212.  Pt 1: Why Scrupulosity is so Complicated and Hard to Treat

Hello and welcome to Christian Faith and OCD with Carrie Bock. I’m a Christ follower, wife, and mother, licensed professional counselor who helps Christians struggling with OCD get to a deeper level of healing. When I couldn’t find resources for my clients with OCD, God called me to bring this podcast to you with practical tools for developing greater peace. We’re here to bust through the shame and stigma surrounding struggling with OCD as a Christian, sharing hopeful stories of healing and helping you replace uncertainty with faith. I’m here to help you let go of the past and future to walk in the present abundant life God has for you. So let’s dive right into today’s episode.

So what’s the deal? Why is scrupulosity so complicated, so hard to treat? I’ve said before that the obsessional reasoning process is the same, and so it doesn’t really matter what theme that you have. Inference-based cognitive behavioral therapy, or ICBT, will work for you. However, I’d like to somewhat revise my statements on this because even though ICBT can work for all themes of OCD, scrupulosity, I’ve realized, is a whole other animal. There are so many different layers of complexity to this that we really need to talk about—challenges that people run into when they’re trying to get help for scrupulosity, as well as challenges therapists might run into who are trying to help people struggling with scrupulosity.

I’ve come up with several points.

Number one is the lack of awareness in churches and biblical counseling circles that leads to a delay in clinical treatment for scrupulosity. This is a huge issue because most people see this as a spiritual problem. They’re going to seek a spiritual solution first. That just makes sense. They’re gonna go to a pastor, a ministry leader, a biblical counselor, and say, “Hey, I’m wrestling with this issue. I’m afraid maybe I’ve blasphemed. I’m afraid maybe that secretly I’m really a Pharisee. I’m a wolf in sheep’s clothing that the Bible is talking about. I think maybe I’ve lost my salvation.” All of these different ruminations that Christians who are struggling with scrupulosity have.

Unfortunately, many people still have this idea in their head of OCD that it’s like Monk and they’re all germaphobes, or they all have color-coordinated closets. And we really need to do more education within the church. We had a podcast episode that I did with Rachel Kuku Woodward on what I wish pastors knew about OCD. Please share that with your pastor, your ministry leader, deacons in your church. We would love to get that information out there because people need to know what religious OCD looks like.

Oftentimes they don’t know what religious OCD looks like, and some of these issues can be common spiritual doubts among people that don’t have OCD. There is a delay in seeking care. What happens is people will go to these individuals for reassurance. They’ll receive some reassurance, but of course it doesn’t stick. So then the person is coming back and is even more distressed and more upset. Or maybe they’re ruminating about a completely different spiritual issue the next time. So it doesn’t occur to the person that’s talking to them that this is what OCD looks like.

I have gotten to the point where I shudder a little bit when someone with OCD tells me that they’re going to biblical counseling. Now some of you are like, “Carrie, I know that you’re a Christian and I know that you read the Bible and love the Lord. So why would you say that? Are you anti-biblical counseling?” No, I’m not anti-biblical counseling. I think it has its place. I think it might be really helpful for someone that’s, for example, trying to figure out how to emulate a godly marriage according to the Bible. Maybe they didn’t have good examples of that, or maybe they just didn’t grow up in a church that was teaching about how to be a godly wife or how to be a godly husband. Maybe it could be really great for people who are needing to deal with forgiveness. They find themselves having a lot of bitterness or a lot of anger towards things that have happened to them that they wanna deal with on a spiritual level and forgive people. I went through some of that work in college. It was amazing and incredibly helpful for me.

So I think there is a place for biblical counseling—not when it comes to OCD treatment. The reason for that is because 97 out of a hundred times, that person is going to said biblical counselor who doesn’t have any knowledge about OCD, how to treat OCD, and that person is just providing reassurance or co-ruminating with the individual with OCD, which is only strengthening the process, once again delaying treatment and causing the OCD to strengthen and get worse. Think about this for a minute. Someone is gonna get help and the help they’re seeking is actually making them sicker. This has gotta stop. We have to educate and coordinate our faith communities as therapists and be working arm in arm together to help support people in the best way possible—spiritually, mentally, emotionally, medically.

Number two, scrupulosity is really complicated and hard to treat because there are all kinds of different views about mental health and medication in the church today. Now I believe that we have come a long way. I am very hopeful. The reason I’m hopeful is because when I started this podcast over five years ago now, there was just very, very little to nothing in regards to Christianity and OCD. Now that has changed. There have been more personal stories that people have written or shared, knowledge that is coming to the forefront. But I searched, I dug down in the Google search, and I just didn’t have resources. And that’s one of the reasons that I’m here talking about this with you guys, because I became very burdened that there’s nothing that’s clinically sound and biblically sound mixed together.

I was hearing from too many Christians that they were just getting the easy kind of answers, the pat answers in the church. “You know, you just really need to pray about this more, and if you just trusted God with that. I mean, just let it go. Just trust God. You know, if you have enough faith, God will move the mountains for you.” All of these things are not particularly helpful when someone is in an immense state of suffering.

And of course, it’s helpful to pray. Of course, it’s helpful to read your Bible. But if we have somebody who’s up in debt, up to their eyeballs, we’re not just gonna throw them a Bible, say a prayer for them, and walk away. I hope you wouldn’t do that if they came to you for help and said, “Hey, I’m in debt up to my eyeballs. I’m struggling.” I hope that you would be like, “Hey, can we find you a financial counselor? Maybe somebody that can sit down with you and look at what you owe, look at your interest rates, find a pathway out of this if that’s something that you’re willing to do.” Most people who are in really bad shape like that can’t get out on their own.

And so the same thing with mental health struggles. If someone is coming to you and they have a severe medical problem like diabetes or cancer, of course we’re gonna pray for that person. Of course, we’re gonna maybe send them encouraging scriptures. We’re not just gonna leave it at that. We’re gonna say, “Hey, what is your doctor saying? What’s the plan? What does the treatment plan look like? How is your diet? How are other things going on in your life?” We wanna really care about people at a deep level and meet them where they are and help them meet their needs.

But somehow when it comes to mental health in the church, we’ve got this idea that we should be able to throw some kind of Jesus Band-Aid on a gaping wound and that that should be fine. “Well, Jesus is all you really need,” and just move forward.

Wisdom comes from God. James 1:5 says if we ask God for wisdom, that he’s gonna give it to us. And sometimes that comes from scripture. Sometimes that comes from the Holy Spirit speaking to you. But many times it also comes through other believers, through people who can speak truth into your life or knowledge that maybe they have received educationally that they can then pass on to you. God calls us as Christians to live in community.

If you talk to anyone who has been through an addiction and has become sober for any length of time, they will probably tell you that there was some type of community involvement that helped them in that process. Typically, people don’t just stay in their bedroom and get sober and shut the whole world out. Typically, they’re involved in some type of support group, or they have some type of mentorship happening or sponsorship happening, because we need other people. Sometimes it takes this huge level of humility to be able to say, “You know what? I need help.”

And when somebody is coming to us in the church with immense emotional burdens—we can see that it’s affecting them physically. Maybe they physically look super tense, fidgety. Their voice is shaking when you’re talking to them. They’re crying all the time. We need to be able to support them in getting the professional help that they need, whatever that looks like. I think unfortunately, many churches have dropped the ball on this and haven’t provided encouragement or referrals to professionals.

I wanna say a few words about taking medication. I’m not a doctor, so this is coming from a therapist, but I sincerely believe that you can have Jesus, love the Lord, take medication, and go to therapy, and that those things are not in opposition to each other. Sometimes people in the church feel like, “Oh, if I take medication somehow that’s a sign of weak faith.” It’s not.

I love what Tiffany S. says in her book Anxious with Jesus. She talks about praying while taking your medication, and just this combination of allowing God to use the resources that we have and understanding and elevating him as the ultimate healer. JP Moreland wrote a book called Finding Quiet, where he talks about taking medication for anxiety as a believer, and I believe that’s a really great explanation for anyone out there. I would love to get in touch with him. So if you happen to be buds with JP Moreland, I’ve tried to reach out to him via his website, I think, and really haven’t been able to get in touch with him. So if you are a networker, connector, I’d love to have him on the podcast. You can share this with him.

You’re not less spiritual for taking antidepressants any more than you’re less spiritual for taking chemo drugs or less spiritual for taking diabetes medicine. Let’s say it louder for the people in the back. Okay? We have to really get this sunk deep down into our psyches that it’s okay to take these medications, especially when you are in the midst of treatment and really trying to learn new skills. You’re struggling, it’s hard, or you’ve just gone through a really rough bout where your symptoms have become more severe. Don’t be afraid. Talk to your doctor. Talk to a psychiatrist. Utilize these things as resources.

I really encourage you, if you have OCD, to look into the FDA-approved medications for OCD because sometimes doctors get a little wild and just start prescribing various antidepressants. And so if they are prescribing something that’s not on that list, I would just say, “Hey, what is your thought process behind that? I’m just really curious. I did my research and I noticed that these were the medications that were FDA-approved specifically for OCD.”

Point number three is that the American Christian church has a really unhealthy relationship with thoughts and feelings in general. I know that is a very broad statement, but it’s something that I’ve seen over and over in my work, where there’s almost this subtle idea that we’re having to fight all the time with our thoughts and feelings. And how much energy does that take? That consumes a lot of energy—trying to fight with these things that are natural, that we all deal with and we all have to face at one point or another.

It’s much easier to take a more flat mindfulness approach of like, okay, it’s here. I may not like it, but I still have to figure out, okay, now that it’s here, I can either acknowledge it’s here or deny that it’s here. If I deny that it’s here, it’s still gonna be there and I’m still gonna have to deal with it at some point or another. It’s gonna keep coming back up and keep bugging me.

I think there’s this emphasis in the church to do one of two things: either to take our thoughts and feelings super seriously and put a lot of energy into them, or to deny them completely. And either is an issue. We have to find a balance point, a middle ground.

So if we’re putting too much emphasis on thoughts, it’s like bad thoughts have to be feared. We have to watch every little thing that comes into our mind. “You have to watch your thoughts because your thoughts will become your behavior.” That is not always the case. There are lots of things—trust me, I do not have OCD—but I’ll tell you, there are lots of things that come into my head that I do not act on. I’m like, “That is a really bad idea right now. Do not do that.”

This is why we have filters in our mind of past experiences, of things that we’re like, “Okay, if I do A, I know B is probably going to happen, and so I’m gonna not do A, even though I may really wanna do that right now.” I may really want to get defensive in this argument, but I know that it’s just gonna continue the argument and cause more relationship problems. I may really wanna scream right now because somebody is not listening to what I’m saying, but I’m gonna stop. I’m gonna walk away. I’m gonna take five deep breaths, come back, try this situation again.

Could you imagine if you acted on every thought that you had? How many of you have had a thought this week that said, “I don’t wanna do this,” and what if you acted on that thought? Even today, I’ve been recovering from a cold. I still am dealing with some sinus issues. I was losing my voice earlier this week and I said, “You know, I just am not sure that I wanna record this podcast episode.” Yet here I am recording because it’s important, because I wanna talk to you, because I know that if I don’t do it this week, it’s gonna get pushed off to next week and then I’ll have more to do next week. All of these things can go through my mind. They’re being filtered through my values at that point. And my values say, “Hey, even though we don’t feel like it right now, we’re still gonna show up and do the thing.”

You may feel that same way about work. There may be times where you do not wanna play with your children because you’re exhausted, but you still do it because you know it’s important and you wanna connect with them. Just think about that last time that you really thought, “I’m not sure I wanna do this,” and you did it anyway. See, you acted against a thought that you had.

When we overemphasize our thoughts, we may get really stuck on taking every thought captive, really having to activate quite a bit and do something about these thoughts. I talked with someone recently who was a former pastor who dealt with OCD, and he said, “Man, the pastor told me to take every thought captive. That just ruined me.” Now we have a whole podcast episode on that. You can go back and listen to it another time of what it means for OCD.

What happens when you overemphasize or place greater meaning onto thoughts than they really need to have in OCD is that it only makes them stronger. It only makes them come back more. If you’re trying to suppress thoughts, if you’re trying to neutralize them—like, “Hey, I’m gonna think of a positive memory because I just had a harm OCD thought. I’m gonna try to neutralize it with a positive memory”—rebuking thoughts, those types of things only make them come back more and more and make the OCD worse.

It seems to somewhat conflict with maybe some things that you’ve been taught in church. One thing I find particularly helpful is this concept from metacognitive therapy that says thoughts are like buses or like trains or subway cars—however you wanna think about it. Let’s say that thought bus comes along. You get to decide whether or not you are getting on that bus and continuing that thought direction or not. Or you can say, “You know what? I’m gonna let that bus pass by.” I’m not gonna get on there because if I get on that bus, it may lead me down this road that’s gonna take me to anxiety, intense fear, depression.

If I’m just ruminating on my past mistakes all the time, it’s gonna lead me to a sad place, and you know that. Obviously, if you have OCD, I’m not saying that this process is easy—to just detach from your thoughts. But the idea is that at some level we do have a choice of what we do with these thoughts as they come up. You may not have the choice of what bus decides to drive by. You may have lots of intrusive thoughts and you’re like, “Hey, I didn’t call for that taxi,” or, “I don’t wanna be at this bus stop where all these buses are trying to pick me up.” But you can decide whether or not you wanna continue on that bus.

Some people see any type of negative thought or temptation as sin. Having a negative thought is not automatically a sin. Having a tempting thought, such as a sexual thought, is not automatically sin. Once again, you get to decide what to do with that thought. You get to decide whether or not you’re gonna continue to go down that road of, “Oh, I had a lustful thought and I’m gonna give in to that and continue to visualize,” for example, versus, “No, I’m gonna disconnect from that and turn my eyes away. Leave that thought alone.” Temptation is not the same as sin, and that’s really important for us to wrap our minds around.

Those types of things can get easily blended in scrupulosity. So I’m blending being attracted to someone and lusting. Those are two different things. You have to be able to separate that out in order to work through it. Or I’m blending, “Hey, I just had a sexual tempting thought,” versus, “Oh no, now I feel like I’ve sinned and I have to confess and do all of these things.” Or, “I had some type of selfish thought and now I have to jump on that and automatically confess it.” Just be very careful about some of those things. Being able to recognize when you’re blending is super important.

In terms of thoughts, there’s a tendency to reinforce black-and-white thinking over certain theological issues. For example, the non-essentials can all of a sudden become essentials that people get really stuck on. Examples of this: Which denomination do I need to be a part of or follow? Scrupulosity will have you going round and round on that one. I talked to a person many years back, I believe, who said this just kind of had consumed all areas of their life because one of the denominations they were looking at was pretty strict and rigid in terms of what you could and couldn’t wear, how you dressed, how you did makeup, those types of things, what you ate. So everything in their whole life just felt really restricted. A lot of confusion over that.

I’ve had somebody reach out not too long ago asking about denominations and things of that nature. Scrupulosity can get really stuck on things that are non-essentials and see them as black or white, like there must be one that’s right. Somehow, if I follow this denomination, it must be right. That means that this one is wrong. “Oh no, my friend’s a part of that denomination. What does that mean? Does that mean that they’re not following Jesus right?”

We have to remember to keep the main things the main things. We’re about following Christ. We’re about spiritual practices that are going to get us closer to Jesus. That’s pretty simple: love God, love other people. That’s what we’ve boiled the first two greatest commandments down to, right?

I’ve had people stuck on Calvinism versus Arminianism. The problem is that you can find YouTube videos or reels on Instagram where people are gonna be speaking very strongly in one direction or another. “We’re right. We’re the Calvinists and we’re right, and here’s the scriptures to prove it.” Then the Arminians are over on the other side going, “We’re Arminians and we’re right, and here’s the scripture to prove it.” This creates a lot of confusion, obviously, for people with scrupulosity.

When we have this type of black-and-white thinking in a church, I think it’s much more balanced to be able to say, “Okay, what are the actual essential things? What are the non-essentials? About the non-essentials, some people believe this and some people believe that. One person isn’t necessarily right or wrong.” We’ve got to let go of some of the black-and-white thinking on the non-essential issues.

Let’s talk for a moment about feelings and either paying too much attention to our feelings or not enough attention to our feelings in the church. I’ve seen both sides of this. A lot of times younger people—teens, young adults—go through this. I remember going through something like this. It’s like, “I don’t feel close to God. What does that mean? If I don’t feel him right now and I’m in this worship service and everybody just seems to feel God and I don’t feel him, and I don’t feel like he loves me.” We’re just way too feeling-absorbed at that point because feelings aren’t everything.

I love my husband and sometimes I feel very close to him. But if I wake up tomorrow and I don’t feel close to him, I still love him. I’m still gonna do things to care for him. I’m still gonna ask him about his day, how he’s doing. I’m still gonna tell him I love him even though I may not have all these warm, fuzzy feelings inside. The same thing is true with God. There are some times where you may feel really close to God, but you can love God and not necessarily have all the warm fuzzies. We’re not gonna have those all of the time. Not all of life or all of spirituality is a mountaintop-type experience. You’re gonna go through some valleys in your life. You’re gonna go through some struggles and some wrestlings. All of that is very normal. All of it’s very biblical. Go read the Psalms.

There were times where David was on a high—defeating his enemies, life’s good, God’s good, everything’s awesome. Then you flip a couple Psalms later and he’s like, “God, where are you? What’s going on? Why are my enemies triumphing over me?” We have to find a more balanced view of our feelings and know that they can’t just dictate and rule our life and spirituality.

On the flip side, I’ve also heard statements in churches like, “Well, you just have to fight your feelings with faith. It’s not all about your feelings. You just gotta speak the truth and move forward, and it doesn’t really matter how you feel.” That’s completely on the opposite extreme. That’s in a different ditch on the side of the road. Two ditches on the side of the road. One, we’re completely all about our feelings and absorbed in them. The other is we’re just like, “No, gotta fight those. They’re not godly.”

God has created us in his image. God is an emotional being. Therefore, we are emotional beings. We’re not perfect, so we do not always handle our emotions in a perfect and holy way. But part of our sanctification process is learning how to manage these emotions as they come up. I really do believe that. God can use emotions in our life to connect us with other people in intimacy and close relationships, and I think that is very important.

I don’t think that we need to fight our feelings with faith because I don’t believe they’re in opposition to our faith. Even if I feel not close to God or I feel abandoned by him or I feel like he doesn’t care about what’s happening in my life, that’s a great and golden opportunity for me to then bring those feelings back to God and say, “Hey, here’s what I’m feeling. What’s going on? I don’t feel like you care about this.” God can handle all of those things. Typically, when you get all of that out, by the end you feel better and you remember, okay, I’m not in control of this. God is in control. Somehow things are gonna work out for my good and it’s gonna be okay.

I am encouraged and I hope that we can grow in this process with the church of having a healthier understanding, a more balanced relationship with our thoughts and feelings—where we don’t feel like we have to pounce on every bad thought, where we don’t feel like we have to shove down feelings that we don’t think align with God, that we can ultimately experience these things without being ruled by them. We don’t have to be ruled by our thoughts or ruled by our emotions. We can recognize that these thoughts, feelings, and body sensations are there. They’re a part of our experience. Ultimately, we’re making choices. Those things may inform our choices at times, and that’s not always a bad thing.

Sometimes you may have a feeling that you really need to pay attention to. If your body is in pain, if it’s sending you a signal that you are physically in pain, you probably need to pay attention to that. I think the same is true with emotional pain. There’s some kind of healing that God wants to do in your life. If we just ignore that emotional pain and we say, “No, I have faith. God is good. Everything’s fine,” then we miss out on that opportunity for God to do that deeper-level emotional work in our life and for us to receive that healing from him.

Join me back next week as I continue this conversation on why scrupulosity is so complicated and hard to treat. If you love Jesus and are struggling with scrupulosity, I would love for you to check out the resources on my website. We’d love to have you join our weekly newsletter. I put out one a week. You get it every Wednesday morning. Not only do we tell you about what podcast episode is coming out, but I really strive to make that valuable. I tell you some stories about things that God is teaching me in my life and how I see some of those things relating to the struggle of walking the Christian walk, and tie that into how it applies to OCD. So I’d love to have you hang out with us reading the newsletter.

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Until next time, may you be comforted by God’s great love for you.

Christian Faith and OCD is a production of By the Well Counseling. This podcast is for informational purposes only and should not be a substitute for seeking mental health treatment in your area.