264 Simply effective group cognitive behaviour therapy in actions/consequences. Inflated responsibility is one of the treatment targets in OCD. 3. What if they wouldn't do the jigsaw if it showed some thoughts/images that go over and over in their mind that they are embarrassed or ashamed or disgusted about? This is a further example of TAF. Just as in a restaurant a person has to consider all the options on the menu in order to choose what is 'good', so too it is impossible to choose a moral good without also considering the moral bad. Further, it is not what is being considered (the scrutinising of the menu) that itself leads to actions, but the planning that leads to action, e.g. after scrutinising the menu asking for a vegetarian menu. That is, morality is about planning and actions rather than intrusive thoughts/ images. 4. What if they wouldn't do the jigsaw because its very old, a bit dirty? Or because someone horrible had done this jigsaw? What if they would do it but with gloves? In this example there is a fear of contamination, but it is a form of magical thinking, imagining that just because someone horrible had done the jigsaw, the person could be contaminated by them - the thought and object have become fused (thought object fusion; TOF) and they need to take steps to prevent the harm by using gloves. 5. What if they have got to order all the pieces in a perfect straight line or a proper circle before starting? What if this order is broken? The above example suggests a perfectionism at work, everything has to be 'just so' in order to proceed. This perfectionism is a very inefficient way of working; most things can be done to a 'good enough' standard, reserving 'perfectionism' for that which really requires it. 6. What if they keep hoarding such jigsaws in case they want to do them? Just about anything could come in handy at some time. It seems likely that an intolerance of uncertainty underlies hoarding, wanting to be certain that everything is available. The contradiction is that in amassing so much material, that which is likely to be wanted is 'unavailable'. Hoarders usually have both a negative belief about their hoarding, e.g. everything is just a mess' and a positive belief, 'at least I won't be without', together
268 Simply effective group cognitive behaviour therapy a felt urgency to immediately wash clothes. It is therefore useful for OCD sufferers to tackle not only the army of besieging thought/images bOCD but also more generally any dips in mood. 5. Managing your MOOD To help you manage your pass them through the MOOD chart (Table 2). The first letter of MOOD, 'M', stands for monitor your mood, the second letter, 'O', stands for observe your thinking, what it sounds as if you have said to yourself, the third letter, 'O', is for objective thinking, more realistic second thoughts, and the final letter, 'D', is for deciding what to do and doing it. Tab e 2 MOOD chart Monitor mood Observe thinking Objective thinking Decide what to do and do It 1. Mood dipped arriving back home from holiday. 2. Mood dipped hearing that I have got to reapply for my own job. I'll have to get the washing done, here I go again getting obsessed about the washing. I am going to be unsuccessful with the time I have had off for the OCD. Everyone has to do washing when they come home from holiday, I used to do it even before my OCD. The time off won't help, but they do know I am very conscientious, maybe too much of a perfectionist for my own good. Colleagues are in the same boat. Get on and do the washing, if I start to get plagued by it I will use the bOCD form. I will arrange some practice role plays with my boss.