Tag: ICBT

181. My Response to the Updated IOCF’s Treatment Recommendations

Written by Carrie Bock on July 9, 2025. Posted in OCD, Podcast Episode.

In this episode, Carrie responds to the International OCD Foundation’s newly released 2024 treatment guidelines. She offers a therapist’s take on the updates, and what they mean for Christians navigating OCD.

Episode Highlights:

What the IOCDF’s updated 2024 treatment guidelines mean for OCD care, and why this shift matters.
How Exposure and Response Prevention (ERP) compares to newer approaches like Inference-Based CBT (ICBT) and metacognitive therapy.
Why faith-based concerns and nervous system sensitivity can make ERP difficult for some Christians with OCD.
Which therapies the IOCDF considers “adjunct,” “second-line,” or “potentially harmful”—and Carrie’s take on that, especially when it comes to EMDR.
How to navigate your treatment choices with discernment, hope, and a plan that fits both your story and your values.

Episode Summary:

What if the treatment everyone says is “best” doesn’t work for you—or feels off with your faith? What if there are other options that deserve more attention?

In this episode of Christian Faith and OCD, I’m offering my personal and clinical take on the IOCDF’s new 2024 treatment guidelines, and unpacking what they actually mean for Christians navigating OCD and seeking faith-aligned therapy.

These updates are getting a lot of attention—and for good reason. As a licensed professional counselor who supports Christians struggling with OCD, I wanted to offer my perspective on what these changes actually mean for those of us trying to find treatment that honors both our clinical needs and our faith.

We explore the IOCDF’s continued promotion of ERP (Exposure and Response Prevention) as the gold standard, while also recognizing that for many—especially Christians—ERP can feel like too much, too soon, or just not a fit.

I highlight the growing visibility of ICBT (Inference-Based CBT) and metacognitive therapy, both of which are starting to gain traction as valid alternatives. I also share my thoughts on why labeling EMDR as “ineffective or harmful” can be misleading and hurtful to people who’ve found deep healing through trauma-informed approaches.

Whether you’re brand new to OCD treatment or have tried ERP and are still searching, this episode is meant to encourage, inform, and remind you that healing is possible—and there is more than one path forward.

👉 Listen to the full episode to get a clearer picture of what’s really changing in the OCD world, how to navigate these treatment options with wisdom and faith, and why you don’t have to settle for a one-size-fits-all approach.

Related Link:

OCD Treatment Guide: Best Evidence-Based Therapies, Medications, and New Advances

Transcript

This summer, we’ve been in a personal story series, and I’m taking a brief break from that Today. I had a guest that I was really excited to have come on the podcast and we tried two different occasions and it just didn’t happen and didn’t follow through. So I thought I would take some time to talk about my response to the International OCD Foundation’s new treatment guidelines and recommendations.

They just put these out at the beginning of June and it’s a big shift from what they had previously. So I wanted us to talk through that and just give you my response and my thoughts on it. Hello and welcome to Christian Faith, an 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. When this episode comes out, I’ll actually be on my way to the international OCD Foundation Conference in Chicago for the first time, and I’m super excited because I.

My best friend lives in Chicago, so we will also be hanging after I’m done conferencing. Previous to this June, if you had looked up the I-O-C-D-F website, international OCD Foundation, we’re just gonna shorten it throughout this episode. If you had looked at their website, you would’ve seen that they were really promoting ERP saying it’s the gold standard.

It’s what we have as far as evidence-based care. That’s exposure and response prevention. If you’re new to OCD lingo or new to the show, we’ve definitely talked about that before. They had a section on their website about ICBT, but basically it said we really need further research and we still recommend that you do ERP.

They had sections about medication for OCD. It’s quite a comprehensive website. If you’ve never been on there, I definitely will link the treatment guidelines in the show notes so that you can go through and read them yourself. Before we dive in, I wanna just highlight why a website like this is so important when people are googling about OCD treatment or help for OCD.

Obviously, the IOCD F’S website is going to come up pretty high. There are a lot of people that are just finding out, they’ve been diagnosed with OCD, they’re going online, they’re searching, okay, well, what do I need to do now? Maybe my therapist has said, Hey, I think you have OCD, but that’s not something that I really treat or know much about.

Maybe their therapist is well-versed in OCD, but this individual is really savvy and wants to be educated. Hopefully we’re all like that. We wanna know and understand our treatment options and what’s available out there. We also have to look at this from a social, political standpoint and financial standpoint.

Let’s be savvy here and know that this is a nonprofit organization that is being sponsored by various business entities. As a result, if we have an organization that’s being majority funded by programs, treatment centers, et cetera, that are promoting exposure and response prevention therapy, of course.

The I-O-C-D-F is going to be promoting ERP. That just makes sense. And so we need to go in this with eyes wide open and understand that while they may be saying this is based on clear cut research, but we all know that can’t be the only driving force behind these treatment recommendations. Research on OCD in my opinion is imperfect at best.

Because these are very complex cases, often with multiple diagnoses. In addition to OCD and clinical presentations are going to depend on whether or not an individual is highly sensitive. We’ve talked about that on a previous episode. Whether or not a person has experienced certain attachment features in their upbringing, I’ve talked about rigid upbringings in a prior episode as well.

While we take research into consideration, we also have to, as a therapist, take into consideration the human being that is sitting in front of us and understanding their story so that we know how best to meet their needs. So let’s get into the guidelines. In the beginning, they talk about how OCD is treatable, and it says, while there is no one size fits all treatment plan for people living with OCD, that’s good that we admit that there are many first, second, and third line approaches that can get individuals on a treatment journey so they can thrive.

And I think that in terms of ICBT, that we might disagree with some of this first, second, and third line approaches because obviously there are first line approach that they outlined here is, as you guessed it, exposure and response prevention medication and combining ERP and medication treatment.

According to the I-O-C-D-F, exposure and response prevention is the most proven, effective first-line therapy for OCD in adults, children, and adolescents. It’s interesting they say this therapy fosters long-term relief from OCD symptoms and builds resilience against anxiety. Then why do I have so many people that are coming to my practice saying, yeah, I’ve done ERP, I’ve kind of gotten what I can out of it.

Or, yeah, I’ve done ERP, but the results didn’t last, and I’m slipping back into old behaviors. I. Or it just doesn’t seem to be fully effective for me, based on my own experience of treating people with OCD and the people that are walking through my front door. I think a lot of them would question that sentence about long-term relief from OCD symptoms.

Then they have a section, this is interesting to me on adjunctive treatments. It says you can add these to improve your response. So adjunctive treatments or other medications or therapies that are added onto first, second, or third line treatments, they can enhance outcomes, but are not meant to replace primary therapies because they have not been found to be effective as a standalone treatment for OCD.

I would agree with that. Under here they have acceptance and commitment therapy. I think there are definitely pieces that we can gain from acceptance and commitment therapy really talks about what does it look like to move towards your values. Very much the acceptance piece as mindfulness. Really allowing the thoughts to be there without having to do something about it and act on them.

They also have dialectical behavioral therapy or DBT. This can be particularly helpful for individuals who have intense emotions and have a hard time managing those emotional experiences. Usually that results from attachment disruption. In childhood or some type of anxious attachment that has developed mindfulness based therapy, which of course is gonna be super helpful for just becoming more aware of how OCD works so that you can catch it before you automatically give into a compulsion.

That’s where mindfulness can be really helpful. It’s just learning to kind of. B, with what’s already here. With a sense of awareness and acceptance. Like, Hey, this is the deck of cards that we are dealing with right now. Instead of, A lot of times what we do is try to ignore, shove things away, neutralize in OCD.

Under adjunctive medications, they explain basically that if you don’t respond well to an SSRI medication alone, you can add a typical anti-psychotic. These are obviously much stronger class of medications that you would want to talk with your doctor about and find out about side effects, et cetera.

Just because someone is prescribed an anti-psychotic medication or an anti-convulsant medication, which they also lift on here, obviously does not mean that they’re having psychotic symptoms. It is just used in a different way, just so we’re not scaring anybody out there or making you think that we’re saying that people with OCD are psychotic.

That is not what we are implying here. Now in the second line treatments they have, if first line options fail, if first line treatments don’t relieve symptoms or cannot be tolerated, second line therapies offer alternative approaches. And interestingly, they put acceptance and commitment therapy in here, which I find bizarre because they just listed it as an adjunct treatment.

So which is it? Is it an adjunct or is it a second line treatment? There are little tabs under each of these, so then if we click on inference based cognitive therapy, it says, inference based cognitive behavioral therapy. ICBT is a specialized treatment for OCD that focuses on identifying and resolving inferential confusion.

A reasoning process that fuels obsessional doubts through tailored sessions. ICBT helps you recognize and resolve the tricks OCD uses to make obsessional doubts feel real and reasonable. ICBT is evidence-based, bing, bing, bing. That means it’s been researched and found to be effective. Has shown significant success in reducing OCD symptoms.

Cbts body of evidence for OCD continues to grow, meaning just because it’s a newer treatment on the scene doesn’t mean it’s inferior to ERP. ICBT has not been studied for children and adolescents, so that is a key factor here. If you have a child or an adolescent that is dealing with OCD, I think it can be much more challenging for them to grasp onto some of these concepts.

I think if you had an older adolescent, they probably could grasp onto ICBT pretty quickly and understandably. That would depend a lot on their severity level that they’re dealing with, as well as their developmental level and emotional level. So each person has to be kind of looked at differently, obviously, but I think that this is possibly why they would put ICBT as a second line treatment option.

Due to, they’re looking at the range of OCD and a lot of people getting diagnosed as a child and adolescent. And obviously those people need treatment that is very relevant and so if that’s why they put it in the second line of therapy, I’m actually okay with that. But we do at least feel like that ICBT is getting looked at more now as an option because of how they put this in here.

Especially in terms of this line of cannot be tolerated if first line treatments don’t relieve symptoms or cannot be tolerated. We have a lot of people out there that just really are terrified of exposure and response prevention, or they feel like it will butt up against their Christian belief systems being required to do these imaginal exposures, and so it’s nice.

To have this listed here as a second line option for them saying, Hey, this is available to you. It doesn’t have to be exposure and response prevention or bust. And I’ve talked with other therapists who have been to the I-O-C-D-F conferences in the past many years ago, and they said it was almost a little cultish about how into ERP they were, and they said it was.

Kind of like almost to a, a bit of a creepy level. I think hopefully some things have shifted and changed since then, since that was many years ago. I also want to just point out and congratulate, applaud people that you guys don’t know. And who have been working so hard behind the scenes to really get the I-O-C-D-F to recognize ICBT as a valid treatment.

And so I am so thankful they are obviously much more research minded and valued. Than I am who are able to go in and say, Hey, we do have this research. It’s been done over and over. We can show that this treatment is effective. We have a large community of therapists now that are using this treatment and seeing success with their clients.

I. Will you please offer this to people as an option who are so desperate in such a high rate of suffering, who need help and need hope? And that’s what we’re here for. We’re not here to bash ERP. If it works for people and you feel comfortable doing it, and you’re at a place where you can do it and do it successfully with a trained clinician, then by all means, please go pursue your healing journey in any way that you need to.

And I’m a hundred percent on board with that. I’ve had people leave me to go do ERP and like I hope they soar and thrive. Like I’m not offended by that by any means. That’s okay. Everyone has to do between them and the Lord, what they feel like is right for them. Now, also, under the second line treatment options, they have metacognitive therapy, which I was really interested in seeing.

Now remember, this is an international foundation, which is really cool because it means that even things that aren’t very popular in the US but are working super well in other parts of the world are being recognized. And I would even put ICBT in that category because it’s relatively newer to the us.

This past year I participated in a two day training for metacognitive therapy, and it was an online training. I could be super wrong about this point, but I believe it was the first metacognitive therapy training for a therapist in the US and it was done by a psychologist named Pia Callison. Hopefully I’m saying her last name, right?

I can’t remember because they kept just referring to her as PIA in the training. She wrote a book for laypeople called Live More Think Less, overcoming Depression and Sadness. This is on my reading list. I would like to get a hold of this, but I wanted to give it to you in case you wanted to look more into metacognitive therapy.

There is also a treatment manual written by Dr. Adrian Wells. That I started and haven’t finished yet. It’s called metacognitive therapy for anxiety and Depression. If you have not heard of metacognitive therapy, I’ll give you the brief overview, but understand that this is coming from a novice. The therapy.

Essentially what metacognitive therapy says is that we all have these thoughts that come into our mind, but we all deal with them in different ways. And if we grab a hold of those thoughts and we really chew on them, ruminate on them, worry about them. Do some type of compulsion in response to the thought.

They call this the cognitive attention syndrome. Metacognitive therapy says that the problem is not really your thought. The problem is what you do with your thought. So they teach something called detached mindfulness, and they use an analogy like having trains that are coming and going, right, and you can choose which train.

You want to hop onto, if you’re at a train station now, you might have a train that’s going east and you really wanna go west. Well, if you hop on that East train, it’s gonna take you way out of the way of where you want to be. Metacognitive therapy has different activities that you do with clients where they will essentially just learn to detach from the thoughts that they’re having In my very novice practice of metacognitive therapy.

What I have seen it be most helpful for is for clients who are dealing with a secondary depression in addition to their OCD. I find it incredibly effective for depression because sometimes we go through things in our life and like it does stink, and cognitive behavioral therapy is like, Hey, let’s reframe that thought and make it better.

Okay, you’re lying in a hospital bed with a broken leg, but now you have more time to read that you’ve always wanted, I mean, whatever it is, you’re trying to constantly in cognitive therapy for depression, trying to look at your circumstance a different way. And metacognitive therapy would just say, okay, so you’re lying in a hospital bed.

You can detach from that thought. You don’t have to focus on it, or you don’t have to change it. You don’t have to make it better. You don’t have to ruminate about it. You can literally do nothing with that thought. And then the theory behind metacognitive therapy is that your brain will be responsible for the self-regulating process.

Essentially, if I get out of the way of having to quote deal with all of these thoughts, then my brain will be able to relax and regulate and be okay. It’s super hard. I’m just gonna say that for the clients that I’ve used it with, it takes a lot of practice. It does take intentionality to be able to let thoughts go because that’s not typically what we do, especially for Christians.

We often feel like we have to pounce on thoughts. I’m gonna do an episode about this in the future. About taking thoughts captive and like, what does that really mean for us? How do we apply that in a practical sense with OCD? Because that’s something that I hear a lot of Christian clients talk about. I will say that when I went through the training for metacognitive therapy, there was something in my life that I was really stuck on.

It was a thought that was true, but the thought was causing me to be really angry. And as I practiced some of the metacognitive techniques on myself and with like kind of a practice therapist, we were practicing on each other throughout the two days. I will say that something just release within me. It was incredible.

So I know that there are pieces of this. That can be helpful and work. But I also feel, uh, still very novice, almost like, kind of like I’ve run out of parlor tricks to use and I would love to pursue additional trainings in metacognitive therapy because I do think there are pieces of it that can be useful.

And as I’ve said, this is something that’s being used in Europe. I think it originated in Denmark. I’m not really sure. Just know that metacognitive is another therapy that is out there for you, but you may have a little bit of a challenge finding someone in the US who does it. If you are in Europe, you might have a little bit of an easier time under second line treatments, they also mention space, which we’ve had as a previous episode as well.

So supportive Parenting for Anxious Childhood Emotions is what space stands for. It’s an acronym. The cool thing about space is that you as the parent can do this. Even if your child or adolescent is digging in their heels, they’re refusing to go to therapy, or maybe you take ’em to therapy and they’re like not talking to their therapist or they’re just saying, I’m not doing this.

You as the parent can get this training in space and really be supported on how to respond to reassurance seeking how to reduce accommodation, how to be really compassionate and empathetic, while also at the same time not doing things that are gonna feed the OCD in your child or adolescence. So I love that they put space on here because I think it’s a great option for parents.

So just moving down the treatment recommendations, we then get to third line treatments. So for severe or treatment resistant OCD. Third line treatments are advanced options for individuals who haven’t found success with first or second line treatments, including combinations of the various types of therapies.

And these are reserved for severe treatment-resistant cases and require close clinical oversight. So they have transcranial magnetic stimulation. TMS. By the way, we are still looking for a guest, so if you know a guest who’d like to come on and talk about TMS, that’s definitely something I wanna explore more on the show, as I believe more insurance companies are paying for TMS.

Now, TMS originally was used for treatment resistant depression. So if your depression is super, super bad as a result of OCD, and you’ve tried various medications, typically in order to do TMS, you have to quote, like fail out of so many medications. Next in line we get to emerging treatments, experimental.

Some treatments show early promise, but require much more research, psychedelics and IV ketamine therapy supplements, and pharmaco genomic testing. PGX. I personally disagree with PGX because I’ve seen in a couple different cases where it’s actually backfired and people have been taken off of medications that were helpful for them to be put on something.

Supposedly that’s better for their based off of their genetic testing. That’s just my personal experience. Take it with a grain of salt and then we get down to little section on pans. Pandas, I’m not gonna talk through that. Then treatments to avoid ineffective or potentially harmful. I mean, that’s a very strong wording.

I-O-C-D-F. It’s important to avoid treatments that lack scientific evidence. These therapies have not been proven effective and may delay access to evidence-based care. So they have ineffective psychosocial treatments. EMDR what? Hypnotherapy, psychoanalysis, psychodynamics, psychotherapy, et cetera. What’s interesting is that the EMDR has a link, and if you click on the link is actually a more balanced article.

One of the co-authors is someone I know from the ICBT community, Bronwyn Schroer, who uses EMDR and ICBT to treat co-occurring PTSD and OCD. If you click on the link, it does give you a much more balanced point of view to say. EMDR for OCD specifically doesn’t have a large body of research and most of that research being done in adults now I know because I have taken trainings from them that add dej.

Sorry if I mispronounced your last name, and Suzy Matheson have something called the Flash Forward technique that they use for OCD. I think the argument is that this is glorified exposure therapy because you are having people imagined their worst case scenarios and then processing that as a traumatic memory.

Now, I will say that odd and Suzy, who are researchers in the Netherlands. They’re super incredibly brilliant. I’ve taken a couple of their trainings and I probably honestly could go through them again and get something more out of them. They are also pioneers of what’s called EMDR 2.0, which focuses on working memory taxation versus just the bilateral stimulation.

Hopefully I’m not getting too nerdy for some of you I know we also have some therapists that listen to this podcast as well. Essentially, EMDR 2.0 just adds another layer and sometimes can help people process through things if they’re getting stuck. So it’s something that I have incorporated into my practice, and I do think that because people who struggle with OCD have so much going on in their brains.

Sometimes they benefit when they are processing trauma. They benefit from that EMDR 2.0 approach. So you could also argue odd and Suzy are seeing people in the Netherlands who are in intensive treatment therapy programs and probably have a pretty high level of distress that they’re dealing with. I think it might be hard to differentiate.

Are they benefiting from EMDR 2.0 or are they benefiting from really the flash forward technique? Is this just glorified exposure therapy? So flipping back to the I-O-C-D-F website where they’re talking about EMDR and they’re saying, okay, it’s not evidence-based for a standalone treatment. I would agree with that, but it still could be recommended as part of an overall treatment plan.

To treat trauma slash PTs in co-occurring OCD and PTs d. They also say that we could benefit from more research, so that webpage is much more balanced than saying ineffective or potentially harmful. I think that that’s very harsh and that that’s very unfair for people who might benefit from EMDR as part of their treatment process.

I have sat with many client who has processed the onset of their OCD because that was truly so traumatic for them. They did not know they were going through OCD. They did not know what was happening to them. They might have thought they were going crazy. They had an intense high level of. Fear. It was a very dark time in their life, and even just being able to go through EMDR surrounding that situation has been so healing for so many people, and I think that’s why it hurts my heart a little bit that I-O-C-D-F would deter people from getting EMDR therapy who might really benefit from it.

I’m not saying it’s going to solely cure your OCD. It’s super helpful in terms of dealing with childhood woundings in terms of dealing with traumatic events that may be exacerbating OCD symptoms. I see that all the time. So for someone who just lands on this website and sees potentially harmful and then right under it, EMDR, that’s really gonna deter quite a few people from getting it.

They also have brain spotting on here. And then they have ineffective medical treatments. The reality is that getting effective, helpful treatment for OCD is super challenging, and we have to rewind and say that back in the 1960s, which is not that long ago, this was considered an untreatable disorder. So we have come a long, long way, and I think we still have a long way to go.

There’s more research that can be done, more research that probably needs to be done. Even though for me, I am not the biggest fan of research. I would much rather have people come in. I kind of know who my ideal client is that I work well with, and I will try some things out with them. And if it doesn’t work, we’ll try something else.

If I consistently see something not work for people, I just pull it out of what I offer. I don’t even offer it anymore, and I’ve been doing that for years and it has worked super well for me and I’ve been able to help a lot of people. I’m thinking of somebody that I have right now that really had a long course of exposure therapy and medications.

A course of EMDR treatment for some early childhood trauma and woundings, and then I’m working with this person on ICBT right now, and it’s just been so interesting to see that this person has hope again. They have hope of getting better. They feel like this treatment really makes sense to them, and they’re like, okay, I’m getting it.

And I feel like I’m able to start seeing some progress and I’m putting some pieces together that I wasn’t able to put together before. And one of the reasons that exposure wasn’t helpful for this person was that they just weren’t able to tolerate it. So they would try to expose themselves, but then it was like they couldn’t move on the hierarchy ladder.

They got to a point where things just became too much and became like their nervous system was just getting super triggered. The whole reason that I’m here, that I’m speaking into this space and even talking about this stuff is because I want people to know that there’s hope. That no matter how low you feel like you are right now, no matter how badly you feel like you’re struggling, that there are these different treatment options.

And you know what? If you find a therapist and you guys just don’t jive, let’s keep it real. Sometimes that happens and I’m gonna do an upcoming episode at some point on terminating. In therapy, like kind of ending a therapy relationship. And it can really be challenging sometimes. And so I hear that, especially if you feel like, you know, this person just doesn’t get it because they don’t share my faith.

We’re now at a point where we have over 175 episodes for you guys to listen to. That can hopefully help you on your OCD journey if you’re interested in ICBT or think that might be a good fit for you. You can check out Christian’s Learning I ccbt over at care bach.com/training. I also do MDR and I ccbt intensives.

For those of you who really feel like you have trauma in the way of being able to. Get the help that you need with OCD and really just need a wraparound approach. OCD Warriors, you are amazing individuals, so tough and so strong, and continuing to fight even though you’ve had some really hard or really low points in this process.

I want you to know that I see you and want to continue to support you guys any way that I can. 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.

177. Being Diagnosed with OCD Later in Life: A Personal Story with Heather Vignali

Written by Carrie Bock on June 11, 2025. Posted in OCD, Personal Testimony, Podcast Episode.

In this episode, Carrie welcomes fellow therapist Heather Vignali to share her personal journey with OCD, including how symptoms emerged during a major life transition—and how ICBT, EMDR, and her Christian faith played a role in her healing.

Episode Highlights:

The ways OCD impacted Heather’s life, including obsessive safety concerns and compulsive monitoring of her daughter.
What “anxiety tongue” is and how somatic symptoms can signal deeper mental health struggles.
How Inference-Based CBT (I-CBT) helped Heather understand the root of her intrusive thoughts through concepts like the Feared Possible Self.
Ways EMDR and other integrative therapies can support healing when trauma and OCD intersect.
How OCD can impact faith, and how to navigate scrupulosity while reconnecting with spiritual truth.

Episode Summary:

Today’s episode is part of our series sharing real and personal experiences with OCD, and I’m so excited to introduce you to Heather Vignali—a licensed professional counselor serving New Jersey and New York. Heather works primarily with adult women navigating anxiety, OCD, self-esteem challenges, and relationship stress. And for clients who want to bring their Christian faith into the counseling process, she offers that too.

Heather shares her own journey of recognizing and getting diagnosed with OCD—something that didn’t fully surface until a major life transition: her daughter’s senior year of high school. As she prepared to launch her daughter into the world, Heather started noticing signs that went beyond everyday anxiety. Physical symptoms, compulsive checking behaviors, and relentless fears about her daughter’s safety became daily struggles. Like many, she initially didn’t realize these were signs of OCD.

Through this conversation, we talk about what it looked like for her to begin questioning her own thoughts, how she discovered Inference-Based Cognitive Behavioral Therapy (ICBT), and what it’s been like to walk through the ups and downs of treatment. She gets real about what it felt like to live in the “OCD bubble,” and the shift that happened when she understood her feared possible self—this internal fear of being negligent or careless—and how it was driving so many of her compulsions.

We also dive into how OCD started to impact her faith, bringing in scrupulosity and intrusive doubts about salvation. If you’ve ever wrestled with thoughts that feel out of alignment with what you know to be true about God, this part of her story will really resonate. Heather shares how she found grounding again, how remembering God’s faithfulness helped her re-anchor her faith, and how both therapy and truth-telling community played a key role in her healing.

Tune into the full episode to hear more of Heather’s story, how ICBT helped her reframe the way she relates to her thoughts, and how she’s now using her experience to support others.

Related Links and Resources:

www.facebook.com/HeatherVignaliLPC

IG: @heathervignalilpc

Transcript

All right, welcome to the show. Everyone. We are doing a series on personal experience with OCD, and I’m very excited about this because I know that it’s a popular topic that a lot of you look for. You’re just really wanting to hear from other people who have been in the trenches where you are, who have made the struggle to get the proper diagnosis and help for their OCD,

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 today on the show I have Heather Vignelli. She is a licensed professional counselor in serving New Jersey and New York, primarily working with adult women who are struggling with anxiety, OCD, low self esteem, relationship stress. And she’s able to offer a Christian perspective for clients who are desiring that as part of their counseling process. And she is going to share about her story today. Welcome to the show, Heather.

Heather: Thank you. Excited to be here. Thanks for having me.

Carrie: Tell us a little bit about your process of noticing OCD symptoms. Or did it start more as general anxiety? What was that like for you? Yeah,

Heather: Super funny. Kind of how it came about. I always have had sort of an underlying current of anxiety in my life. I don’t think I ever didn’t I definitely noticed that as a trend throughout my life, even as a young girl, and it wasn’t until probably I was just about a year ago. And keep in mind also, I recognize now that there were things before last year that certainly contributed to the diagnosis, but at the time, what kind of triggered it was? My daughter was in her senior year of high school, my one and only and just definitely noticing triggers kind of coming up one after another, and the end of an era I have been, of course, very close with my daughter. When she was born, I was a single mom, she was like my pride and joy. That

Carrie really speaks to OCD symptoms showing up in a time of stress and transition. So you’re preparing for launching her out into the world after you’ve spent all of these years raising her.

Heather 3:03

Oh, yeah, and I’ve had help. Of course, my mother has definitely been so helpful to me, and I actually met my husband when she was four, so he kind of came into the picture a little bit later, but for all intents and purposes, until we were married and then living together, I was very much the primary caregiver, and kind of doing it, a lot of it on my own, let’s say, when she got into her senior year, it was like, Oh my gosh, right, I’m losing my baby. There were a lot of different things that kind of came up throughout the tail end of the year, September of 2023 I noticed a little bit of an uptick in the anxiety, and I was wondering, Hmm, that’s weird. But then it wasn’t until the beginning of 2024 that I started noticing not just my stress levels going up and my anxiety going up, but also like different symptoms that I hadn’t really necessarily noticed before. One of the things that I noticed was this weird thing that my tongue would do, Huh, interesting. Okay, yeah, super weird tension in my tongue and in my jaw like a tick, not so much like a tick. It felt like my tongue was swollen and almost like it hurt, very weird. So I was doing a lot of biting on my tongue and like, trying to figure out what the heck was going on. Like, maybe I need to go to the doctor. And I knew also that my anxiety was like, kind of ticking up. And so I thought, Geez, I wonder. I’d never thought about it before, even being in the clinical world, I’m like, I wonder if this could be just a somatic symptom of anxiety. So on a whim, I just looked up anxiety and tongue issues or something like that. And it was like, anxiety tongue.

Carrie 4:38

There’s something called anxiety tongue. You’re educated now. Who

Heather 4:42

would have thought, right? And so I thought, Okay, this could be related to the anxiety I’m feeling. I certainly have a lot of triggers going on. This is kind of making sense, but it started to get very uncomfortable. Like, really uncomfortable. I felt like, anytime I was talking, I was tripping over my own phone. Felt like, oh, can people. Even understand me. Even though they could, they could totally understand me. But it was just constant as the year progressed again, triggers keep continuing to come up events, while the senior stuff comes up senior sunrise. And, you know, she was a competitive dancer. She’s still doing that, but didn’t know she was gonna continue doing that. We thought it was like her last competitions ever. So we’re like, this is the end of everything. So everything’s kind of coming in, prom, graduation, all these things are coming up. I started examining some of the thoughts that I was having. I feel like the only way that I can explain it is not so much with words, but more like gesture in my face. Like, Huh, wait, these thoughts are weird. Some

Carrie: Some of these thoughts are a little off. How did it show up? Like, what kind of things were you thinking?

Heather: I was always like, I said, very connected with my daughter, but I was noticing that I was extra worried about her safety. Some of the thoughts that I have and still do struggle with, I would not say that I am, like, fully recovered. I definitely still have some polls. I mean, it’s only been a year now since the diagnosis, but once I started recognizing the thoughts that came up. They were more about her safety and just having this feeling of impending doom anytime she left right, she started driving. Her she got her license right. She’s driving, she’s applying to college, all these things that made me feel like she was unsafe in the world. I’m thinking terrible, awful things. I mean, the worst of the worst. Do you think the worst thing? That’s what I thought. And it was constantly riddled with thoughts that something terrible was gonna happen to her, completely unwarranted.

Carrie: Did that cause you to check in on her extra often, or you’re like checking the app to see where she is or not.

Heather: Just one app, three apps, three apps. Okay, three apps. I got very creative and wound up with three apps on my phone. And my kid is great. She understands because she actually had been diagnosed with OCD at a young age. So she does understand the struggle to a degree. Of course, our themes are different, but she does understand the struggle. And so she’s very kind to me, very gracious with me. But yeah, so there were definitely things that I was noticing, not just in my thoughts, but in, like you’re saying, with what I was doing. So for years and years, I’d been checking her window every single night, without fail, like to make sure or locked, or to make sure it was locked, and we live on the ground floor of an apartment building, okay, and so I don’t think it’s out of pocket to be thinking, Oh, well, gee, probably a good thing to lock your doors. But I mean, I have bars on the doors, and it started to occur to me, it is interesting that the only window that I check at night is hers. I trust that the other windows and doors are perfectly secure, but I don’t trust even if it looks exactly the same way that I left it, I know I left it the night before, I still felt compelled to go over and check make sure there was a ritual to it, the way that my hand felt on the blinds as I peeked through to look at a certain area on the other side of the just certain things that I was like, Wow, this seems super selective and super specific. And I thought, well, that’s odd.

Carrie: Did you find yourself devoting the sensory information like icbt talks about, that’s part of the inferential confusion is that distrust to the senses. And so I’m wondering, maybe that’s why you needed three apps on your phone, because it’s like, well, what if this one app is wrong and she’s not really where the app is saying that she’s at was that kind of what it was like, like, I don’t know if I believe this one. I’ll have to pull up another one and just

Heather: Aabsolutely so yeah, with the apps, I have three different ones that check three different things. One is on her phone. One is on her car, the other one is also on her phone, but it allows me to listen to the environment. Opens up her microphone so that I can hear on my end, what’s going on. I know it makes me sound a little cuckoo, I know, but it definitely was something that I felt like I needed to have. There was an urgency to know what was going on around her, even if I knew, for all other reasons, that she was perfectly fine, that if something terrible was happening, that I would somehow know, I would somehow find out. You would hear

Carrie 9:09

the scary, mad guy on through her phone, and be able to call the police and say, I know where she’s right. She’s right over here. Sure,

Heather 9:16

even if I had just texted with her 30 minutes prior, that couldn’t just be enough for me to believe that she was okay. Yeah, I started kind of thinking, Gee, I think I need to look into this a little bit more. And it wasn’t until that point that I started really understanding what OCD was and getting a better. Started taking credits in OCD treatment or just understanding it, because I didn’t realize how very different it is from just regular run of the mill anxiety I had no idea, just did not recognize that. Now, a year later, I’ve basically redefined everything that I do, because I definitely feel called to help other people who are struggling in the same ways with OC. D. So it wasn’t until that time, though, that I started getting my own treatment, learning about OCD for myself, because I started recognizing these things in my clients, and I got the diagnosis, which later on would become meta OCD and starts to become OCD. About OCD,

Carrie 10:18

right? Yeah. Do you really have OCD? And oh gosh, are you sure you’re not just, like, faking it or making it up?

Heather 10:27

Oh, gosh, yeah. What if you’re lying to people? How awful would you be if you were lying to people? It’s been interesting, because since a year ago when I got the diagnosis, I feel like I’ve actually gone through ebbs and flows. It’s like, kind of like, there have been peaks and valleys with the experience of like, now knowing that that’s what it is, I feel like I definitely get sucked into the bubble from time to time, and it can be pretty troubling when you’re in the bubble.

Carrie 10:53

Did you find an icbt therapist? Was that something that, as you had kind of done your research, that you were wanting to do or wanting to pursue, like, how did you get to the treatment phase and kind of connect with somebody?

Heather 11:06

I had started to ponder whether this OCD, I should probably know more about what OCD is, and I took a workshop fundamentals type, okay, yeah. OCD, 101, yeah. OCD, 101, and I’m like, I need to figure out, because I think I might not only just be seeing this in myself, but I think I’m seeing it in other clients. I knew ERP was a gold standard for treatment, but literally, I think on Facebook looking for OCD providers, and I stumbled across the icbt Facebook group, and I started asking questions, and I started seeking out people that might be able to help me figure out if that’s what I’m dealing with. I had a woman reach out to me on Facebook messenger who was so gracious with me and so lovely. She’s like, everything you’re describing sounds like it’s probably an OCD type thing. You’re going to want to get yourself connected with OCD therapist. And since I was already in that group, and for anybody who is a clinician and wanting to know icbt Like that is the group to be in. It’s a wonderful group. Just amazing resource. Oh my gosh, I don’t think I’ve ever been in a Facebook group with other therapists that’s been so positive, unbelievable support. And so I put up a post and I said, Hey, I think I have OCD. I don’t know, but I would really love to meet with someone who might be able to assess and treat and so I heard back from a couple of therapists who were also in network with my insurance. Oh, that’s great, praise God. And I started work right away, did the assessments and started with icbt. And icbt really clicks for me. It’s like, really super logical, and it just kind of aligns with the way I already think,

Carrie 12:44

yeah. That’s super interesting is, I just heard that feedback from a client this week. This makes so much logical sense to me as I’m learning it, it’s like, yeah, and I’m a very logical person, and so I like that this makes logical sense. So I appreciate you saying that, because I do think that it’s connects and resonates with certain people, definitely.

Heather 13:04

So that’s how I wound up finding my icbt therapist. Unfortunately, I had to move from her to another one, because then she no longer took my insurance, but still with an icbt therapist, there

Carrie 13:16

are resources online for people to find an icbt therapist. Icbt dot online, if that’s something they’re interested in. I’m in Tennessee, and so as you’re processing that for yourself, and I think before you teach it to somebody else, you kind of have to understand it yourself. So those kind of grade that you were able to, like, kind of integrate and work without on yourself. Was there a particular like point in the process where you were like, something clicked, and you were like, oh, or it felt like this is a game changer. Because I think in the beginning, people go into the process and they’re kind of like, okay, this is nice. I’m kind of sort of getting some of this, but they’re like, how do I apply it? And there’s this, I said, okay, just hold on. Just hang in there. You got to build the foundation of the house. First you got to know and understand the concepts. You got to wrap your mind around it, then you will know how to intervene. And as you get into the later modules, of course, it gives you what to do, the intervention modules, but initial ones, you’re just assessing, and you’re building awareness. Was there a particular module or somewhere in the process, or something clicked, and you were like, oh, oh, yeah, okay.

Heather 14:16

I think it was feared possible. Self module four, okay, yeah, I was pretty early on. Everything up to that point made total sense to me. Again, this was a modality that was like, it fit right into the way that I already thought. So it was like, oh, like, That makes so much sense. Sometimes, with other modalities, it can be like, Wait, what are we doing and why? What’s the purpose? Again, where does this How does this work with icbt? I didn’t feel that way. It felt very straightforward. It felt very like easy to grasp. And I think by module four, when we really started to break down the feared possible self, that’s when I started to be like, Whoa. I definitely connect with that feared possible self that we kind of which was carelessness. This negligence. And actually, even going further, my therapist is pretty firm on it just being like bad, because carelessness is bad, negligence is bad, but this theme of carelessness and negligence definitely resonated for me. So I started, I think, at that point, looking through the lens of, oh gosh, is this like me behaving out of my real self, or my feared possible self, which we didn’t get to the real self at that point yet, but the feared self, I started to kind of examine a little bit Oh gosh. Is this coming out of this fear that I could be somebody that’s careless or negligent? And so I think it was from there that it just clicked. It was like, Oh my gosh. This has been the thing. This is why I’ve been so worried about my daughter. What if I miss something? That was always the question, what if I miss that she got into an accident? Or, what if I miss and I’m just gonna say, one of my thoughts was human trafficking. What if there’s a school shooting? Or what if, basically, what if she’s taken away? Yeah, what if I miss that, though? What if I miss something? And if I’m not on top of it and checking all the time, all the time, then I might miss it? Yeah. So that was kind of where I started to

Carrie 16:10

kind of boils down to, like, bad mom, which is, I think really fits in with that feared possible self of it’s the opposite of who you actually are like you’ve been very attentive and involved in your daughter’s life, it sounds like through school and extracurriculars and all those types of things the whole time. So it’s completely the opposite of what your actual behavior is showing you, right? So in some sense, I don’t know, it’s like this transition. There was this fear of, like, losing her forever, that maybe was a distorted from losing her to, like, launching to college or something like that, like, it’s a loss at a smaller level,

Heather 16:50

absolutely, yeah, my brain was definitely glitching out, for sure. Wasn’t the way that I was making sense of things, which is so unusual, instead of, like, if she’s not answering me, automatically, she’s dead. Yeah, automatically she must be dead. That was just the thought. I know that sounds terrible. I know that that’s probably maybe shocking for some ears, but

Carrie 17:10

that’s so OCD, right? Like, not just like, this is a possibility, but this is going to happen. Like, you know, this is the probability of what this means. It couldn’t

Heather 17:21

be that she was just busy doing a project, or that she was talking to a friend, or like it couldn’t be her phone’s on silent or something, nothing like that. Nothing normal, no normal reasoning with that. It was like

Carrie 17:33

totally obsessional. Were you able to get through all the 12 modules?

Heather 17:37

I am working through eight, and still working through them little by little. Done some 10. My therapist now does them a little bit out of order, so that’s okay with me. She also integrates a little bit of the metacognitive treatment too, which is kind of probably good for me considering the presentations. Yeah, yeah. So that’s another thing that she kind of integrates as well.

Carrie 18:02

Just started doing some metacognitive therapy with clients. It’s been an interesting side note. I’ll update people on the podcast at some point how that is, but it’s very, very different in a lot of ways from other types of therapy that I mean, there’s some integration of different things, but it really just teaches you that, hey, if you can learn to leave your thoughts alone, kind of like a dog that’s going after something and you just say, leave it. Just leave it there. Don’t engage with it, don’t try to solve it, don’t chew on it, don’t ruminate on it, don’t worry about it, let it go. And that is hard to do. And there are different exercises in metacognitive that trains you to really, like, learn how to do that and to they call it lazy mindfulness, which is interesting, but that’s hard for people with OCD, because you’re not used to being lazy, right? You’re like, no, I need to get on this hot right now. I gotta do something that’s urgent. Yeah, it’s urgent. Probably my clients that have had the most success with that, I think, have had some secondary depression along with the OCD. And so if they’re able to let some of those hopeless, worthless, negative self talk cognitions like if they’re able to let some of those go, then it helps them be able to move into more of the icbt process. So everything all if you have a good therapist, they know how to integrate these different things into it. We have people in the icbt community that use ifs parts work, some that use EMDR for trauma when appropriate. That’s another thing I think I love about this therapy, is that it integrates well with other therapies. It’s not like you can only do this one thing. It’s kind of like if somebody’s able to go in and assess and say, Hey, you might need some a little bit of this, or let’s try that and see if this can go as well. So I think that

Heather 19:45

having that ability to sort of like bob and weave in between modalities, I think if you can do it, great. I’m not trained in all of them. I’m trained in EMDR, and so that’s something that for my clients has been super beneficial, and I haven’t felt as. As inclined to use EMDR with my clients in general, probably because of the OCD that I have right as far as negligence goes, and that’s like, you know, I just want to make sure I’m doing it right. You don’t want to give my clients the best care. But once OCD kind of came onto the scene with icbd treatment, I thought, oh my gosh, this is a great way to interweave EMDR, because I have seen so many clients, myself included, who have the trauma in history that is being used. It’s like OCD hijacking that trauma and then using it as personal experience, right? Like you remember that time. Don’t forget about that time. Be negligent. Now, keep yourself safe, right? Being able to, kind of like, pause in the icbt treatment and then go to clear some memory that is being hijacked by the OCD is super cool to be able to do that with the EMDR. I think

Carrie 20:58

sometimes, once you get into modules three and four, where you’re talking about the obsessional story and really working on, okay, how do we even get to this particular theme, obsessional sequence? What consequences are we afraid of? And then when you get into that feared possible self, you’re like, Okay, now you can start to see some of that trauma bubbling up potentially, and are able to address it with EMDR. So yeah, like I said, that integration is really helpful, and EMDR is a little bit of a wild card. People have different experiences with it, and I don’t know, sometimes when people have OCD, they have a hard time really like dropping in down into their emotional experience and their body sensations, because they’re so used to problem solving and thinking things in their head, and that can be a barrier sometimes to people doing EMDR, it may take them longer, or the processing may look a little bit different. So if you tried EMDR and you’re like, it failed, for me, there’s probably you didn’t fail. It’s not a pass or fail thing, just maybe that your therapist didn’t know how to kind of tailor things towards you and finding somebody that can help you get there. I’ve had many people who feel like they’ve had failed EMDR experiences be able to process through trauma. That’s why we have other things too, parts work and all kinds of stuff, because sometimes that’s super helpful in those experiences, or helps process through those memories and time periods. I think what you’re saying, and I would echo, is really, you have to look at this holistically in terms of OCD treatment. People are not cookie cutter. They’re very different. I will never get bored specializing in OCD like never, because each person has different nuances. You could have 10 people who are compulsively washing their hands, and they will be compulsively washing their hands for 10 different reasons, and you really have to get in there and figure out what’s going on and what’s the story, and how did we get to this point, in order to figure out how to tailor their treatment plan in such a way that, unfortunately, we have these therapeutic tools and modules to help us be able to have some structure surrounding that. Because I do believe structure is helpful and important, while also knowing how to utilize that for the individual. I think in the past, in my earlier days of therapy, I was much more of like, oh, okay, step one of the therapy says this, like, we need to do step one. And now that I’ve been doing therapy a lot longer, I’m like, okay, and this is what the therapy is saying, and this person’s step one is gonna look like this, and this person’s step one might look a little bit different, and that’s okay, yep, we’re just gonna go with it, kind of depending on what they bring in and how the flow happens, might

Speaker 1 23:41

have to go back to something else. How would you say this

Carrie 23:45

has impacted your faith? Or have you struggled with, why can’t I seem to just let go, or why can’t I seem to trust God with this? So did any of those things come up for you?

Heather 23:55

So funny, once I got the diagnosis, I think again, there was definitely obsessions over obsessions. It wound up starting to attack things that it had never attacked before. One of them was my faith. So there was a scrupulosity piece that definitely showed up on the scene. There was a lot of like, wow, what if you’re not saved? How do you know you’re saved? All these questions of true faith. I mean, right, as Christians, like, I mean, that’s what we stand on. It’s like salvation. The fact that the OECD, again was hijacking something super important to me, was cause for concern and felt really urgent. And I think as Christians, we can all agree that salvation is urgent and important. Yeah, super important. I think that it did kind of cause a little bit of like a toggling back and forth between, like, knowing and then questioning, right? Knowing the truth like you’ve never doubted this before. You’ve been a believer for how many years, and now, all of a sudden, it’s being hijacked. That’s odd, right? Yeah, there was a lot of scrupulosity that started to kind of play in, which then, yeah. It kind of broke down a little bit of my natural ability to sort of just lean into the Lord and trust that he has me don’t have to be overthinking this. It did kind of break that down a little bit right. Since then, I’ve done some work to kind of get out of that bubble, to kind of like bring myself back to reality, on it, and to not be ruminating on it, because I

Carrie 25:25

think that’s vague for people. Like, how do I sink into the reality of my faith? Because it is unseen. I always say faith requires faith. What does the reality of your faith look like? Like? Did you pinpoint certain times in your life? Like, Oh, I know God was at that time point. Or

Heather 25:40

I definitely was doing a look back on those kinds of moments when it was like, okay, clearly I don’t have to worry about this, because even at that time, I wasn’t even thinking about how God had me and was securing me, but he did. So those moments definitely helped, and I did lean into my pastor, which my therapist gave me permission to do that. She was like, one time you can go the one conversation you may have. And so I did that was very helpful to me, to just get some reassurance that that I already knew what I knew. So that’s the tricky part about OCD, I feel like, is we forget that we know what we know. We forget to keep our eyes on the things that we know for sure because we’ve seen it. I think that a lot of people that I speak to have had experiences or encounters with the Lord, right? People that are Christians, that are believers, right? They’ve had those experiences or encounters with the Lord, and I think that when they look back at those moments, it’s like it’s undeniable. So we have to remember to look at that as truth. I think there’s

Carrie 26:42

so much power, and that’s why the Bible talks to us about remembering so much, even in the Old Testament where it went through, I’m the God of Abraham, Isaac and Jacob. You remember these people? Remember these guys, remember these heroes of the faith. You’re a part of that lineage. And I am still here, like I am, still I am, yeah,

Heather 27:00

so definitely keeping those things in mind, remembering those things, and then, of course, having that conversation with my pastor was certainly help to me. And also just recognizing that God isn’t the author of confusion. I wouldn’t be sitting here confused if this was something that was God ordained, right? Like, that’s not God. So knowing to kind of pull away from that, because I already know that this could not be from God, yeah.

Carrie 27:25

And so that helped you, almost like, disengage from some of those thoughts, thought processes,

Heather 27:29

correct, I would say, if anything, though, the one thing that wound up kind of coming from it is that it did strengthen my relationship with the Lord in a big way, just kind of feeling the closeness like he’s like, I’m a year like, I got you. I’m right here. So I think that out of all the nightmarish parts of sort of wrestling with OCD, the one thing that I can say that’s been kind of a blessing out of the muck OCD is just that the relationship with God has been strengthened as

Carrie 28:01

we kind of wrap things up. Is there anything else that you would want to say to people just who are struggling and they’re Christians with OCD and they just feel like maybe they’re at a really low point or a really bad point, like, what would you want them to know or to take away from this conversation? It

Heather 28:16

doesn’t have to look like this. Okay? Stay this way, right? You don’t have to be trapped in the OCD bubble all the time. There can be relief from it. And for me, I think that’s always gonna be best with God. So yes, there’s gonna be a mental health component. In my personal opinion, I feel very strongly that, yes, we have spiritual components to who we are. We’re living in a spiritual world, yes, but there’s also a mental health component. Especially when it comes to OCD, there’s a mental health component. And so I would caution anyone like you, don’t have to handle it on your own. This isn’t something that you have to pray about. It absolutely lean into the Lord for help with it, yes, but you can get treatment from a therapist that will help you to actually deal with what is happening in your brain. It is a glitch in the brain. I really do strongly feel like there can be help for that. You know, not just spiritual, but mental health wise.

Carrie 29:11

Yeah, that’s right, beautiful. Thank you for sharing with us today. I know that this is going to be encouraging and a hopeful story to share with people.

174. Is ICBT Right for Me? How Do I Know?

Written by Carrie Bock on May 21, 2025. Posted in OCD, Podcast Episode.

In this episode, Carrie explores whether inference-based cognitive behavioral therapy (ICBT) is a good fit for individuals struggling with OCD—especially those who haven’t found success with exposure and response prevention (ERP).

Episode Highlights:

The key differences between ERP and ICBT, and why ICBT may be a better fit for certain individuals with OCD.
How ICBT helps unpack the reasoning behind obsessions rather than just managing behaviors.
Why ICBT can be especially valuable for Christians seeking faith-sensitive OCD treatment.
The limitations and challenges of ERP, including dropout rates and religious exposure concerns.
What it takes to succeed with ICBT, including a willingness to deeply engage with the learning and healing process.

Episode Summary:

If you’ve been listening to the podcast for a bit, you’ve probably heard me bring up ICBT—Inference-Based Cognitive Behavioral Therapy. And maybe at some point you’ve thought, “Hmm… should I be looking into that?” Or maybe you’ve heard over and over that ERP is the gold standard for OCD treatment and thought, “Okay, but what if it’s not working for me? Then what?”

You’re not the only one asking that. I’ve sat with so many clients—strong believers, committed to healing—who’ve tried ERP and walked away feeling like something was missing. Maybe it helped for a bit, or in session it seemed manageable, but day-to-day it just didn’t stick. Sometimes the approach just didn’t fit with their personality, or even worse—it didn’t feel in line with their faith. And let me be clear: ERP has helped a lot of people, and I absolutely respect that. But it’s not a one-size-fits-all solution. If you’ve felt discouraged or even a little defeated by it, I want you to know: you are not broken. You’re not a failure. You just might need a different path.

In this episode, I start breaking down some of the key ways ICBT differs from ERP—not just in method, but in mindset. We look at the reasoning behind obsessions instead of just sitting with them. We explore how OCD uses facts out of context and hijacks your thought process, and how, through ICBT, you can begin to untangle that web with clarity and confidence. We also talk about why certain types of exposures may actually feel wrong to you—not because you’re avoiding healing, but because they don’t align with your core values and beliefs.

If you’re someone who wants more than just “sit with the anxiety,” if you’re a thinker, a feeler, a person of faith—then ICBT might be the thing you’ve been hoping for but didn’t know existed.

Now, I’m just scratching the surface here.

To really understand if ICBT is the right fit for you, go listen to the full episode. I’ll walk you through four key signs this approach might be what you need—especially if you’ve tried ERP and still feel stuck, overwhelmed, or conflicted about the process.

You don’t have to stay in that place. You don’t have to choose between healing and your faith. There is a path forward—and I’d be honored to walk it with you.

Transcript

Hello, OCD Warriors. I know that many of you have been hanging around the podcast for a little while, and you hear us talk about inference based cognitive behavioral therapy and you’re thinking, I am just not sure about all this, because on the one hand I hear a lot of people say exposure and response prevention.

That’s a treatment that I should be using. That’s what I should be going after. It’s called the gold standard for OCD treatment. How do I know if ICBT is really right for me, or I didn’t even know what either of those things mean?

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.

If you are completely new to OCD therapy and you’re trying to find treatment options, this will be a great podcast episode for you. Or if you’ve been around for a little while and you just, maybe you’re looking at trying something different, but need to know if it’s legit or is a good fit for you, then this episode is for you as well.

I’m gonna break down a four points of how you know if ICBT is right for you. The first one is maybe you’ve been through ERP and you just haven’t seen the results that you’re wanting. So if you aren’t familiar with exposure and response prevention, this is a common first line of defense for OCD treatment.

ERP is actually based on behaviorism and concepts of habituation. Now you have to understand that ERP was originally created for phobias. We create this exposure hierarchy for someone who is afraid of spiders and. First we show them a picture of a spider, and then we have maybe them and a spider and aerium on the other side of the room, and then we get slowly closer to it, and then by the end of treatment, this is not happening all at once.

Obviously, it’s a slow and steady process for people as they get more and more used to the spider and their anxiety level comes down, then maybe at the very end of the exposure hierarchy. You would have someone like hold a spider. So this is just an example for treating a phobia. However, it was then adapted for OCD, and there’s some problems with that because OCD is different than a phobia.

Phobias might develop as a result of negative past experiences or a belief that someone has something maybe that they’ve been told. OCD is a lot more complex reasoning process. When you come to work with as many people that are dealing with OCD as I have, and you listen to their obsessional reasoning process, you’re like, oh yeah, in OCD land.

Like that makes sense. Like I understand how you got to that conclusion. And what we’re doing in ICBT that I do is we’re rewinding, dismantling understanding. That reasoning process of how you got from point A to point B to where the compulsion now makes sense. And if we can unravel that and slow it down and understand it, then we can essentially help you rewire the way that you’re thinking about life and how to get back in a non obsessional reasoning process, which you use all the time when you’re not in the midst of OCD.

Back again to ERP. ’cause I’m trying to help you understand the differences between how someone with ERP is approaching OCD versus someone’s using ICBT is approaching OCD. For ERP, they’re really focused on waiting out the anxiety. So they would say, have the obsession. Sit with uncertainty. Sit with the anxiety that comes up when you have that obsession.

Don’t try to fight it. Just let it be there. Sit with the anxiety. Don’t do anything about it. Don’t try to deep breathe through it. Don’t try to resolve it. Don’t try to argue with it. Literally, just let it lie. As you do that, that anxiety level is going to come down. So you’re trying to interrupt this obsessive compulsive loop, and that anxiety is in the middle.

When you have the compulsion, there’s a little bit of relief, but actually the act of doing the compulsion just strengthens the obsession. That’s the obsession compulsive cycle in a nutshell. What I find seeing people who have worked with an ERP therapist and then have come to me, is that some of them actually made some good progress in ERP therapy while they were in it.

Okay. Some of them will tell me, yeah, I could do the exposures in session when I was with my therapist. But then once I got outside of session and I was living in my own day-to-day life, it was a lot harder for me to follow through on that. And you know how challenging that can be if you’ve been in therapy.

When your therapist says, Hey, go do the thing. And you’re like, I know I was supposed to do the thing this week and I didn’t do it, and then there’s that feeling of failure. Maybe that comes up and hopefully you have a good relationship with your therapist where you can kind of work through that stuff and say, okay, let’s kind of pull back, figure this out.

Regroup. It’s okay. Start over. That’s all right. If you have a good therapist, there’s a lot of grace and there’s a lot of compassion, a lot of understanding, and also a lot of slight kicks in the butt occasionally too, right? Like there’s this balance of being really compassionate and also trying to push people towards change and growth.

I used to have a supervisor that says it’s a little holding and a little hitting. We don’t actually hit anybody just for the record. Or maybe you’ve had some ERP therapy before and you felt like, yeah, I could do the smaller exposures, but I just didn’t feel like I could do the larger exposures for other people.

I’ve heard them say everything just feels like a 10. I just don’t feel like I can do any of it. And so there’s all these just different challenges that can come with it. ERP has about a 20% dropout rate. There are a lot of people that are just quite frankly, afraid of the therapy. Obviously, we don’t want people to be afraid of the therapy if it’s something that they need.

So this is a challenge that this community has, right? It’s like there’s a lot of people that have heard ERP is really scary. It’s really hard, and they’re like, oh no, I can’t do it. I’m not gonna do that. You have about 20% of people who start and then drop out and. According to the book, resolving OCD, he has some stats in there.

And now this is a self-help ICBT workbook that 60 to 70% of people who go through the ERP do see some level of improvement of symptoms, but 30 to 40% do not. Well, of course you feel a little bit rough if you’re in that 30 to 40% category because. Okay. I was like told this is the gold standard here. Right?

And I’m not getting better. That’s a really big blow. And you probably paid a bit of money to get that therapy. ’cause a lot of times those therapists don’t take insurance to deal with OCD. There are various factors, of course. Um, the training of the therapist, did they just start practicing this particular modality?

Have they been doing it for a little while? Your level of severity is that matched with their level of training. And then 60 to 70% of people that go through ERP 40 to 50% of those will see complete remission. So let’s start back with and say we have a room full of a hundred people that are gonna go through ERP.

I’m not even gonna count the dropouts at this point. Okay. So putting the dropouts aside, the people that actually went through completed ERP therapy, a hundred people 65 are gonna get better. That’s 60 to 70%. I just cut it in half. 65, let’s say, of the people get better. 45% of those people would be 29 out of our original a hundred who are in full remission.

Yikes. 29 out of a hundred. I mean, we do have to understand that OCD is a chronic condition that waxes and wanes throughout lifetime. We know people are often gonna have some level of obsessions that are coming in their mind, but the issue that I have is that people have been told in the OCD community, there is only one right way to go about treatment, and that’s something that I really take issue with because it’s just not true.

It is fair to say that ERP has probably been researched the most. It’s been around longer than ICBT, and so there has been more research done around it. Icbt has had some research as well, and you’re certainly welcome to look at Icbt online. There are scientific papers on there if you were into reading those.

I’m not super into reading research because for me, research is a very artificial level of environment and they’re often treating one thing, whereas people come to me with multiple different issues. Often it’s not just that they have OCD. They also have relationship issues, and they have family of origin issues, or they have had significant trauma that’s feeding into the OCD, et cetera, et cetera.

This is just a carry thing probably. I don’t find studies incredibly helpful because a lot of people get ruled out before they ever make it into the study. And I don’t say this to disparage anyone from engaging in exposure and response prevention because it has helped hundreds and thousands of people who would otherwise still be suffering.

And so if you are one of those people that I. Has really benefited from it, and you believe that’s what you need to continue doing and that’s your conviction, then by all means, keep doing that and keep working towards your recovery in a way that works for you. What I would wanna say is that for anybody out there that is feeling hopeless.

Or feeling like, you know what? I have been through multiple rounds of ERP. I’ve been through maybe a therapist that was less experienced, and then I went out and found a therapist with even more experience in ERP, and I just feel like I’ve kind of been there, done that, and I’m not better, or I’m really having challenges with it.

I would say don’t live in shame or don’t feel like. Oh, I’m just a person that’s hopeless and I’m not gonna be able to be helped. That is not true at all, and we’ve seen some great success with people that have done ERP and then learned ICBT, and they’ve been able to just approach their treatment differently in a way that was more helpful or more tailored to them.

All right. Point number two is that ICBT may be right for you if you don’t wanna expose yourself due to the content of your obsessions. Now for things like Scrupulosity or something where you’re having to do a lot of imaginal script writing, and this is a challenge that we have, and Dr. Connie Hanney and I talked about this a few episodes back about the hope for Scrupulosity is that these imaginal script writings cause people to write down things that are not true about themselves, that are not true about God.

Imaginal scripts about going to hell or God being angry with him, and it just doesn’t really seem to align with our faith. Imaginal script writing might occur for people in other areas like homosexual OCD or pedophilia OCD. Maybe there is a exposure and response prevention therapist that is telling you to do certain things.

That go against your faith system that are not providing faith sensitive exposure. So they may say, well, go ahead and look at that homosexual porn. Or, go ahead, you’re afraid of lusting. Go ahead and look at that pornography. I’ve talked about this before, but the International OCD Foundation, which is a secular organization by the way, actually has really great information on their website about doing religiously sensitive exposures.

So they do talk about how your exposure should not be going against your faith. They do really encourage their clinicians that aren’t familiar with someone else’s faith to really consult with their pastor, priest, et cetera, whoever their religious leader is for guidance on what’s appropriate as far as exposure.

So I do really appreciate that coming from a secular organization, however. My experience in talking with people is that some Christians have been asked to do things in ERP that were not religiously sensitive exposure. So if that’s you, talk with your therapist about that, maybe guide them in a certain direction or.

Just get out of there. If your discernment alarm is going off, God gives that to you for a reason that, Hey, I don’t need to be doing this. Even if you are using ERP for something like contamination and fear surrounding getting sick, I hear about people in ERP who are doing things like eating gummy bears off of a toilet seat.

I understand the concept of habituation and not being afraid to do certain things, and I understand at some level that some of these exposures are kind of like really meant to be over the top in order to test the anxiety. So if I’m super anxious about this and I tell myself I’m gonna get sick, and then I do the thing.

I don’t get sick. Then that kind of tells your body like you are, okay, but when are you ever gonna need to do that in your real life? You are not. So my clients are not having to do weird things like touch the trash or, and lick their hand or eat gummy bears off of the toilet seat. Or do something and then not wash their hands in ICBT.

You get to live your everyday life. Like that’s what we want people to move towards is to reason in a way where you can go about your day-to-day life like someone would who doesn’t have OCD. I’m not asking you to do anything like over the top third point ICBT might be right for you. If you are looking to examine the logic behind your OCD reasoning process.

ERP is really focused on just the behaviorism aspect. Have the obsession, let it be there. Don’t engage in the compulsion, wait out the anxiety, sit with the uncertainty. It’s not really focused on how you got to where you are and really getting at what I feel like is the root issues. So when someone’s theme shifts, then it’s like they’re having exposed themselves to a whole host of new things.

Right. And it doesn’t seem to me, is just what I’ve seen from others that have had ERP. It doesn’t seem like the habituation follows through with the different themes. So it’s like if someone starts out with a contamination, they do some ERP around that, they get some type of bearing, but then it shifts over into relationship rumination.

I. They’re just really at a loss about how to deal with that, because it seems like such a completely different thing. You went from a tangible compulsion, maybe to an intangible compulsion like rumination or reassurance seeking something like that. Whereas with contamination, it was a lot about avoidance or washing hands, doing just very tangible type things.

With ICBT, I have a lot of clients who are very logical thinkers and they’re problem solvers. They think on things at a very deep level, and they like this idea of, let’s examine the reasoning process of how I got to this place in the first place. How did I get to the point where doing all of these compulsions makes sense, even though I know it completely defies common sense?

Or this is something like I quote shouldn’t be hung up on, like, why am I so hung up on this? Because it produces a lot of shame. But then when you go through the initial modules of ICBT and you break it down. I’ve had clients say, wow, this just feels really validating because I just thought I was being ridiculous this whole time.

And now I realize like how OCD is using things like facts to support its argument. I’m sure that you know all kinds of facts about whatever your theme is because you’ve Googled it or you’ve talked to people or you’ve looked it up. I mean, you’ve thought it to death. What ICBT does is we’re not trying to argue with it.

We’re just really trying to understand it, understand how you came to this point, and then, like I said earlier, just unwinding that and going, okay, how is this inferential confusion process? Different from how I reason and make decisions about other things. Like someone will say, well, I’m really concerned about catching the flu this season.

And I mean, there could be flu particles on this shopping cart, or there could be flu particles on that door handle. And you say, okay, well, but there’s a lot of things that you’re not necessarily concerned about contracting, maybe. Someone that has these types of concerns, they probably can tell me statistics about how long the flu virus lives on something, what it takes to kill it.

And OCD will use these little facts to support its ideas about a situation. And I always say you can’t argue with the facts. There’s no point in trying to argue with them. I would say that we can identify most of the time that the facts are completely outta context. They don’t necessarily have to do with your specific situation.

OCD also uses a lot of personal experience to support its ideas and claims. Well, we can’t really argue with something that happened to you. It happened to you and it was probably bad, and you probably don’t want it to happen again. The thing is that now OCDs hopped on that and has gone way overboard in trying to prevent the bad thing from having.

ERP isn’t necessarily looking at where these intrusive thoughts are coming from other than to say, they would probably say, Hey, OCD latches onto things that are important to you that you value. We definitely agree with that, but ICBT says, these intrusive thoughts aren’t as random as you think that they are, that they come from somewhere.

They don’t just originate out of nowhere. They aren’t as random. Maybe as we have believed in the past that they were. My last point is that ICBT might be right for you if you are willing to immerse yourself in the work. And I specifically used the word immerse for a reason, because there is a lot to learn.

There is a lot to pieces to put together. And someone made a really good analogy recently in our Facebook group for clinicians about how it’s kinda like a puzzle. You’re not even sure what it’s gonna look like. You don’t necessarily have the picture in front of you, and you’re putting these little pieces together.

In the beginning, you may not necessarily see how they fit and then. A couple pieces come together, it’s like, oh, okay. I could see that, but I’m not really sure how that fits in with over here. But then over time, as you continue to put those pieces in, things become clearer and clearer. I usually tell the folks in Christian’s learning ICBT that it’s like building a bicycle and then learning how to ride it.

You have to have all of these pieces, and then you have to understand how they work together, and then you have to actually put it into action, like the action behind it of riding the bicycle. It’s not an easy therapy. It’s not like, oh, hey, here’s 12 steps to your whole new life. You really have to. Learn it, digest it, and then there’s different layers of understanding to it.

And I think even for me practicing it and teaching it to others, like I’m continually growing in my knowledge. We just had two self-help books for ICBT come out that have honestly blown our minds because it’s all of the same information. It’s just communicated differently than we’ve had it before. If you want to look those up, they are resolving OCD volume one and resolving OCD volume two.

You can buy them on Amazon. They’re quite huge. It’s a lot to go through on your own. You might just be kind of intimidated and not wanna open the book just by looking at how big it is. I wish that they were a little bit simpler, maybe, and easier in terms of how they look, but. They’re designed to be pretty comprehensive for you to digest on your own or to go through with a therapist, especially if you’ve been in OCD land for a while and your OCD is untreated and it’s pretty severe, it’s gonna take you a lot of work to get out of it.

Either way, I don’t care if you use ERP or if you use. ICBT. If you have a high Y box two score, you’re either gonna need some intensive treatment or you’re really going in there and hitting it hard. Or you are gonna need some extended time to really digest the stuff. Know it, to learn it. Repetition, like repetition, repetition.

When I teach this material, anybody that’s kind of been in there with me would tell you, Carrie does a lot of review. She repeats some things. She shows you the exact same slide and maybe says it in a little bit different way, or says, Hey, remember this slide and how we talked about this. Here’s another example of how this shows up.

Hopefully this gives you a little bit more information and a little bit more of an idea about whether or not you feel like ICBT is right for you. I think with any OCD treatment you have to be ready to do the work. ’cause like I said, it’s not easy. It is work. I’m not gonna sugarcoat that for you. I’m not gonna say, oh yeah, in six weeks you’ll have a whole new life and new you and you just won’t be obsessing anymore.

Not saying that, I realize we’re in a microwave society and we want it better, faster now. I often have to tell my students, slow down. Learn the material, it will come take one step at a time. If you want to join Christian’s learning ICBT, we have it out now as a fully self-help product where you can go through it in 12 weeks.

You will have six months access to it. So if you wanna do one lesson every other week, that’s a possibility for you as well, certainly. But you can go through all 12 modules. At your own pace, or you can add it in addition to seeing a therapist, just to deepen your knowledge base. And if you feel like you want more coaching and more support, you can certainly join us in the fall in mid August.

I’m gonna start teaching those live. So if you think it would help you to have the accountability, it’s gonna be Mondays at 4:00 PM Central Standard Time, and all of this information is going to be at careba.com/training. We’ll put that for you in the show notes. Whatever you decide to do for your OCD recovery, when you are ready to dive in and do the work, just remember that there is always hope in Jesus Christ.

God loves you very much. And desires peace over all of you, and that is what I am praying for you. 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.

173. Who Are You Really? Discovering Your Real Self with Angela Henry, LCSW

Written by Carrie Bock on May 14, 2025. Posted in OCD, Podcast Episode.

In this episode, Carrie sits down with Angela Henry, LCSW, a therapist in private practice based in Northern Indiana, to discuss her journey into OCD treatment, the integration of faith in therapy, and how Inference-Based Cognitive Behavioral Therapy (ICBT) is transforming lives—especially for Christians struggling with OCD and scrupulosity.

Episode Highlights:

What the “feared possible self” is and how it’s quietly shaping your compulsions
Why OCD recovery isn’t just about symptom relief—it’s about reclaiming your identity
How ICBT helps Christians reconnect with the truth of who God says they are
What makes ICBT a powerful, research-based alternative to ERP—especially for Christians with scrupulosity
Why it’s okay to keep your values—and drop the fear that’s twisting them
Practical ways to integrate faith into the recovery process, even when religious practices have become tangled with fear

Episode Summary:

Have you ever felt like you’re living under a weight that isn’t really you?

In this episode, I sit down with Angela Henry, an OCD specialist and Christian therapist, to explore the powerful concepts behind Inference-Based Cognitive Behavioral Therapy (ICBT)—and how it helps uncover the real self God created you to be.

Angela shares her faith-led journey into OCD treatment and how the concept of the feared possible self resonates deeply with those battling OCD, anxiety, trauma, and scrupulosity.

We also dive into how OCD often hijacks Christian values like excellence or devotion and twists them into compulsions driven by fear.

We talk about what it looks like to drop OCD while keeping your God-given values, how to trust your internal sense data as one way God communicates with us, and why identity work is central to healing—not just symptom relief.

You’ll hear stories from Angela’s clinical experience, a moving mirror-based real-self exercise, and how discovering your real self can be a spiritual breakthrough as much as a therapeutic one.

If OCD has convinced you that you’re a danger, a disappointment, or spiritually defective… if you’re exhausted from trying to earn God’s approval through compulsive prayers or mental checking… this episode is for you.

Related Links and Resources:

angelahenrylcsw.com

Transcript

Carrie: Welcome, Angela. Can you tell us a little bit about yourself?

Angela: Sure. My name is Angela Henry, and I am in private practice in Northern Indiana, and my practice primarily focuses on OCD, anxiety, Tourette syndrome, pans, pandas, and BRBs. As well as a little bit of trauma work. When I first started, I worked primarily with children and adolescents, and now I’ve kind of moved into seeing some adults as well.

Carrie: You can make those shifts and changes when you have your own business, so that’s helpful to know. Tell us, how’d you get into like OCD work? And this is a specialty.

Angela: That’s kind of a funny thing because I kind of feel, and this is kind of where my faith journey can come in too, is I didn’t go searching for OCD.

It actually found me before I went into private practice, I worked in a pediatric multi-specialty clinic and I worked again primarily with pediatrics and teens. And did a lot of autism work, a lot of A DHD, non-medication work counseling and social skill development, different things like that. And then when I went into private practice, I noticed a lot of people started coming to me that had OCD.

And so I started educating myself and went to BTTI, and that’s a whole story how I got to BTTI too. I don’t know if you wanna hear it, but it’s just such a cool thing. I’ll try to nutshell it a little bit, but this email came across that they were giving out some free scholarships to BTTI. It’s the Behavioral Institute for OCD through the I-O-C-D-F.

And I just thought I’m supposed to apply for this scholarship, and I just had a peace in my heart that I was gonna get it. I had no clue. They just wanted more skilled professionals in the Midwest. And so I applied for it and I got into the BTTI and I felt so honored. And at that point, I really didn’t know a whole lot about OCD, but I knew that I needed specialized training.

I had already gone for specialized training for Tourette syndrome through the pediatric specialty clinic that I worked with. And so I had OCD, what am I trying to think of? Training. And then I had the Tourette’s training, and it kind of all comes together where eventually people with OCD were coming to me, but then I learned about pans and pandas.

We’ve had an

Carrie: episode on that before. It’s been a little while, but yeah, it can cause what looks like sudden OCD symptoms.

Angela: I felt like God was really equipping me all this journey of having specialized training to treat Tourette’s, and then the specialized training to treat OCD and then again working with peds and all the specialties that come with that.

It just formed a really nice package for me to be able to treat a lot of these kiddos. Not just with OCD, but again with ticks and the Pans Pandas presentation. Long story short, I didn’t go searching for OCD. It came knocking at my door, and so I knew I needed to get extra help to know how to treat these people in my area.

There’s not a lot of people who treat OCD either. There’s just maybe almost less than a handful.

Carrie: That definitely makes sense then, and I think falls in line with what I hear from a lot of people in different parts of the US is it can be hard for them to find specialized therapists. But today we’re having a conversation about ICBT and this sense of the feared possible self versus the real self and how that connects to Christianity.

So how long have you been using ICBT in your practice?

Angela: Well, I was one of those early people that adapted it. And one of the early Friday people when there was just a handful of us on the screen talking about this new modality and how can we use it. And interestingly, as I was learning and becoming more specialized in OCD and going through the BTTI and learning how to treat OCD is when I actually started learning about ICVT too.

I felt like I was really going through a doctorate in OCD learning, ERP learning, ICBT. The original thing I think that happened was I’m A-E-M-D-R certified therapist as well, and I think I had made some comments maybe in some different Facebook groups on EMDR, and at that point it wasn’t well received.

It’s still

Carrie: not in some circles depending on who you talk to.

Angela: Right. And I remember Bronwyn and I didn’t know who she was at all reaching out to me and talking just briefly through text about her experience as well. I can’t remember if it was her that told me about ICBT because we came in to the Facebook group around like I think a week apart or so.

Or maybe it was Carl. I can’t remember who it was, but I reached out to Carl, and Carl sent me a special invite because you had to go to the Facebook group through a special invitation.

Carrie: It wasn’t just open to any clinicians or anything like that, right?

Angela: Yeah. So I joined that group and it just seemed to make a lot of sense to me.

The more it made sense, the more I wanted to invest in really consuming it and trying to understand and make it accessible to the clients that I was serving too.

Carrie: Yeah, and I think there is a ease in from, if you’re coming from the EMDR world, and we’re talking about kind of getting down to the root of the trauma and trying to clear out earlier traumas that are contributing to present anxieties and other symptomologies that people are experiencing.

For me, I was seeing a lot of people with anxiety and I started to apply some of the things that I was doing with OCD in terms of EMDR and then had some specialty E-M-D-R-O-C-D trainings. But before I knew what the feared possible self was, that was what I was going after with EMDR. I just didn’t have the language for it.

I didn’t know, but I would say there’s something underneath all of these. Symptoms and people’s lack of confidence to be able to engage in treatment or deal with the symptomology that they were experiencing. And these were, I would say, lighter cases of people suffering from OCD. I wasn’t working at that time with people that had more severe.

Symptomology like I am now. But I think that sometimes there’s more than one way to get at what you’re working on in terms therapeutically. But I like that ICBT has definitely way more research around it than EMDR. With OCD, I think that they need a little bit more kind of beef up in that department, but this is a great opportunity and option for people who are looking for evidence-based research treatment practices.

For OCD,

Angela: it pairs nicely. With my belief system, with my faith, and as you know, we can’t just talk about our faith in sessions unless the client brings it up first, but it’s something that I feel like I can use my faith and belief in a way that really resonates with ICBT and how I view people the world.

In terms of the feared self, it’s kind of funny because I’ve gotten a chance to do some presentations with some different colleagues, and it seems like I’m typically asked to do either the feared self or the real self, and I love that they feel confident with me doing those pieces because. Out of ICBT.

I mean, there’s a lot of great things that I love about ICBT, but that feared possible self and the real self just really hit it home. We know that there’s a difference between the feared possible self and there’s a vulnerable self, which all of us hold. And then there’s the feared possible self, which is specific to OCD.

Carrie: How do you define the feared possible self to clients?

Angela: So the feared possible self, how I define that is. It’s this feared possibility of who you might become if you’re not following the directions of OCD and the compulsions that it’s asking you to do. It’s this feared version of yourself that OCD makes you feel might be possible.

I. So, of course people with OCD are going to want to do those compulsions because they would never wanna be that version that OCD makes up about who they could become or who they might be. And I think that all of us have a piece of that in the overarching, what did we call it? Yeah, vulnerable.

Absolutely. We humans are vulnerable to so many different things. I think that’s one of Satan’s tricks is that if he can have us question ourself, have us look at ourself and take who we really are, which is our real self, who is in my belief system, who God made us to be, who we’re supposed to be walking in light of who God made us.

But if Satan can have us look at those things and tweak it. And send it off one or two degrees, and then we are living in this feared, possible version of ourself.

Carrie: Yeah. It’s like you end up doubting your true identity Absolutely. Is what you’re saying. Yeah.

Angela: And then we end up walking in such a different path than what we were meant to be created for.

You might have been supposed to be living in Paris or walking in light of one version of yourself, but then you end up way off course and living in Africa because he likes to take things and just move it off a few degrees, and then it disrupts our course and how we were meant to be living.

Carrie: I think that’s a beautiful thing about OCD treatment is it can lead you back towards a authentic practice of your faith because you’re not living in that state of intense fear anymore.

I was thinking about like there’s no fear in love. So if we have our identity and the love of God that how God sees us, then we’re not gonna be stuck in that place of fear. And I think that’s the goal for Christians who are struggling with OCD. Totally agree. That’s a beautiful way to say that. There’s an opposition to this feared self of who?

That’s the lie You buy the lie that OCD cells of, Hey, if you just do these things, then you’ll be considered a careful person versus a careless person or. You’ll be a devoted follower versus someone who doesn’t really care about their faith, and then you’re engaging in all of these extra maybe religious compulsions, or you’re doing extra checking to not be careless.

Angela: And especially when it comes to scrupulosity. You can look at that and you can say, either I’m at a moral crossroads and I don’t know what I believe anymore. Or it’s OCD because we have this knowing, and I think in ICBT when we’re talking about direct evidence and we’re talking about our internal sense information, our internal desires and intentions.

Yeah, that’s huge. That to me, that’s just one way that God speaks to us. He’s always speaking to us. He’s always giving us information. He gives us information through our five senses. He gives us information through our internal desires and intentions, and again, the real authentic self, who we really are, who he created us to be.

OCD wants to diminish that. It wants to have us not be in line with the things that we know, and then we end up going against the things that we know and how God is speaking to us and we move in a different direction because that feared possible self seems so real and so true. Yeah. And so that can be so scary.

OCD definitely. It’s a doubting disorder. It’s a distrust of self disorder and instead of trusting in who we know we are. Our real authentic self. I think sometimes we outsource. We outsource our trust and we put the trust in compulsions to keep us safe. And it’s really like needing to lasso that trust back and bring it back to ourself where it was really meant to be all along.

’cause God gives that to us. Yeah,

Carrie: it’s like putting your trust in God and what he’s shown you. Like in terms of the sense data and the internal sense data, instead of putting it in, I’m gonna take control. I’m gonna take the reins, I’m gonna fix this and make it so that I don’t ever become that feared self.

I’ve noticed it’s really hard, this concept of perfectionism. I. Within Christianity, there can be this fine line where we’re trying super hard to be someone that we believe God is going to accept, versus the reverse of that is saying, I’m already accepted. I’m already fully loved what Jesus died for me, that has made the difference and now I can live out of that.

It’s a complete transverse of the way a lot of people are looking at things.

Angela: I love that you’re bringing that up, Carrie, because I remember talking about this in consultation with Dr. Artema. It was a case with ringworm, but how people can keep their desire for excellence, to do things excellently, to do things to the best of their ability.

Those are values. Values that God finds pleasing. He wants us to do anything that we do. He wants us to do the best that we can so that it gives him glory. But then OCD takes a hold of that and rearranges it, and it’s off kilter again. It’s changed the degrees, so it was meant to be here, but then it ends up someplace else when OCD kind of taps the shoulder of it.

I remember Dr. Artemis saying, you can keep your values. That’s okay. You can keep your values and you can drop OCD.

Carrie: That’s great. I think that’s really good for a lot of people to hear.

Angela: They’re mutually exclusive, right? Right. They’re not the same. They’re very different. So you can keep your values of wanting to do things with excellence or doing things well and drop the OCD.

That’s really good.

Carrie: At some level, there has to be this acceptance or understanding that we’re not perfect and we’re not going to get it perfectly, and the acceptance that part of that real self as a Christian is a forgiven self and a self that is in process not done yet. And continuing to go and like, I’m gonna mess it up and I’m going to have to ask for forgiveness, and that’s okay.

That’s part of a healthy process. Let’s talk a little bit about like kind of when you’re helping people get in touch with their real self. A lot of times what clients will tell us is, well, but I’m not that way all the time, or I don’t know if I can really identify with what these activities are showing me.

Talk to us a little bit about that. It’s kind of maybe hard for people to accept their real self sometimes.

Angela: When I spoke at, I think it was I-O-C-D-F last year, and Amanda Petrich and I were doing feared self and Real Self, and at that point I was doing the real self portion, and this was a really powerful visual I think for this.

I had sticky notes and I had a handheld mirror that she was holding and I was asking her questions about her real self. I was asking her. Questions like when you cry at a movie, what is the thing that’s making you ugly cry? Because that shows your heart. If you were standing at your funeral and people were standing around, you know, the video that was playing, and they were saying, oh my gosh, Amanda, she was so great, what would you be hearing?

What would they be saying about you? And as she was answering these questions, she was writing them on sticky notes. She was putting them on the mirror that she was holding, and at this point she was actually wrapped in toilet paper to visualize the feared possible self keeping you in bondage because it’s keeping you away from the life that you were supposed to live.

So she’s wrapped in toilet paper and she’s answering these questions and we’re putting it on the mirror and asking her a question. I remember she got tearful. I can’t remember exactly how I said it, but let’s say you’re gone someday and your kids are remembering you, and what kind of values did you instill?

What did you model for them? And she kind of stopped for a second. She’s like, I think I’m gonna cry. And it actually makes me tear up in this moment because I think. There’s capital T. Truth. Yeah. Little T truth is what I consider kind of Satan kind of masquerading is what would be capital T truth, but capital T, truth is wherever it is, right?

Can be on a stage at I-O-C-D-F talking about the real self. She kind of choked up for a second. She said, I think I’m gonna cry. But I think those tears were because she was seeing and experiencing and taking in through God, whispering to her who she really is, her real self. And when we see that it is a beautiful moment, and it could be a reason for tears, right?

Yeah. We put that on her mirror and then we started to take off the toilet paper. We started to take off the bondage of the feared possible self, and what you’re left with when you do that is your real self, your real authentic self. She could see then on the mirror, face to face, it was reflected back at her.

And I said to her, what do you see now when you look in the mirror? And she saw all those truths, all those capital T truths about who she really is looking back at her. That’s awesome. And I see me, and that’s kind of one of those mic drop moments.

Carrie: Yeah, and I just don’t feel like the identity work is something that I’ve seen come out of exposure and response prevention.

And I could be wrong on that and maybe there are other people who would disagree with me or see that, but something that transformative where people are able to walk away and say like, I have a greater sense of who I am, who God has created me to be. I just haven’t seen that happen with another form of therapy for OCD.

Angela: Exposure and response prevention. I think when they’re making new associations between the once feared thing and then they’re no longer held in bondage of that to walk in freedom, I think that’s one way that they can walk in their real self. I just don’t think, and that’s a beautiful thing because then they’re walking in freedom.

Carrie: They’ve moved towards their values because they’re not engaging in the compulsions.

Angela: But I don’t think ERP spells it out like ICBT does. Yeah, self vulnerable, self and authentic self. Mm-hmm. And I think Icbt does an incredibly beautiful job of spelling that out.

Carrie: The reality is you look at people’s lives who are suffering immensely from OCD, maybe they’re ruminating for hours a day, or they’re taking two hours to wash the dishes at night.

They’re getting up at their morning bathroom routine is taking them two to three hours. A lot of times what I will say to them, I might even ask them or explore, if you weren’t spending this much time on this, they’ve been doing it maybe for a long, long time, for years. If you weren’t spending two hours on the dishes, what would it look like for you to get that time back?

What would you do with that time? Because that’s an identity issue. I’d say, well, I’d spend that time with my husband, or I’d spend that time with my kids. Awesome. That’s great. That’s who you really are and where you really want to be. And so it can be hard when you had so much identity surrounding OCD, like, well, this is just who I am and this is what I do.

I have a whole process for. Whenever I have to take out the garbage, for example. I mean, it gets really sucked into people’s identities in all of these tiny little ways in their day-to-day life that when they’re able to break free from that and move towards their values, it’s just amazing to see the transformation process that people have had.

Angela: I know ICBT has a special word for that called the void. That discomfort that we experience when we’re no longer doing the compulsions because we do have so much more time to do the things that are value driven. And I kind of see it as a coming back alive to oneself, kind of like we talked about when we’re outsourcing trust in self to compulsions.

Once brought that back and we might experience a void of all the time that used to be taken by those compulsions and we can come back alive to ourself and do the things that bring us joy.

Carrie: That’s great. And be able to, for people who are dealing with scrupulosity to. Find an authentic connection with God and be able to engage in their spiritual practices in a really healthy way instead of it being compulsive.

Angela: I was actually thinking about that earlier when you were talking about something different, but. I think it’s when we were talking about how you can keep your values, but drop the ooc D let’s say we’re compulsively praying. Yeah. That’s not how we praying. Because you have a desire to, it’s out of fear. So now we’re freed.

To do things in a way that’s pleasing and actually honoring to God instead of compulsory.

Carrie: I’m curious for you, since you have a trauma background, for those listeners that have experienced traumatic events or maybe things in their family that they’ve just had a really hard time recovering from or shaking in their adult life, how do you feel like that fits with what we’re talking about?

Angela: I can say, and we might intersect a little bit of EMDR. Is that okay? Yeah. Uhhuh, yeah, sure. In EMDR, and this might be more like the vulnerable self theme. Mm-hmm. Kind mixing in with EMDR, but when we talk about those traumatic events. I think that those traumatic events can happen. And then I kind of think of that as at some place in your life, there was some fertile soil for seeds to be sown that grew into this negative core belief.

And I would segue that and kind of match that with the vulnerable self theme, not the feared possible self, but the one that everybody has. And at that point, as those seeds were sown through a traumatic event, I visualize that as being kind of like Jack and the beam stock. And that might kind of sound weird, but those seeds are thrown and then the beanstalk starts to grow.

And inside that is that negative core belief that’s starting to grow. That’s the bean stalk. Mm-hmm. That’s the vulnerable self. And as further events happen, it kind of feeds back into this growing beanstalk. It becomes more and more believable, this negative core belief or this vulnerable self theme with EMDR.

We go back into those events and we update the system with what I call capital T truth. And in OCD we’re going into a feared possible self, but we’re updating the system and we’re taking out the feared possible self, and we’re installing, if you will, the positive core belief or who we really are, that real authentic self.

When we do that, we can pull out that beanstalk by its root and do away with it. What was a little T truth masquerading around as Capital T Truth. Keeping us in bondage away from who we really are and how we were really meant to live.

Carrie: I think that those therapies in my practice integrate really well together for people that definitely have some significant trauma that they feel like has contributed to the OCD.

Not necessarily, I’m not saying cause, but through gasoline on the fire of the OCD. Absolutely. It really has been helpful and beneficial. Thanks for sharing all of this. It’s been a joy to meet you and get to hang out with some of the ICBT people and learn from the just very generously giving and community.

That’s a wealth of information.

Angela: Thanks so much for having me. I really appreciate being here and talking to things and sharing.

162. Hope for Scrupulosity with Dr. Constance Salhany

Written by Carrie Bock on February 25, 2025. Posted in OCD, Podcast Episode.

Welcome back to Christian Faith and OCD!

This week, Carrie continues the Themes and Treatment series with a deep dive into scrupulosity. Joining her for this powerful conversation is Dr. Constance Salhany, clinical psychologist and founder of Cognitive Therapy of Staten Island, They explore how ICBT offers a powerful, self-theme-based approach to treating scrupulosity, helping individuals break free from cycles of fear and guilt.

Episode Highlights:

What scrupulosity is and how it manifests in religious and moral concerns.
The difference between scrupulosity, religious OCD, and spiritual OCD.
How ICBT (Inference-Based Cognitive Behavioral Therapy) approaches scrupulosity.
The role of self-themes in OCD and how they shape obsessional doubts.
How understanding one’s identity as a child of God helps in overcoming scrupulosity.
Why trusting in a personal relationship with God is key to healing from scrupulosity.

Episode Summary:

Have you ever found yourself constantly worrying about whether you’ve sinned, confessed properly, or followed every religious practice to the letter? If so, you may be struggling with scrupulosity.

In Episode 162 of Christian Faith and OCD, I had a conversation with Dr. Connie Salhany, about what scrupulosity is, how it develops, and most importantly, how to find freedom from it.

One of the most challenging aspects of scrupulosity is how it extends beyond just religious concerns. I’ve seen this quite a bit with my clients—what starts as one type of OCD can quickly spill over into the moral/religious realm. Someone might initially struggle with obsessing over everyday decisions, wondering if they’re offending God without realizing it and then wonder if their salvation is in jeopardy.

Scrupulosity isn’t just about religious concerns—it’s deeply tied to OCD.

As Dr. Connie shared, many people with OCD experience obsessional doubts that spiral into scrupulosity. It can even overlap with other OCD subtypes.

For years, Exposure and Response Prevention (ERP) has been the gold standard for OCD treatment. But, Inference-Based Cognitive Behavioral Therapy (ICBT) has been gaining attention, especially for scrupulosity.

ICBT focuses on identifying the “self-theme” behind a person’s obsessional doubts. It helps reframe these fears by distinguishing between obsessional doubts and reality.

Dr. Connie shared how true healing comes from trusting not in a set of rules, but in someone—in a loving God who knows our hearts.

“The most important thing in treating scrupulosity is helping people know, that they know, that they know—trusting not in a something, but in a Someone.” – Dr. Connie

If you struggle with scrupulosity, remember: You are not alone. God’s grace is greater than your doubts. There is hope and help available.

For a deeper dive into this conversation, listen to the full episode.

Have you experienced scrupulosity in your faith journey? Send me a message—I’d love to hear your story and encourage you along the way!

Explore Related Episode:

133. Looking for an Alternative to ERP? Find out if ICBT is Right for You

Transcript

Carrie: Welcome back to our themes and treatment series on the podcast, where today we’re talking about all things scrupulosity. I feel very honored and privileged to have Dr. Connie Salhaini on the show, joining me to talk about this important topic. Dr. Salhaini is the founder and clinical director of Cognitive Therapy of Staten Island and the founder of Catholic Mental Health Professionals.

As someone who originally trained in CBT and exposure and response prevention, I think she provides some really unique insight ICBT. Inference based cognitive behavioral therapy has shifted and changed her practice over time, specifically in working with clients who are dealing with scrupulosity.

Hello and welcome to Christian Faith and OCD with Kiri Bach. I’m a Christ follower, wife and mother, licensed professional counselor who helps Christians struggling with OCD get to a deeper level of healing. 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.

Tell us a little bit about

Dr. Connie: yourself. Sure. I’m a clinical psychologist from New York, and I have a husband and children and grandchildren and a dog. And I’ve been doing this work since the stone ages. I’ll say it’s since the mid 1980s when I was a student. So it’s a long, long time. Has this been your only career that you’ve had?

Well, when I was a college student, I worked in Burger King and lots of other places, but this has been my one and only profession.

Carrie: I just know a lot of people in the counseling field have had other careers or things and shifted gears, but I’m similar. I have not been in the field as long as you have, but this has been my only career.

That’s awesome. Your kids are grown now and you have some grandkids.

Dr. Connie: Yep. Great life, yeah. So many blessings.

Carrie: How did you get involved in the process of becoming a clinical psychologist? Did you start out working with OCD, or was that something that you just started seeing a lot more of? How did you get into the OCD work?

I knew

Dr. Connie: that I wanted to treat anxiety disorders. I knew that I wanted to do the best I could, so I researched. And at that time, CBT for anxiety disorders. I just got my hands on everything that I could. I landed an internship at a non profit patient advocacy organization called Freedom From Fear. At that time, they still do a clinic.

And so I worked in the clinic and it was A super exciting time back in the mid 1980s. Now I’m talking before Prozac, folks were using exposure, but not like with ERP that we know today. So we were using it and they had a satellite at the place that I was working, which was a research through Columbia University, College of Physicians and Surgeons and the Psychiatric Institute.

It was just such a blessing to be there at the time when they’re doing all of this groundbreaking research because the people who were coming in with OCD weren’t getting better with the tricyclic antidepressants and with some of the treatments that were done at the time. And there was like a buzz of excitement.

I had this great mentor and she was wonderful. And she was, oh my goodness, head over heels in terms of all of the research and everything, and it was really contagious. And then from there, I mean, I just kept learning. I always wanted to try to learn as much as I could for my patients. And so I learned Becky and CBT and I learned some ERP and I took classes with whoever I could take classes with, follow up with whoever I could to learn anything that I could to help people.

It was really a passion.

Carrie: You were starting to see like, Oh, what we use for anxiety. We can’t necessarily use the same strategies or the same approaches for OCD. Exactly.

Dr. Connie: Yeah, it was really, really exciting time to be there.

Carrie: And then you got trained in exposure and response prevention that was considered.

the treatment for OCD as far as the psychotherapy standpoint.

Dr. Connie: And as well as a variety of other treatments that I learned for other anxiety. Well, at that time, they were anxiety disorders, now OCDs by itself. So I learned everything that I could. And now, what’s really interesting is that two and a half years ago, I became aware of ICBT, inference based CBT.

And that spark that I was telling you about, Yeah. And it was like this contagion, this fever, it took over and I wanted to, again, to learn everything I could about ERP. And then ICBT became my thing. It threw myself in and I started to see amazing things happening.

Carrie: You’re one of the people in the ICBT community that is really kind of known for treating scrupulosity.

Certainly, there’s a lot of clinicians who treat it, but that’s one of your specialty areas within ICBT. That’s what we’re really trying to explore today is what is scrupulosity? Like, how would you define that just for the lay person?

Dr. Connie: That’s really a great question. Scrupulosity, like if we look at Where it dates back to, I think it’s always been here, but we can see maybe 15th century Roman Catholic Church and this notion that folks who have worries about sin, about committing some grave sin, a need for atonement.

Yes. And it’s kind of like. We could say like seeing sin where there isn’t sin, or it actually comes from like a little pebble, a scruple. The idea is that this little sharp pebble, right, would be like sharp or hurting and think about like a sensitive conscience and the person being exposed to this pebble and the pain.

Just thinking about the term scrupulosity, you know, depends on the literature, it depends on what you’re reading. So sometimes scrupulosity looks like a subset. of OCD. Okay. We could be religious scrupulosity or moral scrupulosity for people who aren’t religious but they’re just worried about violating some kind of moral code or value that they have.

Also you’ll see religious OCD, and that’s more about Practices, it could be practices in whatever the faith tradition is, messing up those practices.

Carrie: Like I’ve got to pray a certain way, or I’ve got to pray with sincerity. I have to, like for Catholics, I have to confess constantly.

Dr. Connie: Did I do a fast correctly?

Did I observe certain feast days correctly? We can go on and on. But the idea is that this is grave. This is terrible. This is something that’s going to result in damnation and all of that. And the thing with, um, scrupulosity, we can also see spiritual scrupulosity, again, in people who don’t belong to any faith tradition, but they may have doubts about energy forces, or it almost looks existential at times.

So this overlaps. I think of scrupulosity as OCD and you can see so many ways that scrupulosity can be involved with other forms of OCD. Like for example, pedophilia OCD, someone could have that, right? Oh no, no. What if I’m attracted to children? Oh no. What if I’m going to harm children? Oh no, then God will never forgive me.

Then I’ll be damned forever. It’s interesting because you could even see it in somebody who has symmetry. OCD, just still OCD. I don’t line these things up correctly, these religious objects or whatever. And is this going to be offensive to God? Does God think I’m disrespecting? So it’s quite interesting.

Carrie: That was one of the things I wanted to ask you about. Cause I’ve seen that quite a bit in my clients where you start out with OCD and then everything, it could be even they’re feeling like they’re going to be careless and accidentally hit somebody, hit a pedestrian. What really is then they keep going with that obsessional doubt and say, Oh, well, if I hit a pedestrian, then that would be just terrible because then I would be offending God and be on my fault, all of these different things, even some things that aren’t really moral issues that are just decisions that we make in life, someone might make that a moral issue, become really, really obsessed about it and have God connections to it.

I mean, I think, do you see this a lot with like relationship OCD? Yeah. Am I marrying the person that God has for me, that type of thing.

Dr. Connie: Yes, or vocations, the same thing. No, so we could see it. It seems like there’s anything that’s important to the person. And one of the things that ICBT does so well is it identifies the self theme under it.

And that’s the person who’s afraid of becoming this person that they’re not. Like a person who could be negligent or a person who could be bad. And then we need to define what that means to that specific person. But that theme is like the big story underneath all of these different obsessional doubts.

And I’m a cognitive behavior therapist for years and years and I never saw it explained in this way. And I think that’s why I took a liking to ICBT because we can see how all of this different themes fit. Or interconnected.

Carrie: Yeah. I love that vulnerable self peace and then also looking at the real self.

Who are you really according to your beliefs and in terms of, I think that helps Christians a lot to be able to say like, okay, if I really see myself as a child of God, I mean, that makes a huge difference in how I live out my life.

Dr. Connie: Mary, you are so right about that. I think that is the most important thing about scrupulosity and the treatment of scrupulosity is when people can come to know that they know that they know, like really trust.

You know, that they’re trusting, not in a something, but in a someone, in the relationship that they have with God. And that makes all the difference. Lots of folks know it, but because of the fear, it’s intense. The suffering is awful. When they come to know that, it changes everything.

Carrie: It really does. And I find that a lot of people will seek help from a pastor or a counselor.

A mentor, someone in their church before they seek mental health help because they think this is a spiritual issue. Well, I’m somehow doubting God or what if I’ve committed this sin? What if I have not asked for forgiveness? What if this means I’m going to hell and those types of things? So it looks at mass as a spiritual issue, even though it’s not a spiritual issue.

This is a OCD affects people’s brains. And so I think it’s really important for people to understand that, that this is not a, a deficit in their spirituality. Absolutely. Yeah, the people that I meet really, they want to connect with God in a positive way. That’s really like their true desire underneath.

And all of this OCD gets in the way of them having that really Authentic, genuine connection that they want to have.

Dr. Connie: I agree completely. And I think that’s what draws me to the treatment of scrupulosity. It’s the people, they have such beautiful hearts and real great desires. Just want to please God. They just want to live a good life.

They are really beautiful and they’re so tortured by a story that has nothing at all. And in treatment, if we can restore them to that, it’s amazing. There’s nothing better. This is like a joy if we can help folks to get there. So I love this work for that reason.

Carrie: Exposure and response prevention for scrupulosity relies on a lot of imaginal scripts. Did you have some discomfort surrounding that when you would try to utilize it with clients? Can you tell us more about that?

Dr. Connie: Sure. First off, we know that ERP works great treatment. For myself, in my treatment of folks with scrupulosity, I always shied away.

From imaginal scripts with script, I would do it with other things and I would also do exposures, let’s say, a more, I guess, in depth way with other things. I have no problem sticking my hands in the garbage, touching my face, touching my hair. Modeling that no problem, no problem at all. But I remember even in training, I was like, please don’t give me a script case.

Please don’t give me a script case because I felt so uncomfortable with that. There’s a lot of reasons why I didn’t want to add to someone’s distress, but I also didn’t want to confuse the person in terms of what their faith practice was and what was an exercise in treatment. So then I relied a lot on ACT.

Group. I did a lot, a lot of act work. I’d still do response prevention, but I wouldn’t do, yeah, like those hard, those exposure exposures. Exposures like, oh gee, that a person could be possessed by the devil or wanting to sell their soul. I wasn’t doing, it wasn’t coming from me. It violated something within me.

Again, I leaned on that a lot.

Carrie: Acceptance and Commitment Therapy.

Dr. Connie: Correct. Acceptance and Commitment Therapy. But even then, it wasn’t the best fit. I can see it now. Yeah. I’m not saying that Acceptance and Commitment Therapy doesn’t work. I’m not saying that, or that ERP doesn’t work. But for me, this is a better fit.

And I think it’s also a better fit for a lot of the people I see. Some other folks would never do those exposures. Or how about convincing clergy to allow that. Oh my goodness. That was part of what we used to do. Yeah, let’s talk to your priest. Let’s talk to your minister. Let’s explain to them what we’re going to be doing. That was a hard

Carrie: Sure, that makes a lot of sense. I think really what you’re talking about is we have to, as therapists, have to be aligned with a particular treatment because our clients are going to feel it if we’re not fully aligned or we’re not fully bought into it. And that affects, obviously, our ability to provide the services.

And I think what you said is true is like when we find something that feels like a really good therapeutic fit for our people, then the people that come to us, it kind of just fits with them as well. It’s like this nice, natural flow. How has ICBT been helpful for your clients with scrupulosity?

Dr. Connie: One of the things that I think ICBT does is it restores. The trust in themselves, in who they really are, and also it helps them grow spiritually. So when we’re removing those obsessive doubts, and some people have told me they don’t believe those obsessive doubts anymore, and I love it. I say to people, why not? And they say, well, it doesn’t make any sense. Yeah, I love that when we can do that with someone and they’re free to then practice their faith in the way that they want to, their relationship can become so much more close.

It’s difficult work and it requires the willingness of the person to do this work, but I have seen that kind of success. I think it also, ICBT doesn’t blur the lines. As much as for me, the therapeutic exercises and the spiritual practice ICBT is value free. So anyone can come with their value systems intact and there is a respect for that and so that you don’t have to go there at all with ICBT.

And I think that another thing that happens, you mentioned the real self, and this is so important, restores what people they know, but they’re doubting their true intentions, their true desires. And who they really are. It provides this other story. The doubt has this whole set of reasons behind it. We clear that up and then we look at obsessional narrative and come up together with an alternative narrative, which in my experience often is about how they are the beloved child of God.

And it just changes everything. And then after that, then we can get into situations with reality sensing and get them back into doing things in a non OCD way. It’s just so different.

Carrie: Yeah, I loved what you talked about with the true desires and intentions because that’s something that gets really doubted heavily in some of those things that we talked about before, like the pedophilia OCD and then leading into the scrupulosity OCD.

I think there are so many Christians that because they haven’t necessarily just worked on OCD in general, it’s, oh, well, I have all these horrible thoughts, whether they’re violent thoughts or thoughts about harming children or thoughts about blaspheming God. Then they’re making some type of spiritual meaning surrounding that.

Well, because I have these awful thoughts, that must mean then therefore that I’m not a good Christian or I’m not close to God or I’m not going to heaven, whatever type of meaning they’re making out of it. And so really just being able to peel back and provide some just general education about OCD, you’re not choosing to have these thoughts.

You’re not wanting to have these thoughts. This is a process that’s happening in your brain, and we can retrain your brain and retrain your ability to reason with these types of thought processes differently and really targeting that obsession that you’re having and kind of debunking the argument that it’s making.

It has led people to be kind of aligning what you were saying with their head and their heart. Well, I know that God’s loving, but I feel this fear towards God, or I feel, I notice when I have these obsessions come along that I’m really super scared, but I know that God is loving. I know that I am practicing my faith.

I know that I’m doing the right things, but it’s not aligning. And so really going through this process of teaching people the modules of ICBT is super helpful. And also, I think just really letting people know that they have options for their treatment is so huge. You as the client have the options that somebody feels like ERP is really the way that they want to go and they feel aligned with that, that they can certainly pursue that.

And if they want to do ICBT, that they can pursue that. And I think that that’s really huge for the OCD community and something that we’re trying to continue to educate people on and let them know.

Dr. Connie: Absolutely. It’s so important what you said about the reasoning process with. ICBT, it’s kind of validating for people that these thoughts don’t just intrude upon them, that there’s a reasoning process behind it.

Once they can see that, and once they can clear that up, then they can realize that those horrible feelings that they’re having, the fear, the guilt, the false guilt, as well as that, is coming from the story. Yeah, that’s where it’s from. They change the narrative and everything changes. So how does it work?

Go back to the obsessional doubt and we’re upstream as we say. Right.

Carrie: Well, for sharing all of this information. Our listeners will find it really helpful and we’ll put links for them to find you in case they’re in New York or want to pursue seeing you.

Dr. Connie: Oh, that’s wonderful. Thank you. Thank you so much.

And thank you for the work that you do. It’s so important to have somebody like you doing these podcasts, especially faith based work.

Carrie: I just want to share with all of you what God has been working with me on in my life. As I Have been studying the scriptures and coming across very specific scriptures that maybe I have shared with certain clients dealing with scrupulosity or scriptures that I felt, Hey, wow, this could really unlock something for someone with OCD.

I’m starting to take notes on those things, write down questions, and I’m not sure what this is going to turn into, if this is going to come out in podcast form or it’s going to come out in written form, but. I know that when I have it all collected and gathered together, I will be sharing it with you. I definitely have a passion for helping Christians with OCD to have a really healthy understanding of theology because oftentimes wires have gotten crossed along the way from Things that we’ve been told or things that we learned from imperfect parents, church situations that maybe weren’t the best or the healthiest, and sometimes those things can get us really stuck and keep us from being able to move forward in a healthy way in our relationship with God and God.

I don’t want anybody to be held back by any of those things. Until next time on the podcast, may you be comforted by God’s great love for you. To receive weekly encouragement, find out about our monthly Meet the Podcast host Zoom meetings and receive information on exclusive sales, become an email insider today.

All you have to do is go to karybach. com and scroll towards the bottom of the page. You’ll find a spot to put in your email and receive a free download in your inbox from us. Until next time, may you be comforted by God’s great love for you. Were you blessed by today’s episode? If so, I’d really appreciate it if you would go over to your iTunes account or Apple Podcasts app on your computer if you’re an Android person.

in and leave us a review. This really helps other Christians who are struggling with OCD be able to find our show. Christian Faith and OCD is a production of By the Well Counseling. Opinions given by our guests are their own and do not necessarily reflect the views of myself or 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.

148. Your Obsessional Story: Christians Learning ICBT coming Jan 2025!

Written by Carrie Bock on November 6, 2024. Posted in OCD, Podcast Episode.

In this episode, Carrie takes you behind the scenes of one of her ICBT training sessions, which she designed specifically for Christians dealing with OCD. She shares a snippet of Module Three, exploring how OCD weaves compelling narratives that can draw you in and offers guidance on rewriting those narratives to gain a deeper understanding of OCD’s mechanisms.

Episode Highlights:

The power of stories: How OCD creates vivid, relatable narratives that captivate our attention.

The importance of self-awareness in recognizing and rewriting your obsessional story.

Common pitfalls of telling ourselves negative stories and the role of shame in our experiences with OCD.

Exploring the concept of obsessional doubt through relatable examples.

Writing alternative stories as a method for reframing experiences and perceptions.

And more about what’s inside the Christians Learning ICBT live training, including practical tools and resources to deepen your understanding and application of these concepts.

Episode Summary:

I’m Carrie Bock—a counselor, Christ follower, wife, and mom. I’m here to help Christians facing OCD find healing through faith. Today, I want to share a bit about my ICBT (Intensive Cognitive Behavioral Therapy) training, focusing on Module 3, where we learn to recognize and rewrite those pesky obsessional stories that OCD throws at us.

Feeling Stuck with OCD?

If you’re tired of battling OCD on your own or have tried exposure therapy without much success, I understand! Starting in January, I’m launching a 12-week course where we’ll go through each ICBT module together, wrapping up in March. If you can’t join live, don’t worry—you’ll get access to all the recordings!

Join the Waiting List!

Interested? Sign up for our waiting list at carriebockcom/OCD. Together, we can transform your relationship with OCD in 2025!

Let’s Talk About Stories

We all have narratives that shape our lives, influenced by our past and our beliefs about God. It’s important to ask: Are these stories coming from God or from our fears?

OCD is great at creating emotional stories that can feel very real. Think about how a gripping movie can make you feel intense emotions, even if it’s just a story. That’s how OCD works—it hijacks our thoughts and feelings.

For example, if I tell you about an “amazing” pen found in a sketchy place, your feelings about that pen would change based on the story. This shows how changing our narratives can change our perceptions.

Rewriting Your Obsessional Stories

Today, I’ll help you recognize and reframe those obsessional stories. Instead of getting stuck in doubt, we can challenge those thoughts and find clarity.

Tune in to the full episode to learn practical tips for identifying your obsessional narratives and rewriting them in a way that aligns with the abundant life God wants for you. Let’s start this journey of healing together!

Explore Related Episode:

133. Looking for an Alternative to ERP? Find out if ICBT is Right for You

Transcript

Hello, do you love going behind the scenes? Well, today I am taking you behind the scenes to one of the ICBT training sessions that I did this fall on module three. Module three is all about how OCD draws you in with a really good story and then teaches you how to write your obsessional story to become more aware Of how OCD works and gets you drawn in.

Hello and welcome to Christian Faith and OCD with Carrie Bach. I’m a Christ follower wife and mother licensed professional counselor who helps Christian struggling with OCD get to a deeper level of healing. 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. Brothers and sisters in Christ, OCD warriors. Are you sick and tired of fighting with OCD? Have you tried exposure therapy or tried finding counseling from a Christian perspective and just have come up short? I know so many people have told me that they have a Christian counselor but that person doesn’t know about OCD or they’ve gone to OCD counseling and something just didn’t feel right because the person didn’t understand their faith.

I want you to know that I’m here for you, and that’s why I’m excited to announce that in January, we’re going to be teaching through the 12 modules of ICBT. We talked about ICBT in more depth in episode 119 and episode 133. I will be teaching one module per week from mid January to the end of March. If you can’t make the live trainings, everything’s recorded and put in an online course platform for you to access.

If you think you might even slightly be interested, or you’re interested in being interested in finding out more information. Please join our waiting list at kerrybach. com slash OCD. About three fourths of the way down the page, there’s an option for you to put in your name and email address. Let me help you have a different relationship with OCD in 2025.

Today we’re talking about stories, the obsessional story. As I started to think about this obsessional story process, I thought, we tell ourselves stories all the time, right? And it’s not always an OCD story. We go through life, we have experiences, and we interpret them, and we tell ourself a story based on our past experience, based on other things that we’ve heard, based on what we know about God and scripture.

It’s not just about OCD. It is, that’s what we’re here to talk about and have a better relationship with, but just noticing, like, When you have experiences, what are you telling yourself? Are you telling yourself the shoulds? I should have done better, known better, been better, whatever. Are you telling yourself, yeah, you know, you should have expected that to happen because it happened in the past?

Uh, you know, a trauma story of, yep, you know, there you go again, experiencing this. Just kind of be aware of that. So, you are, as a Christian, tasked with not trusting everything that you see or hear, but really testing and seeing, is this coming from God or is this from falsehood? So, our main ideas are that OCD draws you in with a good storyline.

And that awareness of that storyline is the first step to changing it. I like to say that OCD has like these lifetime movie versions that they tell you. It’s so vivid. Sometimes you can see it happening. There’s a lot of intense emotions that goes along with it. Just thinking about stories in general, I put this little Incredible Hulk guy on here.

They draw us in with a certain level of emotion. Stories are believable or relatable. Even though we’ve never seen a guy turn into this giant green man and start destroying something. We feel related to this story because we’ve all had anger in our lives. Maybe we’ve been destructive at different points and he doesn’t want this to happen.

It just is something that kind of takes over him and happens. So even though you look at Marvel comics and things, there’s lots of stuff happening or people being able to control time or see all of the outcomes, right? That’s one of the characters, I guess, can see all the potential outcomes that could happen and people are flying and different things happening, but they’re, it.

Some of the core storylines, the characters, we really relate to them, we feel for them. I wasn’t really into a whole lot of these movies, and I went with one of my friends, and people were just, like, wanting to go see Endgame, and people were just crying in the theater, right? Like, these are characters, you know, they’re not real, but we are drawn in and we feel something, and that’s what makes a good story, right?

Like, that’s a really good story that draws you in. There’s some kind of outcome or ending to them. So there are some factual elements that can be woven in even to OCD stories. All right, now for a story about my pen. This is a pen that I have in my office. It’s a purple pen. I like the color purple. So let’s say that if you were in the office and I was like, Hey, do you want to write with this pen?

You probably would say, Sure, why not? Like, I don’t know, it looks like a good pen, it clicks, it works, you know, I’ll tell you, yeah, it writes really well, I like it. So you probably would feel okay with this pen, unless you like had major contamination and you were like, no, I don’t touch other people’s stuff, that type of stuff, and then you might be like, I’m not sure about that.

But if I could tell you a story about this pen, where And I said, yeah, this is a really great pen and I want to tell you the story of how I got this pen. I mean, I didn’t just get this pen at the store. I was out in, you know, the park and there was a pile of dog poop and I noticed this pin sticking out and I thought, oh, that pen looks like it would write really good if I cleaned it up or hey, my favorite color is purple.

I think i’ll take that pen and I took it out of the dog poop and I washed it off and I Clorox wiped. It’s fine. Everything’s good. It’s all right. Like I mean, what’s the problem? Do you notice feeling any differently about wanting to hold the pen now versus when I first started talking to you about it?

Most people, when I tell them the story, are then like, Oh, that’s gross. Like I’m not touching that pen. You know, who does that? But the point is, what changed? Did the pen actually change, or did we just change the story about the pen? And then when we changed the story about the pen, that caused us to feel differently about it.

Not only your five senses, which do get distrusted at times in OCD, but internal sense data. What do you really want? And how do you know that? Like, I can say, just random example, like, I really want pizza for dinner. Like, how do I know that? I’ve been just craving pizza, I like pizza, whatever. I’m just making stuff up as we go along, right?

But really being able to tune into your own emotional experience or your own desires is really important. I’ve talked to people before OCD will make you feel like you have an urge to do something but an internal like urge or pull towards something is not the same thing as a desire is actually wanting to do that.

So that may be something that you have to tease out in your own story and then what you actually value or believe. Jenny’s obsessional story goes like this. My husband didn’t kiss me this morning before he left for work. That is a true statement. That did really happen to her. But now this obsessional doubt injures then, what if he has fallen out of love with me?

I mean, Sally is going through a divorce right now and her husband just left her out of nowhere. That’s the hearsay evidence. Just because it happened to Sally doesn’t mean it’ll happen to Jenny. But that’s what OCD wants her to believe that it will. My ex boyfriend did something similar. Personal experience.

OCD feels like it’s really like, hey, I’ve really got some evidence here for you. I read an article about how if your man doesn’t kiss you before you leave the house, that is one sign he’s out the door. He could be cheating on me. It’s possible. Now we’ve got like, you know, almost like another obsessional doubt coming in there, right?

Like, oh, what if he’s cheating? People leave and get divorces all the time. Yeah, I really can’t argue with that fact. Um, What if I’m next? I couldn’t handle it. Consequences of obsessional doubt. This piece, like, of not being able to handle it, that kind of dips the toe into the water of the feared self theme.

You may be saying, like, Oh, well, that’s a nice story carry. Now what do I do with it? Just remember that you’re still in the phases of building awareness. We’re not necessarily intervening right now, but if you can intervene, or you may pick up on like, oh, now that I pick up on that OCD, I’m not gonna give into it as much as I would have before.

I’m not gonna entertain it like I would have in the past. So just kind of be aware of that piece coming down the pike. All right, talking about having a shameful thought, maybe it’s a sexual or blasphemy thought, and then like, oh, that goes into, I shouldn’t be having this as a Christian. What does this mean?

What if this means I’m not a good Christian or don’t love God? And I think I stuck with the don’t love God, because obviously some of these could be going a lot of different directions, right? And then these are some of the things that I’m, the potential consequences that I’m calling myself. What if I don’t love God?

Well, not everyone does. That’s a fact. Rules, you know, take your thoughts captive. Watch the things that come into your mind that you think about. Lots of information on that in various places. Spiritual guidance, pastors, teachers, authors, podcasts, so much, so much information out there now. Personal experience of maybe what a former church taught and then anything possible according to OCD.

So let’s look at this obsessional story. So I have these intrusive sexual thoughts. It’s a fact. I can’t change that. What if I don’t really love God and that’s why I have these thoughts? So that would be our obsessional doubt that we stuck with for this example, but it could have gone, as you see, there were other obsessional doubts.

And so whichever one you choose, that probably is going to take the story a little bit different in a direction. That’s okay. That’s what my previous church said. hearsay. I have to rebuke this thought in the name of Jesus. That’s a compulsion. I have to take every thought captive and make it obedient to Christ.

That is true according to the Bible. When I was addicted to pornography, I was dwelling on thoughts I shouldn’t. That would be a personal experience. And if I don’t win the battle of my mind, I’m giving the enemy a foothold. The consequences of the doubt. So some of you may be, um, a little bit overwhelmed too on, okay, Carrie, I have a lot of different obsessions.

What do I write my obsessional story on? I’m going to give you some guidance. Sometimes, very occasionally, the anxiety about writing the obsessional story or seeing it out like Just out there can be super super high for certain themes So I would say if that’s the case We’re really in the interest of you learning the process right now, right?

If that’s the case if it is too anxiety provoking I mean like gonna give you a panic attack is what i’m trying to say Not to say that writing obsessional stories shouldn’t cause you any anxiety But if you’re like panicking trying to write your obsessional story You Maybe try working on something that is either a past experience, like it’s not bothering you now, but it did in the past, just so that you can learn and process it and sit with it, or picking something that is still an obsession, but it’s a lower level, like not going to send you into a panic.

And then once you feel like you have the flow of what you’re writing and the process of putting those pieces together, then that is going to help you be able to. probably sit with the harder one. Even if we have multiple stories, the feared self or vulnerable self theme is going to run between those stories.

So they’re going to be similar. A lot of times there is a common thread and that’s going to be your common thread. So if you do end up like writing a couple stories, if you feel inclined to do that. I wouldn’t literally like write more than two. I mean, remember, we’re not wanting to like obsess about treatment.

So if you wrote a couple stories and kind of compared them, I was like, Oh, okay. Like there should be some type of overlap or pattern that you’re seeing. Rely, whether it’s, hey, I’m seeing in both of these stories that I’m really relying on hearsay evidence, or I’m seeing in both of these stories that I’m really relying on past personal experience that may be related to my trauma, or I’m noticing it’s like the same exact personal experience, even though the themes may be different for you.

And you would want to look at like, okay, what can I glean from this? What’s the pattern here? Because obviously you’re not wanting, like I said, if you have a lot of different themes, you’re not wanting to run the gamut for every single thing in your life. You don’t want to have to do this, I guess, is what I’m trying to say for every single thing.

And usually information like this will generalize. So, recognize that you only got about 12 minutes of a 50 minute training. Obviously this was not intended to be comprehensive, but just to give you a snippet and a sneak peek inside the training and the examples that I use to help people understand the concept.

mindfulness, a prayer. There’s a scripture verse for every week. And we dive into the lesson, and all of that is so intentional so that we can put our mind, heart, and spirit in alignment and in the right place. We’ve had some amazing question and answer times in the beginning and end, so know that you completely have the freedom to ask questions.

People will type them in the chat or they will email me privately and I can answer it publicly. So there, even if you aren’t able to attend live, there’s still opportunities to ask questions so that you can really get in there and apply these materials. Next week we’re going behind the scenes again to talk through writing alternative stories and I’m going to share a true experience that happened to me, how I wrote an obsessional story about it, I did make up that part, and then what a potential alternative story would be.

Definitely tune in for part two next week. Until next time, may you be comforted by God’s great love for you. Were you blessed by today’s episode? If so, I’d really appreciate it if you would go over to your iTunes account or Apple Podcasts app on your computer if you’re an Android person and leave us a review.

This really helps other Christians who are struggling with OCD be able to find our show. 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.

119. ICBT as an Alternative to ERP from the Client’s Perspective with Crystal Propes

Written by Carrie Bock on April 17, 2024. Posted in OCD, Personal Testimony, Podcast Episode.

In this week’s episode, Carrie interviews Crystal Propes about her journey with ERP therapy and her transition to Inference-Based Cognitive Behavioral Therapy (ICBT), highlighting its effectiveness from the client’s perspective.

Episode Highlights:

Insights into Crystal Propes’ personal journey with OCD, including her experiences with various treatment approaches.
The principles and techniques of ICBT.
How ICBT differs from ERP therapy in addressing mental compulsions and providing functional certainty without distress.
Personal examples of applying ICBT techniques in real-life situations

Episode Summary:

Welcome to Christian Faith and OCD episode 119! I’m Carrie Bock, a licensed professional counselor from Tennessee, and today I’m thrilled to have Crystal Propes with us. Crystal and I connected on Instagram, and I’m excited to share her story with you.

In this episode, Crystal dives deep into her personal journey with OCD and her experience with inference-based cognitive behavioral therapy (ICBT). We often feature professionals discussing therapy techniques, but it’s equally valuable to hear personal stories. Crystal’s experiences underscore that if one treatment doesn’t work for you, it’s okay—there are other options out there.

Crystal’s journey with OCD began in childhood, with symptoms manifesting as early as age three. From emetophobia to severe anxiety during her school years, her story is a powerful reminder that OCD can evolve and change over time. Despite her struggles, Crystal persevered and eventually sought therapy. She initially tried exposure and response prevention (ERP) therapy but found it overwhelming and not suited to her needs. Thankfully, Crystal later discovered ICBT, which resonated more with her and helped her focus on managing mental compulsions and staying present.

Tune in to hear Crystal’s full story and insights. Remember, if one treatment doesn’t work, it’s not the end of the road. There’s always hope and help available. Don’t give up!

Explore Related episode:

18. ERP is Not the Only Option for OCD

Transcript

Welcome to Hope for Anxiety and OCD episode 119. I’m here today with another personal story of anxiety. I am your host, Carrie Bock, a licensed professional counselor in Tennessee, and here I have Crystal Propes. We actually met on Instagram, which was really fun, and I just had reached out to her and she agreed to be on the show.

Crystal has been posting a lot of information about ICBT, which is inference-based cognitive behavioral therapy, and just her perspective of it from the client that I feel is very helpful. Sometimes we have different types of shows. Sometimes we have shows with different professionals who tell us about the nitty gritty details of specific therapy, but we always find it’s helpful to share personal stories on the podcast of people who have actually been through the struggles and the trials that so many of you have gone through with OCD, and it encourages other people to continue to seek help because we want people to know that there’s hope and there’s help and with our story today, if one treatment in particular doesn’t work for you, that it’s okay to know that there are other treatment options out there for you.

You don’t have to be stuck in a rut. I think a lot of times people feel like I’m the exception to the rule and I’m the one that this therapy is not going to work for and I can’t get help. And then they stop and we just don’t want anybody to stop today. If you hear nothing else from this episode, that’s what I would want you to know from the therapist’s point of view.

_______________________

Carrie: Welcome, Crystal. Tell us a little bit about your story with OCD. How did that start? And when did you notice it showing up? And then when did you realize like, Oh, that’s what this is?

Crystal: My story is a long one. Now that I think back about it, I mean, I didn’t think this hard about it until recently, but now that I think back about it, I knew, like, that it had showed up in childhood, but I wasn’t sure how young.

I think I was three, so, which is very young, right? I’ve lived with this my entire life, but yes, I think I was three. I started my first manifestation of OCD with emetophobia. But I had a lot of other issues with it. I was overwhelmed with big situations. I remember having so much DPDR, like, going, “What’s next?”

The kids are supposed to be excited, but I’m sitting there in silence. My mom’s like, “Are you okay? What’s wrong with you?” And it’s like, “I don’t really know. I just feel overwhelmed.”

I would get really particular about the order of my toys and, like, my toys being played with a certain way and it would give me, like, extreme anxiety to, like, let people borrow books, just all kinds of little things that shouldn’t have caused anxiety that it did now that I look back on it.

I think what really, I would say, like, when my brain broke, even though I definitely had OCD before then, I was 12. I was in 7th grade and I was a teacher’s assistant. for my teacher and so I spent a lot of time alone in her room as one of my electives and I was like grading papers and stuff.

Obviously, being quiet alone gives you so much room for your imagination to run wild and I just remember having this thought, what if you’re terminally ill? What if you have cancer? And then that just latched right on. It’s like, why did I think that? Is God trying to tell me that I have cancer? Is there something wrong with me?

I spent like a long time after that, like terrified and I couldn’t figure out why. I thought I was going crazy and I didn’t want to say anything about it. My mom because I really didn’t know what was going on and I just remember like kind of dealing with that on and off all throughout high school.

I remember seeking reassurance from my mom, like, I’m not going crazy. I’m not crazy. Am I? There’s nothing wrong with me. Just like Googling stuff to make sure I was okay. Lots of rumination, lots of body checking. That’s kind of my experience with like my early OCD and how it started.

Carrie: Those thoughts, you’re just sitting there and then all of a sudden the thought pops in and OCD gets going and you get really latched into that thought and into the meaning of “What does this mean that I’m even having this thought?

What is this saying about me?” Emetophobia, for those who don’t know that are listening, maybe they don’t experience that, is fear of throwing up.

Crystal: It has existed largely in the background for the most of my life. Like, as long as I wasn’t directly exposed to it, I was okay. It didn’t live my life around it.

My OCD has worn many hats over my 30 years with it, and most of them were not aminophobia. Even though I’ve always been aminophobic, again, like, unless directly faced with it, it really didn’t bother me until I had kids, and they’re in school, and they’ve brought home germs, and I’ve been traumatized by it.

But yes before that, it really was mostly other themes that popped up, but now it’s the opposite. Now, all my other themes extremely well, and the am phobia has dug its calls in,

Carrie: It’s interesting how symptoms like this wax and wane over a lifetime. Like you said, sometimes things are really upfront and then, “Okay, I am not as worried about those things,” and then those fall into the background, and because of other life stressors raising young children and bringing home all of the germs, obviously that’s stressful. There’s more fears about getting sick or people in the household throwing up and then you getting sick and throwing up.

Can you walk us through that process a little more? Becaus those were the pieces that caused you to seek out ERP therapy initially.

Crystal: Right. Before I get into that, I wanted to say like, I didn’t realize it was OCD and not generalized anxiety until I was about 18. There’s a gap there though from the time I realized it was OCD at 18, but I didn’t get an official diagnosis until last year at 32, even though I knew what it was.

I didn’t seek out therapy until then because I dealt with it on my own fairly well, even though it was so hard. severe when I was in college, extremely severe, but I ended up seeking out therapy because about two years ago, my kids started bringing home stomach bugs. I was blessed with the fact that my daughter, my oldest never had one until she was five and in public school in kindergarten.

That was the first one we ever had to deal with. Nobody caught it that time. So like, it was traumatizing for like about two weeks until I was sure like, okay, everything’s probably dead. And then I was okay, but then we got another one five months later, and then we got another one five months later. We had like four, and I had two or three of them, back to back to back.

By the time I would get over one, we would get another one, and it was just back to, and the one that took our whole family down, it was extremely traumatic for me. And I think people who don’t have a phobia, It’s hard to explain the level of fear you experience in relation to a true phobia.

Some people never feel that type of fear ever in their life, but if you’ve ever been terrified of something, you have to think of the most scared you’ve ever been in your entire life. Like the scariest possible thing you can think of and being faced with that and having to take care of your kid through that and then having to deal with it yourself.

I’m literally shaking while taking care of my kid. And then I get sick. It’s like the worst I’ve ever felt in my life. All my fears are realized. It’s just as bad as I thought it would be. I am traumatized, truly traumatized from this. I haven’t been officially diagnosed with PTSD, but only because I haven’t been evaluated for it.

We decided to treat the PTSD first, but I’ll get into that a little later on. I was super traumatized. I found that my kids, we started school and my kids, I was just watching them, their every move, hyper-villagently watching them, afraid they were going to fall ill at any second, just anticipating the next bug that I was going to have to deal with.

I was spending every second home with them. It stuck in my own head, ruminating, hypervigilance, my hands crack and bleed, I wash them so much, just like so miserable, even though I was technically functional. I was still taking care of my family, I was still taking care of my kids, I was still sending them to school, they had everything they need, they were fed, they’re happy, but then I’m sitting there playing with them and I’m not present, my brain is miles away.

Carrie: Sure. Did you have a lot of cleaning rituals related to that that got ramped up?

Crystal: I have some. My therapist is big on not telling me what’s a compulsion. He wants me to decide what I think is compulsive. We’ll get into that talking about ICBT therapy a little bit because I distinction between it and ERP that I like.

I’m a compulsive hand washer. I will admit that right away. I feel like if I’m going to touch something that’s going to go into somebody’s mouth, I can’t have touched anything in between. If I wash my hands and then go touch something that’s not food, I have to wash my hands again before I touch food. That’s probably excessive. My hands bleed. I also do some things that may or may not be compulsive. My kids shower when they get home from school, but to be fair, they roll all over the floor at school and floors are gross. And I can’t change their hair. I can change their clothes, but I can’t change their hair.

I also have a tendency to llysol” all their shoes and “lysol” all my car after they get out from school. I have a three year old that like licks everything and puts everything in his mouth. If I didn’t have a three year old that was a germ collector, I wouldn’t be this intense about it. I do have some cleaning things that may or may not be compulsions. The mental compulsions that I have, the hypervigilance, the mental review, the ruminating, they far outweigh the physical ones in, like, time and, like, distress level that they cause.

Carrie: That’s the hard thing that I see a lot of my clients dealing with is okay, you can put the Lysol down and walk away. That may be really hard for some people.

I don’t want to minimize that, or you can tell somebody, “Okay, touch this and then don’t wash your hands,” but you’re always going to have your brain with you and so you have opportunities to ruminate all the time throughout the day. Those are, I think the hardest compulsions to deal with are the mental ones, like you were saying, that makes a lot of sense to me just from talking with my clients, and it makes sense that after seeing your kids be sick so many times, that it became stuck in your brain that am I ever going to get out of this? Is this going to happen again? And then this was terrible, horrible, awful and I’m trying to prevent these types of experiences from happening. It rose to this level of where you decided I need to go to therapy and you had done some research.

I’m assuming like other people have on what type of therapy should you get? If you have OCD. And you found exposure and response prevention. This is the therapy that’s recommended.

Crystal: I knew about ERP for a long time. I have never wanted to try ERP. I have never thought that it would work for my phobia, but I was desperate. I knew about both ICBT and ERP going in. I was struggling to find an ICVT therapist and I was desperate. So I was like, okay, let me try. this therapist that says that they do ERP and CBT and is trauma-informed and see if they can work with me, but I don’t want to do exposure therapy directly related to my phobia.

I went in thinking maybe he can work with me, and he really seemed like he might. He was really nice, good Christian guy from my state. I thought this was going to be a good experience. He had a lot of experience with trauma and stuff and honestly, if he hadn’t been where he was working, I think that he may have been a really good therapist for me, but I felt like being treated as just like a number on a assembly line. “You have OCD, you have ERP. This is exactly how we treat this.” There was no room for my personal experience. We started with it and I just felt like any time he brought up, “okay, this is what we’re going to do.” Make this an exposure or okay, now we’re going to work on a hierarchy. It gave me so much anxiety.

I never felt better after therapy. I always felt immeasurably worse thought of like having therapy was giving me anxiety and it just felt like a bunch of extra work on top of what I was already dealing with. I was like, okay, look, I’m already so exposed to this. I don’t need extra exposure. I’m already so traumatized by this.

I don’t need extra trauma. I don’t want to create a hierarchy of my fears and then you make me work through them because I already faced my worst fear all the time. Like I deal with this all the time. I have three young children in public. It really wasn’t a good fit. So I talked to my friend and was like, Hey, can you find me an ICBT therapist? And she came through for me big time.

Carrie: That’s awesome. How long did you stay with the ERP therapist?

Crystal: There was one or two weeks where I did two sessions in a week and then others where I just did one. Of course, we get a stomach bug right in the middle of the day. It’s been like one or two weeks that I decided to start therapy and my kids have a stomach bug.

It was awful. Not only am I like trying to start therapy, I’m also dealing with my worst nightmare at the same time. Of course only like five months after we had the last one we had. It’s again, I had just gotten started to feel better and then this happens again. So I think I did four or five weeks of ERP in total.

Carrie: Okay. So there were enough sessions to really determine, like, “This doesn’t seem to be jiving with what I’m intuitively wanting to do, and I don’t feel maybe fully heard or understood how traumatizing this is for me.”

Crystal: Right. I felt like I was having to spend so much time explaining what I meant and what was really bothering me and what I really hoped to get out of it.

None of that was coming through. I don’t know, like maybe he didn’t have a lot of experience with aminophobia in general. It just seemed like he could only do exposures and plan exposures. That’s not what I wanted. I already have exposures. What I primarily wanted to get out of therapy was to learn how to stop the mental compulsions, to stay in the present moment, to redirect my attention to reality and be able to be present with my kids. I don’t think I’m ever not going to be immunophobic. I can’t imagine a day where if there is a stomach bug in my house it’s not going to terrify me. I absolutely can imagine a day where I am not worried about it unless it is directly in my house. You know what I mean?I didn’t think ERP did a good job of making me more present. It’s like, “Okay, well, you’re not present, but you just got to function anyways.” But I’m already extremely functional. I don’t need help functioning. I need help being present, and that’s where I CBT spoke to me.

Carrie: I will tell people too, it matters where you put the I on CBT. If you put it at the end and you say CBT I, it’s CBT for insomnia. If you put it at the beginning and say I CBT, I know we’re therapists. are confusing than it’s inference-based cognitive behavioral therapy.

Tell us a little bit about what you’ve learned about ICBT. I know you’ve done a variety of reading on it in addition to going to therapy with someone who’s trained in ICBT.

Crystal: Let me preface this by saying this is not an ERP hate. Like I know it helps so many people. I don’t want people to think that I’m hating on the therapy that got them functional. I do realize the value in it. I just want to say that. Now let me dive into the therapy that I love. I knew a little bit about it from a friend who had gone through it and now is a fledgling therapist herself providing ICBT therapy in her clinical rotation.

I didn’t dig too, too much. I understood the concept. I understood how it worked. I didn’t dig too much because I wanted my therapist to guide me through it. And he’s done an incredible job of that. This is a good time to get me because I’m almost done. I just finished module 11. There’s only one module left.

Inference-based cognitive behavioral therapy is based off the concept of something called inferential confusion, which basically means that you have a trigger and then your brain has an obsessional doubt about it. What if there’s a germ on this doorknob? But you have no evidence that there’s physical evidence that there’s a germ on that doorknob. It looks clean. You didn’t see anybody sneeze on it. No one’s sick in your house. You have no reason to think that doorknob is dirty, but then OCD comes in and says “Well, what if somebody touched it and if you had a microscope, you could see it? What if the person who delivered your mail yesterday had a cold and he accidentally touched your doorknob while he was delivering it?”

Your brain thinks of all these faulty reasoning methods as to why your doorknob could be contaminated, but none of that is real, right? You don’t have evidence of any of that. All you have is your imagination thinking of all the ways it could be. That’s like really where ICBT lives. It teaches you that you’ve created a story based on faulty inferences that you have gained from all these reasoning methods that seem logical in your OCD brain, but they’re just a little off.

Past experience matters, but does this matter to this situation? No, you’re probably applying it and the situation’s different, or yes, germs technically do exist, but do you have any evidence that are dangerous germs that could actually hurt you on the door? It’s just all about teaching your brain how to recognize the obsessional doubt and the faulty reasoning behind it that goes into weaving this story and then redirect yourself to actual reality, the here and now. You Dismiss your doubts because you realize that they’re based on your imagination, so they’re not relevant to your present life.

Carrie: That’s awesome. I started reading the ICBT manual. I found it very interesting going back to what we were talking about, about mental compulsions versus physical compulsions. What ERP does is it focuses a lot more on the compulsions. ICBT focuses more on stopping because there’s a loop of sessions and compulsions. ICBT is focusing more on stopping the loop at the obsessional part rather than stopping it at the compulsive part. I think that makes a difference when you’re talking about mental compulsions, being able to say, “Okay, right now, it has kind of taken over my imagination and now I’m imagining the worst case scenario where everyone in the family is sick in the hospital, dying because of the stomach bug that I caught off the doorknob”

Crystal: I think with ICBT, it’s a metacognitive therapy. It resolves the obsession. The thing I love about ICBT is that when it works when you finally get it. I’m not perfect at it yet/ Don’t get me wrong, but the more you practice the better you get and it’s like a slow burn First, you just start recognizing,” Crap! that is so outlandish.” Yes, that’s a faulty reasoning method, but you can’t stop. You’re still compelled to do it, but it could be possible, but as you recognize more and more of your obsessional doubts and what is actually drawing you into the OCD bubble, you get better and better and better at not getting into that rumination cycle, right?

It’s like, wait, no, this is an obsessional doubt. I don’t need to take it further, but he greatest thing about it is when it works, you don’t have to sit with uncertainty. We get to have functional certainty in ICBT and I love that because you can be certain according to your senses, right? You can be certain enough.

The greatest part about it is that you never get to the distress part because you get to sit in that functional certainty and say, okay, this is enough for right now for the present moment. Possibility doesn’t matter because it’s not relevant right now. I went through an experience recently that like could have been really triggering for me, and I used my ICBP techniques.

I went to a funeral and I’ve had some death religious OCD in the past and obviously, I was around a bunch of people. I went in a public bathroom, lots of triggering things and I feel like with the ERP would say, all right, do it anyway and just sit with the discomfort, but with ICBT, I did it anyway, but I was never distressed because we resolved the obsession. We never got to the anxiety part of the sequence. We never got to the compulsion part of the sequence because we never got to the anxiety part. It’s like, yes, I did all of this. Yes, it would have been triggering in the past, but because I was able to stay rooted in reality, and I didn’t even get into the OCD bubble at all, like, No, I didn’t have to tolerate discomfort. No, I didn’t have to tolerate uncertainty because I had functional certainty, and I just operated it as I would as any normal person in a normal, non-obsessive circumstance would have. It was really cool to like be able to explain that to people. Yes I face triggers, but I didn’t even have to face discomfort.

Carrie: Did you prep yourself ahead of time or work with your therapist ahead of time on that experience in order to be able to do that?

Crystal: Not specifically. The death was a family friend and was not unexpected, but obviously, we didn’t know exactly when it was going to happen, but if I had done this back when I was like, not as far into the modules, I would not have had as good of an experience with this.

ICBT does a lot of background buildup before you get into the real skill building because you have to learn the metacognitive part. You have to learn exactly. where your obsessions come from, why the reasoning methods are faulty, and you have to learn so much of the beginning of ICBT is learning to recognize your obsessional sequence without changing it, because at that point you don’t have the skills to change your, like, your obsessional sequence.

You just realize, “Okay, this is where my obsessional doubt is, this is what my feared consequence is, this is giving me anxiety and dread and that is why I’m going to do a compulsion. But it’s hard to just stop the compulsion with like no guidance, right? Once you realize that you can notice all of that, then you get to the later modules that teach you about reality sensing and the OCD bubble and the alternative story.

It teaches you how to stay grounded in reality and create a story that is based in reality. And then it’s not compulsive because you don’t. argue with your OCD, right? ICBT is not arguing logic with OCD. It’s saying, okay, reality says this, and I’m going to believe it. And that’s where you leave it. So it teaches you those skills.

So I had just gone through module eight and module nine and module 10, which talk about all the tricks OCD uses to pull you in and why they’re tricks. Module eight is a reality fencing and it tells you about how to stay grounded in reality and not like give in to the OCD bubble. Module nine, the alternative story, which I absolutely love because it’s like you’re choosing to create a story, but you can create any story, so why not make a reality-based story and then stick with it? That helped me so much because I had just done all of that work. I was able to use that. I walked into the public bathroom. I was like, no one’s sick in here. The bathroom’s really clean. I’m not going to dig into it anymore. No what if, no hunting for reasons that it could be dirty or contaminated.

I hugged a bunch of random people and there was no like, what if they’ve been sick? It’s like, well, they look healthy. They seem healthy. Nobody looks like they feel ill or anything. So, I mean, I’m just going to believe the reality based story.

Everybody here is healthy and I’m not, it’s not dangerous to hug them. And you learn those techniques and you don’t have to dig into it. It’s so helpful. I will say like, it took me months, it took me probably four months of just noticing before I was able to employ and it helps a little bit. Noticing does help. I noticed that I was able to get out of my OCD cycle so much faster, even early on, even when after module two, it didn’t really start getting to the point where I wasn’t like even creating an obsessional story to begin with until I had gotten into the later modules. So it just builds on it, but once you get it, it all happens fast.

Carrie: This is something that feels very congruent with the types of things that I teach- mindfulness, which is learning to be in the present moment. The level of awareness and acceptance, what you’re talking about, even noticing your own thought process. A lot of people in the early stages of treatment, they have a hard time even noticing that what they’re thinking is an obsessional thought.

You may have worked on that some prior to this and probably elaborated on that in ICBT, but that’s really the first step is for people to notice. Even when they’re having an obsession before it just seems like, but this just people will say, well, it feels like my thought process and it feels really true when somebody walks into that bathroom, they may feel like it’s contaminated, but what you’re saying is look for the logical evidence that says that it’s not contaminated or that it is maybe it is really dirty. Anybody without OCD would find it disgusting.

Crystal: ICBT spins, I’m not kidding, six modules teaching you exactly how to do that. The first six modules teach you how to slow down your thought process. That’s like the biggest thing with ICBT. You have to slow down. It’s so not intuitive for people with OCD because our thoughts race. It gets your OCD bubble too to slow down your thinking. Instead of ruminating and being like, “Oh my gosh, this is so scary. This is so scary,” It redirects you. It almost pulls you a little bit outside of it to say, “Okay, wait, how did I get here? You spend the first six modules learning how to recognize your obsessional sequence, how you weaved this obsessional story, why it feels so real and the ways OCD pulls you in.”

Literally six modules before it even ever tells you here’s how you get out, and as you learn to slow down the process and work on the whole, do I have direct evidence of this doubt? And that was like one of the earliest things. I think we were in module two when my therapist taught me this. He said, “Just ask yourself, what direct evidence would I have to have right now for my doubt to be true?” By direct evidence, he said he means it will hold up in a court of law. We live by this principle now. I need direct evidence that would hold up in a court of law that my doubt is reasonable. And that was one of the earliest things before I even got to the skill building part of ICBT that started to pull me out of that bubble, that started to help me with my OCD.

What is the direct evidence I would have to have that one of my kids has a stomach bug? And in a court of law, evidence, it would have to be that they are physically sick. I would have to have seen one of them have gotten sick. Because I can’t tell you how many times I was like, my stomach hurts, and there’s nothing wrong with them. That’s not direct evidence, et cetera, et cetera. A lot of times the bar for direct evidence is way higher than we realize that it would have to be. Our OCD has tricks warp us into thinking we have direct evidence, but really, we don’t have direct evidence of that. That was the earliest thing that I learned to do to help pull me out of the OCD bubble was say, “Okay, wait, slow down.” You’re creating a story. What direct evidence would you have to have for the story to be true? That was like an early, early skill technique that my therapist taught me that really helped me when my OCD was really bad before I even got into the skill-building part.

Carrie: You said there are 12 modules that you have to go through and learn. As you go through those modules, is there homework involved?

Crystal: ICBT is like a course, literally, I would say like a college course. The way my therapist approaches it, he goes over a module with me, and he doesn’t like read to me, and I do not have the module, he doesn’t send me any of the stuff until after.

He always has some sort of analogy or thought experiment or exercise to do with me in session, and they’re always excellent. I was relating my OCD to parallel, but not exact, situations. So like, I have a lot of anticipatory OCD issues. I’m afraid of the next time we’re going to have a stomach bug.

He would parallel that with the client that was worried about, he worried about noticing shapes, and he would notice a shape, and then he would see it everywhere and get really distracted by it, and it would make him miserable. He would always be worried about the next time he might notice a shape and it would stick in his brain. He would parallel my story to that, and he would parallel, maybe my worry about stomach bugs to someone who was equally as afraid of COVID. These parallel examples, but that took me a little bit to think rationally when it’s specifically about your theme. He would go over that with me and then it would always relate to the module we were on for that week and then he would send me the homework and the homework is always a lot of it is like some writing and then there’s some exercise like thought experiments that we do throughout the week.

We would meet back the next session and go over what I wrote. First go over the quiz and then we would go over the work I did and then any questions I had about it, one to two weeks per module, typically.

Carrie: I think this is really important, Crystal, for people to know what they’re getting into when they’re looking at doing different therapies because it doesn’t really matter which therapy you choose. If you’re not willing to show up and do the work, it’s not going to help you get better in different modules, different types of therapy work for different people. That’s why we’re talking about this to let people know, maybe you have tried ERP and you’re looking for a different option. Maybe you haven’t tried ERP because the idea of it just totally terrifies you and you don’t feel like you can do that. Or maybe people say, I don’t know how to expose myself to certain things that are in my imagination, like being afraid of going to hell, there are different things that they do and exposure and response prevention to expose people to that, but it doesn’t necessarily sit well.

Sometimes Christians struggle with doing some of those exposures and having to find somebody that we will do religiously sensitive exposure sometimes can be a challenge from what I’ve heard from various people that have contacted me through the podcast. So I’m glad that we’re talking about this, but it does, whatever you’re going to do, it does take practice.

It does take intentionality and it does take work be called it the OCD bubble. You’ve spent so much time going through that over and over and over again, like it’s really patterned in your brain. So whenever we’re trying to make these new brain connections, it takes our brain a while to pick up on something new like that, that you’re feeding it. You have to do it over and over and over, just like any other habit we create in our life. We can’t go out and exercise one day and say, Hey, like I’m in fit and in shape.

Crystal: You have to exercise that brain. I will say that was the biggest thing. I would get so frustrated at the beginning of ICBT therapy because I’ll be like, “Yes, you taught me to notice all this and I can notice it. I don’t know how to stop.: That was my biggest thing and then I realized the more I practice, all of a sudden I was just doing it. I can do this now. I cannot put too much emphasis on it, even if it feels you’re just noticing and it’s frustrating that you’re noticing and there’s nothing you can do.

The more you practice, the faster you get and the earlier you notice your obsessional story, the less anxious that you will make yourself. You’re torturing yourself by weaving this terrifying story. You’re scaring yourself. Once I realized that, it’s like, “Wait, why am I doing this? I’m literally just sitting here terrifying myself. Why am I doing this?”

I was already so far in before I realized I was doing it. It was hard to stop, but when you catch it, then you’re not quite as anxious. You haven’t woven as good of a story at that point. It’s way easier to stop. Noticing is, I would say 85 percent of the work. Once you’ve noticed it, once you figure out how to notice it and slow yourself down, that’s like 85 percent of the work. The skill-building part is only 15%.

I spent weeks doing it, he had me doing thought chains. At first, it was retrospective and then eventually I got so good at it, I can do it in real-time.

But it’s like, “Okay, I noticed I was in the bubble. Where did I go wrong? What initial thought took me into my imagination and away from reality? That was so helpful. I think I did them for three weeks. Now I do not have to write them down. I do not have to go back and go through it at all.

I can do them in real-time. Like I said, I’m not perfect. Sometimes they’re harder than ever. For instance, if there was a stomach bug going around at my kid’s school and I knew it, it would be much harder for me to deal with that, right? Or if one of my friend’s kids had a bug, when I get faced with an online, like the other day, the weather channel decided, well, not the other day, this was like a month ago, but norovirus is going around.

I was like, no, I don’t want to know that. I spent the whole day freaked out because of that. Again, I’m not perfect at it, but I will say the beauty of ICBT is that a lot of times you hear you can’t get better without exposures, but I think we need to think about that differently. You don’t have to do exposures to do ICBT if exposures terrify you and you are not going to do therapy for your OCD because you don’t want to do exposures, you do not have to do exposures with ICBT.

You will be triggered because you’re going to have to talk about your fears to be able to do the therapy, but you do not have to do exposures. And the thing about ICBT is that you obviously eventually you’re going to stop doing compulsions and live your life. But it’s not about doing exposures for the sake of exposures.

It’s about I can do this triggery thing because I have no direct evidence that it requires a compulsion. I have no direct evidence that my obsessional doubt requires me to do anything but live to do what I want to do according to my values. That’s the greatest part about it. My therapist, he does ERP with other clients.

Sometimes he’ll be like, “Well, that’s a great exposure” But it isn’t an exposure, right? It’s just something I wanted to do to live my life. We’re just like kind of joking about it being like that. But it’s great, right? Because I didn’t have to plan an exposure, plan response prevention. I just, for instance, we’re going to go to an Easter egg hunt at church on Saturday.

That gives me anxiety, having to take my three-year-old and let him hang out with other kids. Do I need to avoid that situation? No, because no one’s ill. I have no evidence that anything bad is going around at the church. It’s outdoors in the sunlight, and we’ve gone to many things at the church before, and my kids have been fine.

My daughter goes there. All the time with her friends, and she comes back fine. Reality tells me that we can go and it’ll be great. And it’s something I want to do. It’s something that’s values-based. And so it’s not an exposure, right? It’s just me living according to my values and not having to do an avoidant compulsion because reality says that it’s unnecessary.

Carrie: Unless you’re doing massive amounts of avoiding, which there are people that do that, that avoid all types of different situations. In order to live your life, you’re going to face triggering situations, I think is what you’re saying. So you’re going to expose yourself. It’s just not a, Oh, this is a planned exposure to work through my OCD.

It’s just like you said, living your life, which feels really freeing and beautiful that you’re able to go out and do those things.

Crystal: I like to think of it as not an extra exposure, you know what I mean? With ERP, it’s all about extra exposure on top of your triggers to teach your brain how to not respond to it and don’t do a compulsion when you do this trigger,

but with ICBT, you’re remaining in reality, and your obsessional doubt is irrelevant in the here and now. That’s like the biggest thing in ICBT, like, Your OCD is irrelevant. OCD is imaginary. It is a story you have created solely in your imagination, and it doesn’t matter if it’s technically possible.

It doesn’t matter if it’s happened before because it’s not happening right now. And because it’s not happening right now, the only way that OCD could have conceivably come up with this doubt is for you to have imagined it, I love that. OCD is in your imagination, but you need to be in the present. That’s the biggest thing it has taught me is that even though I feel like my fear is a very difficult one, my fear is more probable than not, right? There are lots of people who are scared of things with OCD that will never happen. I am going to be exposed again. I am going to be terrified, and I might even be traumatized by it, but it’s not happening right now, so it doesn’t require my attention right now. That has been the biggest thing for me is learning to let go of the what if and that it’s possible and this could happen in a week because it’s not serving me any purpose.

Carrie: Through that process, you’ve found that you’ve been able to be more present with your children than instead of just in these thought processes.

What if my child gets sick or what if they brought something home or what if this or what if that?

Crystal: Constantly, hypervigilantly monitoring their every move for evidence that they might be ill, you know, I used to spend so much time doing that and I still do it occasionally, but it’s much quicker.

I’ll look at them. I’m like, “Oh, it looks fine and I’ll just move on.” Whereas before I would have stared and I would have asked how they felt and I would have dug, but digging is bad.

Carrie: Well, thank you so much for sharing your story. Tell us where people can find you on Instagram and we’ll put some links where they can learn more about ICBT from a professional perspective, but tell us where they can find you on Instagram.

Crystal: Functionally OCD. They can find me there. You can message me there. Awesome.

Carrie: Awesome. Thank you again for being on the show.

Christian Faith and OCD is a production of By the Well Counseling. Our show is hosted by me, Carrie Bock, a licensed professional counselor in Tennessee. Opinions given by our guests are their own and do not necessarily reflect the views of myself or By the Well Counseling.

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