Clinician's Review and Guide to Sally Winston's, Overcoming Unwanted Intrusive Thoughts

This week, I decided to review Sally Winston’s text, Overcoming Unwanted Intrusive Thoughts. I think this is a valuable resource for clinicians and OCD suffers. I’m a strong believer that individuals who experience difficulties with OCD need to be given multiple resources from various sources throughout their treatment to help them better understand intrusive thoughts. I believe that Dr. Winston’s work helps provide valuable insight on such topics as how everyone experiences intrusive thoughts, how sometimes using self-talk incorrectly can lead to compulsions, the importance of observing thoughts and letting them go, and how energy spent thinking of a thought may make them ‘sticky,’ and more difficult to let go.

Winston helps her readers understand that thoughts are just thoughts. The patients I did prescribe the text to described it as easy to read and worthwhile. I really appreciated how Winston explained how energy and attention into a thought can influence how much you are likely to ruminate. She also described how values influence each stuck thought and they are likely being driven by desires to push or move further away from the feared consequence that can create worry.

“…people who believe that all vulnerable people are living things should be protected are people who fight common intrusive thoughts that sometimes involve action like abusing children, throwing cats out windows, and dropping babies. These are the thoughts you fight- and because you fight them, they stick. If you are someone with strong religious beliefs, you sometimes come up with blasphemous thoughts and worry thoughts about not being faithful. These are the thoughts you fight.. and they stick.”

Winston described how people who have intrusive thoughts are likely to attempt to overcontrol certain situations and those who act on impulse tend to do now and think later, which is the opposite of over control. I believe this could be helpful for those with Harm OCD or Suicidality OCD. I do worry at times that this piece could be used as a part of a compulsion, which may mean that clinicians should consider following up on how their clients are using the literature in treatment.  

I will likely be assigning the reading about the varieties of intrusive thoughts, Chapter #2, to students at the clinic. I do believe this piece to be particularly useful when attempting to explain the different themes that may exist for an OCD sufferer. I can also see why this chapter would be considered valuable to clinicians attempting to normalize certain thoughts. I don’t know if I would include this section in my preferred patient reading list, but I can see the authors intent. I do find that when assigning the Y-BOCS that patients do report back on items that they didn’t know were OCD thoughts or behaviours. I suspect the assessment would be enough for the patient to become aware of OCD additional sub-themes and the Winston Chapter #2 reading would be redundant.

Winston attempts to speak to each cognitive distortion in Chapter #3 in the text. I do believe this is an excellent reading after verbally educating the patient on cognitive distortions specific to OCD. I certainly attempt to spend at least one session on cognitive distortions and assign a homework assignment where the client is responsible for identifying each negative thought and label the distortion. This may be a good chapter to accompany any preferred reading you have on cognitive distortions and OCD.

I attempt to educate my patients from the first session onwards about how they respond biologically when feeling anxious. I believe that Chapter #5, How the Brain Creates Unwanted Intrusive Thoughts, of the text could serve as a resource for those who may want to just provide a resource on the biology of anxious thoughts without providing an explanation verbally. This could potentially be overwhelming for clients, but I do think following-up and allowing for questions to be asked at the next session could help.

If you are using motivational interviewing in your practice to help patients that may be struggling in the pre-contemplation or contemplation stage, you may want to consider having them read Chapter 6, Why Nothing Has Worked. I do believe that could help them consider therapy and create understanding about their struggles and ineffective coping. I do believe that this chapter could help many that are also complacent to their OCD and anxiety. Often, many people with OCD will attempt to shape their world around their OCD. This could be a resource that could be given to a family member of an OCD sufferer. Hopefully, it facilitates dialogue about OCD and creates awareness.

Chapter 7, How to Handle Thoughts When They Happen, is an important reading for all clinicians and clients. I think Winston did an excellent job breaking down how to cope with intrusive thinking when they do become overwhelming. The steps are clear and concise. She describes six steps: recognize, just thoughts, accept and allow, float and feel, let time pass, and proceed. I probably would expand on the last step by adding, ‘proceed and continue on with your day.’ This chapter also includes helpful metaphors for clinicians that could be used in their practice when describing how to let go of thoughts.

Many times, during my practice, people ask what is the ‘best case scenario’ regarding their treatment. I provide an explanation, but often do not follow-up with a reading. Having read the Winston text, I wouldn’t be shy to offer Chapter 9, What Does Recovery Mean. I would probably pair the reading with another text, but I do believe that this could be an excellent supplemental resource.

Overall, I think Winston did a great job and provided our community with another valuable piece of literature.