I won't reply specifically to your case since we can not do case consultation via the Internet. However, I would say in general in cases like this I have suggested a couple of things that may or may not apply to you. First, if distraction is not working then I suggest that they try something else. DOing more of the same probably will not work if it is not working now. I usually have the person change the words that they are spelling out to be more useful to themselves such as peace or happiness etc. Second, if that does not work, I suggest that they could take the words they are spelling out and then use them in sentences, in their mind, that give them comfort. For instance, if they spell out the word "rain," they could think "the rain on the lawn makes me feel so peaceful etc. I know this stuff is not necessarily cog/beh but it may work for some people in some situations.

John