How Your Religious Beliefs Are Incorporated in Exposure Therapy for Scrupulosity OCD

Navigating OCD symptoms alongside spiritual or religious beliefs can be challenging and confusing. As we know, OCD tends to latch on to what we value most. Therefore, faith and spirituality are sometimes topics of concern for individuals experiencing OCD, especially for OCD sufferers who are religious. For some, their OCD creates uncertainty about how well they are living in accordance with their faith.  Others experience uncertainty and distress about the meaning of their thoughts within the context of their faith, and many worry that they have committed or will commit an unpardonable sin that will forever condemn them. These individuals may feel urges to confess, compulsively read scripture, and engage in prayer; or to find ways of neutralizing and avoiding sinful or blasphemous thoughts altogether. These patterns of symptoms fall under a type of OCD called “scrupulosity”. 

How is Scrupulosity OCD Treated?

Scrupulosity OCD is treated using the same approach as other forms of OCD, exposure and response prevention (ERP). ERP is a type of cognitive behavioral therapy (CBT) that entails facing one’s fears without doing anything to prevent feared outcomes from taking place. Before individuals begin treatment, the “fight or flight” center of the brain is convinced that something terrible will happen unless they perform certain routines or rituals. The “fight or flight” alarm is metaphorically rung when the individual encounters something their brain perceives as dangerous. We call these triggers.  By disobeying one’s intrusive thoughts and facing one’s fears despite the content of one’s thoughts, the “fight or flight’ center is forced to make adjustments to what it considers dangerous. Through consistent practice, it learns that OCD triggers are not dangerous and therefore stops ringing the “fight or flight” alarm when they are encountered.  

Will mental health treatment jeopardize my beliefs?

Absolutely not. First and foremost, a major goal of anxiety and OCD treatment is to help you live a life that is congruent with your values. Part of that pursuit entails exploration and understanding of what your beliefs are and how/if your OCD is interfering with them. Faith may align with your beliefs and values. OCD, however, runs contrary to your beliefs and values, even though it may not feel that way. OCD treatment can help individuals suffering from scrupulosity separate what is OCD and what is coming from their true faith values. In doing so, you can learn to begin ignoring the obsessions, distress, and urges that drag you away from your values and instead connect with your faith in a way that is truly meaningful and fulfilling. We often tell our clients that treatment helps people with scrupulosity OCD have a more mature, adult relationship with God and with their faith.

What if my OCD has jeopardized my understanding of my faith?

Uncertainty is a fertile breeding ground for OCD. Any time there is doubt or ambiguity in the picture, OCD can ask the question, “How do you know you’re understanding that correctly?” Religious and spiritual beliefs are inherently uncertain. That is why we call it “faith”. To help determine appropriate, normative ways to think about and practice your faith, it can be important to involve faith leaders in the treatment process. When appropriate, OCD and anxiety specialists can take the required steps to involve faith leaders in treatment to help interpret religious passages, establish normal/healthy behaviors to engage in within your spiritual or religious context, and provide additional support in helping you connect with your beliefs and values in a meaningful way. 

Will exposure entail violating my beliefs?

Again, absolutely not.  However, it likely will involve doing things that purposely raise feelings of doubt about this.  It is important to note that when engaging in OCD treatment, you are always in the driver’s seat. You will not and cannot be forced to do anything you are unwilling to do. The construction of exposures is a collaborative process, meaning you get the final say in whether any particular exposure is part of treatment or not. We have also found that collaborating with faith leaders in the construction of exposures can be extremely valuable and necessary, especially when there is doubt about the appropriateness of particular exposures within a faith context. Not all faith leaders are aware of how anxiety and OCD can impact one’s engagement and relationship with their faith. Therefore, it can also be important that mental health providers provide education and resources that will help faith leaders integrate their expertise with that of your provider.

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