes that differ from the responses that classical BT recommends. Thus, "Refocusing with a Star" is a particularly good way (but not for beginners) to refocus their activities on the very thing that is causing the OCD symptoms (i.e., self-exposure). I am not sure that the star adds much. It may make more sense to just use the standard terms and call this latter refocusing "self-directed exposure," rather than develop still another term for the same concept. Nonetheless, Dr. Schwartz is clear about the clinical relevance of direct self-directed exposure. In Dr. Schwartz's four-step process, "mindfulness" is also a goal; not just symptom-relieving act as it is in classical behavior therapy.

The final step, "Revaluing," is a deeper "Relabeling." The goal is to come to see the compulsive urge as being an OCD symptom/experience. The aim is for the person with OCD to learn not to take the OCD symptoms at face value. The aim of practicing these exercises is to "see the reality of what is going on." To really "know" that: "It is not me, it is just OCD." This feeling is just OCD. This is, according to Dr. Schwartz, "progressive mindfulness."

When you "revalue," under Dr. Schwartz's method, you strengthen the impartial spectator. Eventually, you can get into an automatic refocusing mode. You recognize OCD symptoms almost automatically and move on. You are not just saying to yourself that it is not OCD. It is observing and feeling your own sense of discomfort as the OCD. The goal of progressive mindfulness is to experience the bad thoughts and urges as OCD, not as legitimate or real thought and then you automatically move forward.

Dr. Schwartz's closing words are: "Keep working, keep your spirits up, be mindful, may you be well!" My gold standard for any therapy is "Does it help patients get better?" Since the concepts in this CD are the same as those outlined in "Brain Lock," they will be useful to many patients. I have had many tell me that these "Four Steps" have helped them move beyond their OCD. Mindfulness and nurturing of the impartial spectator are concepts that make sense to many people. It has been my experience that patients with the more severe forms of OCD are not able to effectively utilize these concepts. Rigorous approaches with more external motivators and coaches are required. I think it is important for Dr. Schwartz to acknowledge that these steps do not work for all, so that patients are not unfairly accused of being unmotivated to get better. I have seen family members get very angry when patients have not traveled smoothly through the "Four Steps."

I promised myself that I will never again think about how hard it is to hit a basketball shot. I'll bet I could even impair Michael Jordan, the other Dr. J, if I got him thinking. Unfortunately, with OCD it will take a more active approach to recover, and this CD will give OCD patients another effective weapon to use to battle this disorder.

A copy of Dr. Schwart's CD, "The Four Steps," can be ordered by contacting Daisy Sanchez at the OCF. Her phone number is 203:401-2070, ext. 13. The cost of this CD is $9.98, plus $4.50 for shipping & handling.

A very clear and inspiring book, these authors have created a safe place for the millions who are suffering with habits that have great consequences for their lives, shame, embarrassment, financial ruin, and relationship problems to name a few. The clear message in the Workbook is that we are all creatures of habit ... keep the good ones ... here's how to change the bad ones.

Embedded in the easy-to-read, visually inviting format, are the cutting edge cognitive-behavioral principles which have a documented track record for successfully treating a variety of maladaptive habits including nail biting, hair-pulling, overspending, and overeating. Habit sufferers have heard, "just stop it" from everyone including themselves! Claiborn and Pedrick show a deep compassion for the frustration that goes along with unsuccessful attempts to control a habit. The system they present takes into account both the complexity of habits (how they are interwoven into our lives) and the need for simplicity in order to stick to the changes.

The layout of the book is very pleasant with highlighted reminders and key ideas sprinkled throughout. The book is organized into three sections:

• The first is an introduction to the "anatomy" of habits; how they develop and how they are reinforced.

• Next, the reader is walked through the elements of Habit Reversal -- the state of the art intervention -- including the process of assessment and self-monitoring, triggers, consequences and beliefs that support bad habits, and the development of good "competing responses" to block the bad habits. The explanation of automatic thoughts and beliefs is exceptional.

• The last section contains separate chapters with detailed instructions for many of the most common habits. The reader can easily flip through and find a clear, easy to follow complete behavioral plan for how to proceed in changing their particular problem area.

One of the great strengths of the book is the worksheets. With each section of the book, the authors include unusual and interesting exercises to be completed on the worksheets provided. Of tremendous help is that sample worksheets have been "filled out" by a typical hair-puller, or skin-picker, nail-biter. Not only does this encourage folks to complete the forms, but it provides a mini-support group for the reader because the thoughts and feelings they see in black and white, are the very ones that they have been too afraid to share.

Claiborn and Pedrick have gone above and beyond the call of duty in making this book accessible, conversational and most importantly full of great ideas. A pleasure to read, habit sufferers and therapists alike will be well served by delving deeply into the pages of this much needed resource.

Let me confess here one of my biases: though I am known as a behaviorist, I prefer to think of myself as an empiricist. That is, if someone can demonstrate to me that standing on one's head and spinning like a top for ten minutes a day produces dramatic improvements in OCD sufferers' rating scales and quality of life, then I will be near the front of the line to investigate this approach. But, at the same time, I would also take any theory as to why this "treatment" works with more than a few grains of salt, since history suggests the theory will probably turn out to be wrong; but this doesn't matter, if the treatment really holds up to testing.

So, after reading Shannahoff-Khalsa's claims of huge drops in YBOCS scores [a test that measures the tendency to have OCD] to near zero after six to twelve months of practicing this harmless breathing, I was looking forward to meeting him during last year's OCF Annual Meeting outside Chicago. By the time we sat down to lunch over a couple of salads and iced teas, David had already conducted a well-received and standing-room-only workshop on his Kundalini yoga methods for OCD.

To be sure, David Shannahoff-Khalsa is easy to pick out from the typical OCF Conference presenter. His long hair tied in a topknot under a turban and his flowing beard might lead some to mistake him for an actor in costume as a snake charmer in an Indiana Jones film (if only the props of tall basket and flute were nearby) rather than a serious researcher at a prestigious academic center.

As we began to speak, I was quickly impressed with David's honesty: he was very clear that he is not trained in mental health care, but that he believes deeply in the potential of his methods to relieve the suffering of OCD and wants it to be more widely-accepted. At the end of our salads, he agreed to provide me with the names and phone numbers of OCD sufferers to interview, who had clearly benefited from participation in his yoga treatment groups, and we agreed that our sites would collaborate in planning a well-controlled scientific study of his unique technique.

As we shook hands and parted, David mentioned that he hoped to have available soon a videotape describing his method so that more OCD sufferers could give it a try. With that we said goodbye.

It was nearly six months later that I received an email announcing that the OCD yoga videotape was now available for purchase by interested OCD sufferers. At least, I thought, our patients who were not responding adequately to our usual behavioral and drug treatments would now have the option of trying a harmless approach that would, at worst, help them to relax, and at best, could actually work!

So how to review the videotape itself? Well, I can safely predict that Steve Martin is unlikely to bestow an Oscar on David for it at next year's gala festivities. But that is not the point: This is simply a straightforward, one-camera video of David Shannahoff-Khalsa sitting on his floor, looking serene and encouraging, and demonstrating precisely how to do each of the 11 meditation techniques he recommends for OCD (10 general approaches to stress-reduction, besides the supposedly OCD-specific breath).

After viewing the video, I agree with the following promise in the advertising copy: "By viewing the 11 meditation techniques and how they are to be practiced, someone with no experience whatsoever in yoga or meditation can now learn to practice the techniques." Of course no sensible person, least of all David Shannahoff-Khalsa, would propose that the yogic videotape now be used instead of standard behavioral and drug treatments for OCD. Yet, OCD sufferers who are not satisfied with their progress with standard treatments, or those who suffer from very mild symptoms, may want to give this videotape a try.

But one important caveat: this approach requires a commitment to daily practice of this method for six months to a year -- thus it is not for the impatient or casual observer.

Will watching this tape help you, or your loved one, with OCD? I don't know, but I wish you luck, confident that if not, neither will it do you any harm. If you do purchase this tape and give it a fair try, I hope you will share your experiences, positive or negative, with the OC Foundation, so they can be compiled and shared with other members while scientific testing of this technique goes on.

For ordering information contact:

David Shannahoff-Khalsa
P.O. Box 2708
Del Mar, CA 92014
Phone: 858:534-0154
E-mail: dsk@ucsd.edu

The video's price is $59.99 + $5.00 shipping and handling (checks only).

Parents desperately seek help in understanding this disorder, looking anywhere and everywhere for direction about the right treatments, and the myriad of parenting, social, academic, health care, financial and support problems that OCD forces upon them.

Mitzi Waltz’ book will change this script so that parents do not have to spend countless hours piecing together fragments of information about OCD. This well-written book is a comprehensive one-stop shop that covers diagnosis, causes and treatments, alternative and holistic approaches, insurance, healthcare and school issues for children with OCD.

As a childhood OCD sufferer herself, and the parent of two children with OCD, Ms. Waltz brings to the book the unique perspective of a parent living with OCD. As a journalist, author and editor, Ms. Waltz provides a well-researched and consolidated fund of information for "beginner" OCD parents in an easy-to-read style.

Of particular value to parents, I believe, is Ms. Waltz’ coverage of practical issues pertaining to advocacy and support for children with OCD. Her chapters on insurance, public health and financial aid programs, and school accommodations will help many parents navigate through the murky logistical waters encountered in these areas.

She also covers extensively the details of various medications for OCD, and with appropriate cautions, discusses the wide range of natural, herbal and holistic approaches about which parents are often eager to learn, but do not find satisfactory answers easily. In addition, she provides a lengthy appendix of resources that includes books, organizations, agencies, treatment centers, and web sites that is a wealth of information at the fingertips.

Ms. Waltz also discusses health care in some English-speaking countries outside the USA, which may be a good starting point for readers outside the USA. This is a book for the "smart consumer," and is available by calling Daisy at 203:401-2070 ext. 13. or ordering it at the OCF Bookstore.

The book begins by describing the bad thoughts that can range from everyday experiences to horrifying obsessions. Dr. Baer admits to having his own troubling images when he drives behind a pickup truck with a dog in the back. He also makes it clear that like most people with out OCD these experiences are part of everyday life but don't cause us misery because we don't get caught up in our reaction to them. He gives clinical examples of obsessions from people he has treated and explains about the common types of intrusive thoughts and images. He explains how troublesome thoughts are those that are linked to what is most important to the individual. Dr. Baer makes it understandable why we would try to suppress these thoughts and why that effort not only doesn't work it worsens the problem.

The book includes a clear discussion of the problem of post partum depression and the research showing that women with this disorder have a very high rate of having harm obsessions about their children. Dr. Baer makes it clear however that thoughts of harming children are not restricted to women with post partum depression. Children are the focus of harm obsessions because they are seen as less able to defend themselves.

S. J. Rachman, another psychologist who has written extensively about OCD, often notes that no one has obsessions about harming someone like "Arnold Schwarzenegger." This is because he seems quite capable of defending himself. People who have harm obsessions will always be uncertain about the thoughts and the possible connection to action. People with OCD are often terrified by the idea that they might want to do the things they obsess about or might lose control and act out their violent thoughts. While absolute assurance is impossible, Dr. Baer gently and effectively writes about this fear and puts it in clear perspective. He includes case material that illustrates the difference between obsessions and thoughts which do warrant concern. He includes material to help explain the diagnostic questions involved in making this discrimination.

One of the most interesting chapters to me was focused on explanatory models of bad thoughts. Dr. Baer discusses a number of possible models including ideas about the evolutionary significance of obsessions and Freudian theory about why obsessions might occur. While final conclusions cannot be reached the openness to a variety of explanations is unique and refreshing.

Baer begins with a description of exposure-based therapy a tried and proven method of dealing with obsessions. The clear descriptions of exposure including suggestions on how to use audio tape are likely to be helpful to professionals who are new to treating OCD as well as being a self-help guide.

There is an extensive discussion of cognitive therapy as an alternative to exposure treatment for bad thoughts. This is the new frontier in treatment of OCD and may offer hope for those who have not responded will to exposure treatments or who cannot bring themselves to do the exposure work. Dr. Baer describes some of the techniques used in cognitive therapy and explains the cognitive model of OCD. Unlike exposure therapy, it is not really practical to do the cognitive work as a self-help project.

The book addresses the sensitive problem of religious obsessions. Although the standard exposure therapy is still recommended, consultation with clergy or other experts in the individua'ls religion is recommended and is the standard of practice. It is clear that religious obsessions are simply another example of OCD focusing on what is most important to the individual in its grip.

Although this is a book about bad thoughts and treating them with cognitive behavioral therapy it includes important information about drug treatment of OCD and bad thoughts. Many more people with OCD will find it easier to get reasonable treatment in the form of medications than will be able to find competent cognitive behavioral therapy. If they can know what to expect from medication and apply the exposure methods described in the book most people should be able to make important gains in controlling their OCD.

I am pleased to be in a position to review this book. While it isn't as dramatic as the release of a "Harry Potter" story, I expect that many will want to get a copy as soon as possible. I have been telling patients and therapists to be on the lookout for this little book. I would advise anyone with intrusive thoughts of harm or similar obsessions to read this book and follow the plan.

One of the most appealing features of Dr. Osborn's book is that he does not merely offer us some type of slick repackaging the usual things we have all heard, but instead reaches out to his readers on a more personal level. This allows the humanity and intelligence he no doubt shows to his own patients, to be shared with the reader. This is not simply an expert giving advice, but someone who has suffered personally.

The book, which begins with Dr. Osborn's personal views on, and experiences with OCD, goes on to cover all the bases. It gives a great deal of information on types of OCD, diagnosing the disorder, and its treatment via medications and behavioral therapy. It also reviews such topics as group therapy, family issues, underlying biological causes, OC spectrum disorders, and a historical rundown of OCD treatment.

One aspect of the book that I found particularly fascinating was its descriptions of the famous historical figures who may well have suffered from OCD, including John Bunyan, St. Ignatius of Loyola, Samuel Johnson, Martin Luther, Winston Churchill, and Howard Hughes. Understanding that even some of history's great suffered from the disorder can go a long way toward destigmatizing sufferers. (Perhaps it could even be the start of an OCD "Hall Of Fame.")

Dr. Osborn's approach is clean and structured. I appreciated the fact that it is not overloaded with jargon. He lays out "Six Steps To Conquering OCD," and in addition, offers ten practical strategies that have been distilled from six years of group treatments he has conducted. These are all very helpful and easy to follow.

There is only one real criticism I can make of this book. While it probably seemed like a good idea to list every known American and Canadian support group for OCD in the back of the book, this information is subject to frequent changes, and could quickly go out of date. It is good to know that such groups exist, but it could also be the source of much frustration, trying to track down listed contact people who are no longer holding that job, or groups that have long since disbanded or moved their locations. It would probably be better to just mention that sufferers should contact the Obsessive Compulsive Foundation, which maintains a list of support groups around the world. [Click Here.]

All in all, I would rate this a nice compact volume that is well organized and contains a really good balance of everything a useful book on OCD should contain. Best of all, it isn't simply practical: it reads well. I wish that more writers of the caliber of Dr. Osborn would produce self-help books. I have been recommending this book to my patients ever since it was released, and shall continue to do so.

Part One defines OCD and reviews the diagnosis and treatment options. Dr. Chansky briefly discusses other disorders that sometimes coexist in children with OCD. "Chapter 2: Cracking the Code, Visualizing the Secret Mechanisms of OCD" is a valuable resource for anyone trying to understand OCD. Eight "lessons" explain how children -- and adults -- with OCD get stuck in a "brain trap" and how they can get unstuck. Each lesson is designed to help parents discuss OCD with their children in simple, creative word pictures.

Part Two offers clear strategies to help parents fulfill their roles in the battle with OCD. Parents want to protect their children from pain and suffering while also fostering independence. This is especially challenging for parents of children with OCD. Dr. Chansky expertly guides parents along this difficult path. Chapter 10 discusses the importance of parents taking care of themselves. Powerful strategies are presented for dealing with feelings of anger, sadness, guilt, and shame, overcoming dysfunctional beliefs about OCD, finding outlets for feelings of isolation, dealing with stress, and knowing your limitations.

Part Three discusses the many forms of OCD. Dr. Chansky does not hold back: bad thoughts, worries about harm, scrupulosity, and sexuality thoughts are covered, as well as contamination, checking, repeating, redoing, evenness, ordering, symmetry, numbers, hoarding, and obsessive slowness. And what about brothers, sisters, grandparents, and other relatives? Chapter 15 helps parents decide when and how to involve others in the struggle with OCD. This chapter also helps parents decide how much to involve their child's school. Teachers will also find valuable insight here. The appendix provides lists of valuable resources and sample assessment instruments for OCD.

Throughout "Freeing Your Child From Obsessive-Compulsive Disorder" are quotes from children and parents that help the reader relate to the struggle with OCD. We would like to have seen more help for parents who also have OCD. This presents a particular challenge, but then, this could be the subject of another fine book. Tamar Chansky has produced a comprehensive resource no parent of a child with OCD should be without.

Dr. Penzel's book is a comprehensive, scholarly, yet highly readable resource on treatment of obsessive-compulsive disorder (OCD) and its spectrum disorders, as well as a labor of love.

Fred Penzel, Ph.D. is one of the most experienced psychologists and behavior therapists treating obsessive-compulsive spectrum disorders (OCSD's) today. Dr. Penzel chooses to focus on OCD and four disorders considered in the field to be part of the OCD spectrum, excluding others (e.g., Tourette's Disorder and hypochondriasis). He aims to reach as many sufferers of OCD, body dysmorphic disorder (BDD) (imagined ugliness), Trichotillomania (TTM) (compulsive hair-pulling), compulsive skin picking, and nail biting as possible, with practical tools, in order to provide hope and a path to recovery.

Simultaneously, he provides the clinician a fly-on-the-wall view of how he treats OCSD's. He shares tried and true ways of communicating the rationale for treatment, how behavior therapy works, how to motivate individuals to undertake treatment, how to recognize the effectiveness of treatment, and how to prevent relapse. He comes up with gems, for example, in treating obsessions, "If you want to think about it less, think about it more", and in describing the effect of behavior therapy, when a real shift occurs, "It's like a spell has lifted."

Dr. Penzel uses the term OCSD's to refer to OCD and a group of disorders not currently classified together in traditional diagnostic schemes (i.e., the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]). This grouping is currently considered in the field to make sense, since these disorders share characteristics ranging from compulsive to impulsive. They also have similarities in their neurobiological etiology, and in their responsiveness to behavior therapy and, particularly, to serotonergic medications. Considering these disorders together should have implications for understanding and treatment of OCSD's.

Dr. Penzel describes how to implement two types of behavior therapy. Exposure and response prevention (E&RP) is used to treat OCD and BDD, and habit reversal training (HRT) is used for TTM, skin picking, and nail biting. Dr. Penzel's 18 years of experience are clearly demonstrated in his creative and plentiful examples of how to approach obsessions, compulsions, and impulsions. (He uses "impulsion" to refer to an urge or a call to action which seemingly cannot be ignored, and is acted on if it is gratifying, like grooming impulsions, but not acted on if it is repulsive, as in aggressive impulsions. Unlike compulsions, they do not serve to reduce anxiety.)

The longest chapter, on self-help, and the chapter on treating children are particularly useful in describing the specifics of implementing E&RP and HRT. Here the reader will be treated to detailed outlines of how to do E&RP for compulsions, obsessions, and impulsions, including examples of hierarchies of each and examples of specific exposures. HRT is detailed, starting with a preliminary step of destigmatizing oneself, followed by the traditional awareness training, breathing and relaxation training, competing response training, and a welcome section on augmenting HRT. The latter includes lists of suggestions specific to the different types of inputs that influence an individual's TTM, skin picking, or nail biting.

The chapter on children will assist parents and clinicians with early identification of symptoms of OCSD's. Dr. Penzel alerts the reader to the role of Pediatric Autoimmune Neurological Disorders Associated with Streptococcal infections (PANDAS), which can trigger the onset of OCD and tic disorders. Finally, he tells how to tailor behavior therapies for children, e.g., by adding rewards to maintain motivation.

I have been reluctant to use the term "recovery" in discussing relapse prevention with patients, in order not to imply that OCSD's are addictions. Dr. Penzel's chapter on recovery and acceptance has prompted me to revise that position. He suggests that since it is rare that one's symptoms go away permanently, one must accept that "OCSD's are a potential you will always carry with you." Maintaining one's recovery, therefore, requires a) accepting what cannot be changed, e.g., having an OCSD, having setbacks, and experiencing anxiety, while b) changing what we can, e.g., doing exposures, blocking compulsions, using competing responses, increasing tolerance, and dispensing with perfectionism.

Dr. Penzel reminds therapists, who often become obsessed with change, that we must accept that not everything can be changed. Tweaking failed behavioral techniques alone may not be enough to succeed. Helping patients remove blocks to acceptance, e.g., perfectionism, overcontrol, and an excessive need for certainty, can completely shift the patient's awareness, and that may constitute the real change.

Dr. Penzel also includes in this book a thorough review of medication and alternative remedies, a chapter about family members, an entire chapter on obsessions, and one on compulsions. He also differentiates OCD from obsessive-compulsive personality disorder and discusses common disorders accompanying OCSD's.

There is an outstanding chapter on the biological and environmental causes of and contributing factors to OCSD's.

Finally, Dr. Penzel includes a list of helpful resources, evaluation instruments that can help in assessing OCSD's, and an 18-page glossary of terms.

This book may seem excessively long, about 400 pages, but it doubles as an encyclopedia of OCSD's and a treatment guide. If you are a sufferer of OCSD's or a clinician, I believe you will find this book enlightening, uplifting, and potentially life changing.

The OCD Workbook is the most helpful presentation of behavior therapy for OCD that has been published in quite a few years. Cherry Pedrick, an R.N who has herself suffered OCD, and Bruce Hyman, Ph.D., a psychologist and social worker who specializes in treating the disorder, make a great team. Their book flows smoothly along with a wonderfully compassionate tone while providing an excellent blend of clinical and theoretical material.

The book is divided into four sections. Part One presents an easily digestible review of OCD's diagnosis, proven causes, and effective treatments. Part Two, the heart of the book, discusses cognitive-behavior treatment in detail, including instructions for self-directed treatment programs. Part Three deals with OCD spectrum disorders and childhood problems. Part Four finishes with a discussion of how family members, support groups, and various types of therapists can help.

I found Part Two's presentation of behavior therapy to be exceptional. Clearly written, easy to follow, and yet very complete; it is the best introduction to behavior therapy for OCD that I have yet read. For every major subtype of disorder there is an outline for a complete therapy program.

Have a problem with "hit and run obsessions?" Pedrick and Hyman provide worksheets for assessing the symptoms, monitoring obsessions and compulsions, constructing a situations hierarchy, and then executing exposure and response prevention. All for that one specific problem and with examples of every form filled out! Likewise, step-by-step instructions are provided for the treatment of common contamination, harm, sexual, religious and orderliness obsessions. Pedrick and Hyman do not neglect the hard to treat cases. Pure obsessions, obsessional slowness, and hoarding are also tackled in an easy-to-understand manner with case studies included.

One of the main strengths of The OCD Workbook is the inclusion of a number of different approaches to behavior therapy. For those OCD sufferers who are "psyched up" to make an all-out effort, the book provides a "fast track." For those more fearful, there is a gradual method to follow that still gets results. Recently developed behavior therapy techniques including ritual delay and imaginal exposure are presented in a reader-friendly manner.

I particularly enjoyed the layout of the book. We do not have to wade through one lengthy paragraph after another. Rather, every page is divided into manageable sections with clear headings. Lists, highlights, sidebars, and set-off examples make the book ultra-easy to follow and a pleasure to read. A quibble is the lack of an index.

The OCD Workbook falls short only in trying to cover too much. Non-behavior treatments such as medications are dealt with superficially. Similarly, discussions of disorders that are associated with OCD such as depression, ADHD and Trichotillomania are not detailed enough to satisfy most readers.

All in all, The OCD Workbook is a wonderful addition to our resources. I am already using it with some of my patients. The discussion of behavior therapy is so clear and complete that it is equally helpful for both therapists conducting treatment and OCD sufferers taking on the disorder by themselves.

Not gloom or doom, but hope and laughter are found in this incredibly entertaining new book by Marc Summers, with Eric Hollander, MD.

As vice-president of an affiliate of the national Obsessive-Compulsive Foundation, Inc. (The Obsessive-Compulsive Foundation of Jacksonville, Inc.), I have the fortune or being able to be kept abreast of a vast number of new writings on the topic of Obsessive-Compulsive Disorder (OCD) and related illnesses. I am excited to say that Everything In Its Place is the most fresh, enlightening and entertaining book about Obsessive-Compulsive Disorder written in years.

Mr. Summers does a remarkable and difficult task in this book. Through the telling of his private life and career in the entertainment business, he keeps us enchanted on each page. As he writes about the different stages in his life and how Obsessive-Compulsive Disorder impacted each of them, he not only teaches us about the illness, but also purely entertains us. He makes us shed tears of sadness for his plight, while also has us producing tears of laughter -- often on the same page.

This book is a uniquely wonderful tale that can help those of us with Obsessive-Compulsive Disorder to better cope, as well as teach those who care about someone who is afflicted by the illness to better understand OCD's devastation. At the same time, Mr. Summers gives hope for the future. Probably the best statement I can make about this book is that, if someone is not reading for the knowledge of OCD it provides, one should read it for pure entertainment. It is an easy book to read and it keeps a person glued to each page.

Everything In Its Place is a one-of-a-kind book that I highly recommend to all to read and I believe it should be on the top of every best-sellers' list.

As someone who sees several hundred hours of movies every year, I was excited to preview and review the new OCD-themed short film, "Red Light August." Written and directed by Jeff Gomez (mythical creator of "Magic: The Gathering" and "Turok" comics/games phenomenon, just to name a few), award-winning Red Light August created its own media controversy in the OCD community when publicly shown.

Some critics said it accurately portrayed a "face" of OCD. Others said that face was distorted, inaccurate, and sensationalized.

Red Light August packs allot of punch for a 30-minute film. While the underlying messages and textures are quite complex, the plot is relatively simple:

Because of the aforementioned argument, when I popped a cassette of Red Light August into my VCR I expected this movie to be the "OCD equivalent" of the "Blair Witch Project;" very hip, but with low production values. I was, however, surprised to find that Red Light August has first-class dialog coupled with an extremely high-quality cinema look and superior soundtrack. It has the look and feel of a major feature film.

But that wasn't the nature of the controversy, which basically comes down to the question, "Is this really OCD?"

The viewers who said it wasn't -- including some notable OCD experts -- seemed to focus either on Boothe's masterbation-like rituals and/or a Body Dysmorphic Disorder theme. (These being the most sensational behaviors shown in the film.) While I personally haven't heard of OCD exhibited in quite this fashion, I tend to agree with those viewers who say it wasn't the specific behaviors portrayed which indicated that OCD was present, but rather Boothe's inability to stop his triggers from initializing an unwanted, automated behavioral response.

Regardless of these opinions, to me, the clearest example of exhibited OCD was Boothe's "checking" rituals concerning locking his apartment door and inspecting his apartment windows to make sure they were secured; behaviors which I have personally seen in several of my OCD friends. (He also mentally "hears" a recurring "sound" ... and paces relentlessly up-and-down his neighborhood block.) Boothe may have other psychological and/or sexual problems, but OCD is clearly there.

Equally elusive is the title for this movie. The words, "Red Light" can refer to a number of things including the locale of the movie (a "red light" district) ... "red" being a emotional, "sexual" color ... the color of Boothe's blood which he uses in his "secret" painting ... or even, "Red Light" being a pure, intense red paint color used by artists. "August" always seemed to me a month when time stands still, and certainly in this film, a fragment of Boothe's life is frozen for all to see. Probably, despite me trying to find meaning in even the simplest of things ala Beatles' lyrics played backwards, the title is simply where and when the movie was made (i.e. Spanish Harlem, August 1998).

In this movie, Boothe plays the part of a flawed superhero. Like many OCDers, he is blessed with many accomplished attributes; his artistic talents, superior emotional sensibilities, good lucks, and martial arts abilities. Boothe's "Kryptonite" is his OCD.

While this movie is rated "for adults only," quite frankly, we've all seen more blatant examples of sexual overkill on network TV and on our favorite cable stations. While there is no nudity is involved, however, this isn't the type of film you'd show your Aunt Matilda at Thanksgiving ... or fellow parents at a PTA meeting. It should be seen by adult OCDers, not for educational purposes, and certainly not for purely entertainment purposes, but to demonstrate that OCD can represent itself in a variety of secret, sometimes sexual, and always insidious, forms.

Additionally, while the blockbuster -- and also controversial -- flick, "As Good As It Gets" hit a chord with mainstream America, Red Light August is sure to play a similar sympathetic note among a younger, Gen-X audience. More importantly, it will hopefully prompt more film producers to use OCD as a serious backdrop in their upcoming cinema efforts.

My one "criticism" with Red Light August was that it was so involving, and so well done, that just when the major characters were developed ... the film was over. Hopefully this will be merely a springboard for future Gomez projects involving his Red Light August characters and environment.

To purchase a videotape copy of this movie, send a check or money order for $24.95 (payable to Jeff Gomez) to: Jeff Gomez, Starlight Runner Entertainment, 306 Eighth Avenue, Suite 108, New York, NY 10001. Include your name and address, and the fact that you would like a copy of "Red Light August." You can visit the expansive Red Light August web site at http://www.redlightaugust.com, and you can e-mail Jeff at Carthalion@aol.com.