The Self-compassion Workbook for OCD: A Book Review

by Dr. Lisa McLean

I am someone with lived experience of obsessive-compulsive disorder (OCD), a psychologist working with many clients similarly impacted, and with a strong leaning towards compassion-based interventions, so I really looked forward to reading Kimberley Quinlan’s new book, The Self-Compassion Workbook for OCD.

Quinlan is a licensed Marriage and Family therapist, and Clinical Director of the OCD Center of Los Angeles. She specialises in treatment, advocacy, and education for OCD and eating disorders. This is the author's first book on the topic, and the first one I am aware of that directly centres self-compassion as a core component of OCD treatment. This resource offers a user-friendly guide to understanding the core concepts of both OCD and self-compassion and offers practical strategies for augmenting traditional Exposure and Response Prevention (ERP) treatment, with self-compassion. Quinlan outlines a four-step process for ‘self-compassionate exposure and response prevention’ whereby connecting to your compassionate self is identified as the important first step.

To the frustration of those who genuinely experience OCD, the term has become over-used and diluted in general conversation; “I’m so OCD I have to have all my cushions organised a certain way”; “I’m so OCD, I have to make sure my fingernail polish matches my toes.”  However, it is not OCD unless you believe that by not doing these things, something catastrophic will happen to you or your loved ones and it will be all your fault, or you are unable to leave the house or focus on any other task because the cushions are never ‘just right’. Quinlan does a great job of explaining in simple, clear terms, the core mechanisms and impacts of OCD. She also identifies a number of OCD subtypes that form the focus of obsessions. This includes less commonly discussed subtypes such as paedophilia OCD, sexual orientation OCD, existential OCD, sensorimotor OCD, and hyper-responsibility OCD.

OCD is what psychologists call ego-dystonic, which means acting against your own beliefs or will. This is the most sinister and distressing part of experiencing OCD. Your mind identifies your highest values and worst fears and then uses them against you, causing relentless worry that your fears may come true and/or you will act against your values. Constant vigilance is therefore demanded. The author of this workbook quite rightly identifies OCD as a trauma experience, which causes constant activation of the threat system and creates relentless imagined scenarios of terror.

The Self-Compassion Workbook for OCD cover states “use powerful self-compassion techniques to break through the stigma and shame of OCD”. People who experience OCD will often try to hide their obsessive thoughts and compulsive responses. This results in experiences of shame, secrecy, self-judgement, and self-criticism. Therefore, it makes intuitive sense that a therapeutic approach specifically targeting these internalised experiences will be of benefit.

ERP, which requires deliberate exposure to someone’s worst fear, whilst resisting engagement in the compulsive behaviour that offers short-term relief, can be a very challenging and confronting experience. It requires a lot of courage, commitment, and wisdom, which of course are the core qualities of compassion-focused therapy. In The Self-Compassion Workbook for OCD, the author further identifies six core concepts of self-compassion that will help change the way people impacted by OCD can respond to themselves. These are 1) equality (we are all equal in worth and deserving of compassion); 2) mindfulness, 3) warmheartedness, 4) wisdom, 5) acceptance of imperfection, and 6) compassionate responsibility.

Together with these concepts, the author introduces a number of self-compassion practices, including Compassionate Self, Self-Compassion Break, Compassionate Letter Writing and Compassionate Body Scan. For those who are familiar with Compassion-Focused Therapy you will be aware that the core therapeutic work relates to overcoming fears, blocks, and resistances to compassion. Quinlan similarly identifies and addresses what she refers to as common roadblocks to compassion such as ‘I am not worthy of compassion’, and ‘self-compassion could make me lazy or self-centred’.

The Self-Compassion Workbook for OCD offers brief case studies presented at the start of the book and then used throughout. This provides concrete examples of the application of the concepts. It is also written in a way that provides readers with opportunities throughout the workbook to self-reflect and develop their own ERP challenge list and plan, with helpful prompts and space to write directly in the workbook. It also incorporates a range of exposure practices, including flooding exposure, imaginal exposures, and interoceptive exposures.

Prior to engaging in these practices however, Quinlan helps readers develop skills in self-compassion before proceeding with ERP. Self-compassion is considered a necessary pre-requisite for orienting the mind to respond to the experience of OCD with a sense of warmth, support, and kindness towards the self, and to utilise as a valuable resource in responding to anxiety, uncertainty, and discomfort that inevitably, and necessarily, arise when engaging in ERP treatment.

Overall, The Self-Compassion Workbook for OCD provides a valuable contribution to helping people who are impacted by OCD to offer a self-compassionate response to the distress and suffering they are experiencing, and use this response as the foundation for treatment and recovery. Unlike other books on OCD, Quinlan prioritises self-compassion as a core component of treatment. As someone who understands how relentless and distressing obsessive thoughts can be, and the ultimately futile cycle of compulsions that offer desperate attempts to neutralise them, Quinlan’s book is very welcome. It offers a way for readers to change the way they relate to their OCD symptoms, as well as themselves, and offers a hopeful path to recovery, in an accessible and easy-to-follow format.   

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.