Healing Obsessive Compulsive Disorder (OCD) and Scrupulosity

This is an article in my Catholic Healing Series, where I talk about the most prevalent mental health issues of our time, who the best thinkers are, what the theory is, and how to heal the issue.  If you enjoy this, feel free to check out other articles or videos!

The Issue

Over 2 million Americans struggle with OCD (Obsessive Compulsive Disorder) and Scrupulosity.  OCD involves intrusive thoughts that lead to compulsive actions.  Scrupulosity involves the application of OCD to moral or religious issues.  In the US, this often means a fixation on Christian religious practices.  OCD and Scrupulosity cause people significant anxiety and lead to them spending large amounts of time being preoccupied or researching religious issues instead of working on more productive activities.  The irony of Scrupulosity is that it gets people so worried about God that they cannot hear His Voice.  Not only are individuals impacted by OCD and Scrupulosity, but these issues also cause significant relationship distress with loved ones.  However, there is hope!  There are many tools for effectively managing OCD and Scrupulosity.  I will be discussing them in this article.  However, first, I will discuss Thinkers who are having an impact in the field.

The Thinkers

Kimberly Morrow and Elizabeth DuPont Spencer both have written some of the most popular books on healing from anxiety.  They both have healed countless people and are industry leaders.  In terms of what they are like, they are on the detail-oriented and structure focused side of the profession.  This tells us a lot about what is required to heal from anxiety.  The approach often needs to be systematic.  Additionally, they are delightful human beings.  I would describe both of them as positive thinkers who act as cheerleaders while at the same time using gamified interventions to push people beyond their comfort zones.  To interact with them is to feel encouraged, and at the same time, to feel challenged to be the best version of oneself.  As for success stories, they both have plenty.  A wide variety of people have been mired in the depths of paralyzing anxiety, have worked with them, and now have a new lease on life.  I am about to share their secrets for how that has worked. Dr. Richard Schwartz, PhD is the creator of Internal Family Systems therapy, which often is used to heal trauma.  He began as a systematic family therapist and discovered that many of his techniques were effective with a person’s “internal family,” when a client is seen as having a series of parts or members.  Richard Schwartz is calm, subdued, and thoughtful.  Much of his approach has to do with creating a sense of safety and relaxation where parts of a client’s self are able to unburden and reintegrate.  It is possible to see his sessions online, and the results are eye-popping.  Internal Family Systems represents the greatest breakthrough that I have seen in therapy in the course of my life.

Healing OCD and Scrupulosity

Disclaimer:  these are just some of the tools that can be used to heal OCD and Scrupulosity.  This article does not constitute formal medical, mental health, psychological, or other advice.  Also, I cannot guarantee healing or benefit.  This entire article represents my opinions and applications of the tools, nothing more and nothing less.

Using Exposure Therapy and Cognitive Behavioral Therapy to Heal OCD

Obsessive Compulsive Disorder (OCD) involves intrusive obsessive thoughts that cause people to perform compulsive acts.  For example, a person might have a thought that a benign action was sinful and then might be driven to pray in compulsive, unhealthy ways.  In the extreme, intrusive thoughts can keep people from receiving the Eucharist or going to Confession.  Exposure and Response Prevention also is helpful for many types of OCD.  Build a list of experiences from lowest intensity to highest and start leaning into the anxiety.  Again, use muscular relaxation and, in the case of OCD, Cognitive Behavioral Therapy plays a particularly important role.  Identify the negative thought.  Then, diminish its importance.  The thought likely will have fear attached to it as an emotion.  Even though the thought seems real and feels real, it is not real.  A process called fusion is occurring.  The negative thought is fused to the conscious mind like a piece of metal that has been welded to a structure.  The answer is defusion—to detach from the negative thought and to focus on positive thoughts and activities.  An analogy that I often use is the Wizard of Oz.  The Wizard of Oz makes himself look like a giant, green monster.  However, the man behind the curtain actually is a weak coward.  The same is true of OCD thoughts.  They make themselves seem powerful, but they are, in fact, weak.  Diminish their importance, let them sit, and live in the moment.  This is how a person who struggles with OCD becomes fully alive.

Using Existentialism to Identify the Meaning Behind Scrupulous Thoughts

Viktor Frankl’s Existentialist approach to therapy is all about story and meaning.  Frankl originally used his methodology to understand why he and others survived the concentration camps.  He determined that those who survived the concentration camps often did so by understanding their story in the right context and by living for a higher purpose.  When applied to Scrupulosity, Existentialism can bear interesting fruit.  The key part of people’s stories often lies at the beginning.  When we are young, our biological parents are the emotional face of God the Father in Heaven to us.  When our biological parents are loving, caring, and affectionate, we are far more likely to develop healthy attitudes about God and, even more importantly, a healthy sense of connection with Him.  When our biological parents are distant, angry, critical, neglectful, or manipulative, we unfortunately associate those traits with God.  Once we identify any ways that our parents may have given us a bad association, it can be helpful to go to God and to ask Him to give us a deeper sense of connection with Him and understanding of who He is. Sometimes, people even are taught bad or incorrect things about God.  Behind Scrupulous concerns often lies the image of a small god.  This “god” definitely does not will our good in all the ways that God the Father in Heaven does.  Sometimes, even trauma is part of the story of the development of Scrupulosity.

Using Exposure Therapy and Cognitive Behavioral Therapy to Heal Scrupulosity

Just as in the case of OCD, it can be helpful to use Cognitive Behavioral Therapy and Exposure Therapy.  It can be helpful to be aware that, in many cases, religious practices that are meant to lead us closer to God actually are being treated as if they are God Himself.  For example, a person might think that she or he needs to pray a massive number of prayers every day or God will not love her or him.  Or, perhaps a person worries that she or he will not be forgiven by God if she or he does not make a Confession that lasts for over an hour listing as many venial sins as possible.  Unfortunately, Scrupulous people even convince themselves that they are in a state of mortal sin when they are not and do not receive the Eucharist.  Whatever the thought or tendency may be, it is important for people to identify it and to detach from it.  A person needs to make space for negative thoughts and feelings and continue with healthy religious practice.  Focusing on a sense of relationship with God can help.  So can envisioning a thought box in a person’s mind and a feelings box in a person’s body.  Negative thoughts and feelings can be placed in these boxes while a person continues with healthy activity. In terms of Exposure Therapy, it can be helpful to rank stressful religious practices from low to high.  A person can do a graded exposure focusing on one activity at a time.  For example, a person can start by saying a triggering prayer.  The person can focus on having a non-triggered response by using muscular relaxation to calm the sense of panic.  Once a person manages to do the activity enough without a trigger response, or with only a slight trigger response, then she or he can progress to the next level of exposure.  In the case of Scrupulosity, this might be to make a Confession or go to Mass and receive the Eucharist. Interestingly, the most common Scrupulous intrusive thought among devout Catholic women is “what if I was called to be a religious sister?”  In a different context, many Catholic women, in fact, have this thought and it represents the call of God.  Unfortunately, in the case of Scrupulosity, this intrusive thought is happening within women who have discerned that they are called to the Married Life.  The women have no desire or sense of call to be a religious sister, and their scrupulous minds tell them that it will be extra beneficial for them to suffer by entering the Religious Life.  The key here is to detach from the thoughts and to continue religious practices and dating life.

Using Internal Family Systems Therapy for Deep Healing

In cases where trauma has led to OCD or Scrupulosity, it is helpeful to use Internal Family Systems Therapy for deep healing.  Internal family systems takes a parts approach to the self.  It identifies that people have different parts of the self that have different roles and intentions.  The key parts of the self to look at are the Conscious Self, the Wounded Exile, and the Manager/Guardian. The Conscious Self is the best part of a person and the leader of the internal family system.  It is the logical, virtuous, reasoning, and emotive self.  Its job is to dialogue with the Wounded Exile and the Manager/Guardian to achieve healing. The Manager/Guardian is the part of the self that keeps the person safe.  It likely exists in extreme form.  It likely fears rejection, abandonment, or criticism and uses strategies that grasp for control and certainty.  The Manager/Guardian needs to identify more moderate strategies that allow the person to surrender control. The Wounded Exile originally was wounded in the person’s childhood.  The Wounded Self is carrying negative emotions.  The key negative emotion in many people struggling with Scrupulosity is shame, although sometimes there is loneliness, anger, sadness, or other negative emotions.  The person needs to identify the shame and all negative emotions and then unburden these emotions.  An example of an unburdening ritual is going to prayer and envisioning giving these negative emotions to Jesus, or going to Mass and envisioning all negative past experiences being taken to the altar where they are redeemed and received by the individual with the Eucharist.  After an unburdening, the person can talk to the Wounded Exile and comfort her or him. Then, she or he can mentor the Wounded Exile.  This constitutes a reintegration of a part that was exiled (sent away from the self).

Support from Loved Ones

One of the key things that loved ones can do is to make the individual who is struggling with OCD and Scrupulosity learn to reassure herself or himself.  The most common compulsion that exists is checking with a loved one for reassurance.  While it is not okay for loved ones to be a crutch for those struggling with OCD and Scrupulosity, it is okay for them to help the person co-regulate.  They can offer the person affection and companionship in engaging in positive activities.

Wellness

Wellness gets its own section when it comes to OCD and Scrupulosity.  Practicing great wellness does amazing things when it comes to overcoming anxiety!  This begins with diet.  Of course, if a person has unique dietary needs, that person should consult a nutritionist or dietitian.  In general, the following really help with gut health and in turn predispose a person to overcoming anxiety:

• 1 spoon of fish oil daily
• 1 spoon of olive oil daily
• Daily Multivitamin
• Yogurt, kombucha, kefir, or probiotic supplement daily
• At least 4 to 6 portions of fruits and vegetables daily

These supplements promote a healthy gut that generates serotonin.  It is likely that the serotonin then goes to the brain and helps to reduce anxiety.  Eating a healthy, balanced diet, and keeping portion sizes at health levels also helps with anxiety. In terms of exercise, regular exercise also helps with OCD and Scrupulosity a lot!  It releases endorphins, stimulates GABA production (GABA is a neurotransmitter that helps to calm the brain), generates serotonin in the brain, improves sleep, reduces muscle tension, activates the brain, builds resilience, improves concentration, and boosts self-esteem.  Integrative exercising is extra helpful, because it aids connectivity in the brain.  Examples of integrative exercises are SoulCore and pilates. In terms of sleep, it helps to reorganize brain connections and restores the prefrontal cortex, which helps with emotional regulation.  Also, it lowers cortisol levels, improves cognitive function, and emotional resilience.  Sleep helps to ward off sleep deprivation, which drastically increases anxiety.  Good sleep tips include to aim for about 8 hours of sleep per night, to be early to bed and early to rise, and to practice good sleep hygiene, which involves staying away from screens and exercise in the evening, using a weighted blanket, and having good lighting for sleep. Of course, as Catholics, prayer is the most important wellness category of all!  If we can trust God and surrender to Him, then we can find peace amidst the storm of anxiety.  Turning to Mary gives us the graces that we need to be successful, because she is full of grace!  If an apple a day keeps the doctor away, a Rosary a day keeps the anxiety (and the devil) away.

Medication

Medication can be helpful in the case of OCD and Scrupulosity.  Increasingly, I try to approach almost every issue that I work on with clients as a spectrum disorder.  That is to say, some people are on the low end of the spectrum, some are on the middle end of the spectrum, and some are on the high end of the spectrum.  Medication can be helpful at times, especially when a client is in the mid or high range on the spectrum of anxiety.  Additionally, specific circumstances and the cause of anxiety should be considered.  If anxiety is genetically inherited, that can increase the likelihood that medication will be helpful.  Most importantly, it is important that medication is considered on a case by case basis, and diagnosis and prescription should occur with a psychiatrist. The most common medicines for anxiety disorders are Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).  When it comes to anxiety issues, I tend to favor SNRIs a little, because norepinephrine often plays a role.  As always, though, I defer to diagnosing psychiatrists.  In terms of what to expect with medications, it is important to note that it usually takes about 4 to 6 weeks for the positive effects of medicine to show.  Also, it is important to keep an eye out for bad side effects.  They often show soon to the start of taking the medication.  If there are bad side effects, discontinue use immediately and return to the psychiatrist.  If there are not bad side effects, it often is a good course of action to start at a very low dose and do a follow up with the psychiatrist after 6 weeks to readjust.  Another thing to consider is what withdrawal symptoms are like if a person is planning on getting off the medication.  Some SSRIs and SNRIs do have bad withdrawal symptoms. In terms of what I have experienced with SSRIs and SNRIs, I would say that some people have found them helpful.  Some people have told me that they have saved their life, or given them a new lease on it.  Some people have told me that nothing happened when they took the medications, even over time.  Finally, some people have had really bad side effects and do not plan to return to medication usage.  I consider myself to be medication agnostic.  I think it is a valid option.  If it helps, then great!  If it does not, there are many other options to explore.  One thing that I am adamant about is that medication alone will not solve an anxiety problem.  A person also needs effective tools to manage anxiety.

Conclusion

Anne Lamott says that “courage is anxiety that has said its prayers.”  Amen to that!  Courage is not courage without anxiety.  When we overcome anxiety, it is a prayer that glorifies God that is more transcendent than any prayer that we offer in words.  May we all pray in our lives in this glorious and transcendent way.  In the case of Scrupulosity, may we not offer God a prayer of manipulation, but one of relationship. Resources: The Anxiety Resource Center has educational information on anxiety:  https://www.anxietyresourcecenter.org/resources/educate/ Is anxiety preventing you from flourishing in your life and/or relationships?  Reach out to Catholic Healing Institute and Tom Weishaar for therapy from a Certified Clinical Anxiety Treatment Professional (CCATP) Tom Weishaar, MA LPCC CCTP-II CCATP is the Founder and CEO of the Catholic Healing Institute.  He lives in Steubenville, OH with his wife and three children.