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Tag: ICBT

226. Found ICBT after ERP Wasn’t Effective: A Personal Story with Dr. O. Alan Noble

Carrie sits down with author and professor Dr. O. Alan Noble to share his deeply personal journey through years of OCD treatment, intense suffering, and ultimately finding hope through ICBT.

Episode Highlights:

  • Why traditional talk therapy and reassurance can unintentionally keep OCD cycles going
  • How ERP may help some people while still leaving others feeling stuck and exhausted
  • The key differences between ERP and ICBT in treating OCD
  • How ICBT helps people recognize the difference between reasonable doubts and obsessive doubts
  • How faith, community, and hope can sustain people during seasons of deep despair
  • What real recovery from OCD can look like, even when intrusive thoughts still occur

Episode Summary: 

What Happens When ERP for OCD Stops Working?

I never expected to sit across from someone who had done everything right and still felt stuck. Dr. O. Alan Noble is a professor, author of four books, and a contributor to outlets like The Atlantic and Christianity Today. But behind all of that, he spent years battling severe OCD, doing ERP faithfully, and still watching the relief disappear every time. If you have ever wondered whether ERP is truly enough for everyone with OCD, his story will change how you think about treatment.

Can You Spend Six Years in OCD Therapy and Still Not Get Better?

This is something I hear more than I wish I did. A caring therapist. Reassurance given session after session. A client who left feeling okay until the doubts rushed back in before he even got home. Six years of that same cycle. There is something in this pattern that every person with OCD and everyone who loves someone with OCD needs to hear.

What Is ICBT and Why Did It Work When ERP Did Not?

When his ERP therapist finally admitted “this isn’t working,” it cracked open a door. Inference-Based CBT introduced ideas that ERP had never touched, including that not all doubts are created equal and that the content of OCD thoughts actually matters. What Dr. Noble discovered on the other side of that door is something you need to hear him describe himself.

What Does ICBT for OCD Actually Look Like in Real Life?

Dr. Noble still gets intrusive thoughts today. What changed is what happens next. Using tools from ICBT like the bridging exercise, he described working through an intrusive thought that very morning in about three minutes before moving on with his day. Three minutes versus hours of rumination. That shift is what his wife calls miraculous, and after hearing his full story I completely understand why.

How Do You Stay Hopeful During OCD Recovery When Nothing Seems to Work?

There were days Dr. Noble sat on the edge of a bed in tears, convinced nothing would ever change. What kept him going was not a clinical strategy. It was something much deeper. The people, the scriptures, and the perspective that carried him through his darkest moments are all part of this conversation, and honestly this section moved me the most.

Can Christian Faith and OCD Treatment Actually Work Together?

Dr. Noble’s journey started with a biblical counselor who offered scriptures to meditate on. For most people that feels like a lifeline. In his case it became more fuel for rumination. This tension between Christian faith and OCD treatment is one of the most misunderstood areas in mental health, and Dr. Noble speaks into it with honesty that only comes from living through it.

If you have been searching for hope around OCD recovery, wondering whether faith and evidence-based treatment can coexist, or just looking for proof that things can get better, this episode is for you.

Connect with Dr. O. Alan Noble here:  

x.com/TheAlanNoble

www.instagram.com/oalannoble/ 

//substack.com/@oalannoble

To Live Well: Practical Wisdom for Moving Through Chaotic Times

Transcript

Welcome, OCD warriors, to the Christian Faith and OCD podcast, where we are all about reducing shame and stigma of struggling with OCD as a Christian, sharing hopeful stories, and replacing uncertainty with faith as you develop practical tools for greater peace.

I’m Carrie Bock, Christ follower, wife, mom, and licensed professional counselor in Tennessee. I pray you are blessed by today’s episode. If you have been around the podcast a little while, last summer we did a personal story series, which was really great. And always whenever we have personal stories of Christians who have struggled with OCD, we always get really good feedback.

It helps reduce a lot of stigma, and people feel encouraged to keep going and feel like there’s hope for them when they hear someone else’s story. So I’m excited to bring that back to you this summer. And today on the podcast we have Dr. O. Alan Noble. He’s the associate professor of English at Oklahoma Baptist University, a fellow at the Keller Center for Cultural Apologetics, and author of four books, including his latest, To Live Well: Practical Wisdom for Moving Through Chaotic Times, On Getting Out of Bed: The Burden and Gift of Living- That was a really challenging book for me.

I’ll just throw that out there. Definitely prompted a lot of thoughts and took me back to definitely some times where I felt depressed and didn’t wanna get out of bed. That was rough. You Are Not Your Own: Belonging to God in an Inhuman World, is that also the name of your Substack?

Dr. Alan: Yeah, You Are Not Your Own Substack is the name of it.

Carrie: If you have not read Dr. Noble’s Substack, we’ll put a link in the show notes. You need to get over there and read the posts. They’re good. He’s had also a variety of articles published in different places, The Atlantic, Gospel Coalition, First Things, and Christianity. And you’re also married with three children.

Dr. Alan: That’s correct.

Carrie: We decided kind of talking ahead of time to really focus your interview on your treatment and kind of your shift from talk therapy and ERP, eventually over to iCBT, and that was how I got connected with you, actually, was one of our podcast listeners has a Substack, and she had, I think, linked one of your articles or talked about your book on getting out of bed.

That was how I found out about you, which is a really great connection. So if anybody has any guest suggestions out there, please always share them with us. We enjoy hearing those as well. Tell us a little bit about your journey of what it was like for you trying to find the right treatment for OCD.

Dr. Alan: I started with biblical counselor. That was my first move, was with a biblical counselor, and that was not helpful. This person really tried. He was a very sweet man. He really had a heart for God, and he was very kind and gave me a lot of scriptures to think about. But the scriptures just gave me more to ruminate about, trying to make a decision about what I was ruminating about and trying to figure things out, right?

That’s one of my ruminations, one of my fixations, is trying to figure things out. Those scriptures just gave me more fodder to figure things out. He did tell me one thing, the last thing we said to each other that was helpful and was true, which was that I needed to understand God’s grace for me better and the meaning of the cross.

And I’ve found through my therapy that that piece of truth was true. Even though he couldn’t help me with ERP or iCBT, he did understand that I do struggle with understanding God’s grace. So I went from that. I came from a church background where seeing therapists was not what was done. That’s why that was my first step, and then I went off to grad school, and my next step was after talking to a pastor, I decided I’m gonna take this big leap and I’m gonna see an actual therapist, a quote unquote secular therapist who is actually a Christian, but they studied in secular school, so it didn’t count.

And a secular psychiatrist, and this was a big step, and I prayed about it and I talked to a pastor, and he’s like, “Yes, you should do this.” And so I felt like, okay, I’ve got this blessing. I’m gonna do this. And the psychiatrist was helpful with the medication side, but the therapist, we did some light ERP and didn’t really help too much.

I moved to Oklahoma, was in a small town, and the only therapist I could get was somebody who did talk therapy. And at the time, because I’d only done some light ERP when I was in Texas, I really didn’t know that ERP was the quote unquote gold standard. I didn’t know what I was missing out on, and I just thought therapy was therapy.

And the therapist I got in Oklahoma said, “Yes, I treat OCD. I’ve treated OCD before.” So these were the magic words I was looking for, right? I didn’t know any better. I was expecting– That’s what I was looking for, somebody who says, “I’ve treated this before.” And I went to her for about six years, and she gave me reassurance for about six years.

I would come to her with various fears I had. My doubts have to do with fears about having harmed people and being negligent, and she would be like, “No, you haven’t been negligent. You’re okay.” And I would walk away feeling fine until I started my car and then The doubts would come back, ’cause that’s how OCD works, and I would say, “What if she doesn’t know?

What if she doesn’t understand? What if? What if? What if?” So I kept going back to her because it was almost addictive really. Wow.

Carrie: Did she ever, like, say, “Hey, you’re coming back with some of the same things, and we’ve already talked through this”? Did it create any kind of red flags for her, like my- No … the client isn’t getting better?

That’s really concerning, kinda scary. Uh, however, I will say that your pathway is very familiar to me, that I’ve heard this from a lot of- Yeah … different people that I’ve talked through the podcast or who have sought help from me. It’s like, “Well, I went to this person that was a Christian, and they really understood my faith, but then they didn’t understand the OCD piece or didn’t know- Yeah

how to help me.” Unfortunately, there are therapists out there saying, “Oh, yeah, like, I work with OCD no problem,” but then you get in there, and they’re not providing evidence-based care, which is problematic.

Dr. Alan: Yeah, and again, very kind person, very caring, concerned about me, but was not equipped with the tools to address what needed to be addressed with me.

And then I got connected with somebody who actually treated OCD with ERP. I started actually listening to some podcasts, I think, and that’s what sorta tipped me off. And I saw this person who treated OCD in Oklahoma City, which is 45 minutes away from where I lived at the time, so it was a sacrifice. But I said– I reached out to him and asked, “Maybe you can help me.”

And I explained my symptoms, and he said, “Yeah, you have OCD, and there’s this thing called ERP, and that’s what you need.” I was like, “Okay, let’s try this.” And so I tried that with him, and then I tried it with another therapist, and I tried some intensive ERP. I tried it for at least two years of just intense ERP.

And you introduced me as Dr. Noble, and I do have a PhD. I’m a good student. I would imagine. I’m good at doing my homework. I have four books. I’m good at doing my homework. So when you give me an assignment, I’m doing my homework. And so I did my ERP homework. And I really wanted to beat this because it was severe on the scale.

It was not light OCD. It was taking up long hours of my life and really disrupting my family life. I was serious about beating this because I needed to get my life back. And so here I was practicing the ERP for two years, just doing the exposure scripts. I was listening to exposure scripts. I was doing different exposures that I was assigned, doing everything that I needed.

I would see some relief. I would see some improvement, but then it would just come back again.

Carrie: So it was, like, a little bit of relief, but it seemed to be temporary or short-lived. That

Dr. Alan: was exactly- Yeah … the problem. If my OCD was at an eight out of ten, it would come down to, like, five. And stay there for a little while after practicing ERP just vigorously, and then it would just go back up to an eight again.

It wouldn’t come down. I was applying the tools. I was doing what I was supposed to. Really, applying the tools was my life. Wow, yeah. This was what I was doing.

Carrie: So then it was like recovery was taking all of your time, it seemed like. Did you almost feel– I think sometimes people can get obsessed about their recovery.

Did you feel that way? Like, “I’ve gotta do this, and I’ve gotta do it exactly as prescribed,” and all the things. I

Dr. Alan: didn’t feel obsessive about it, but I did feel obsessed about it. So it wasn’t like a compulsion, but I was obsessed about it in a non-compulsive way. I was like, “This is what I have to do. I’ve gotta beat this.”

It was in the back of my head almost all day. I was either doing a compulsion by ruminating in my mind, ’cause that was my main compulsion, was rumination, or I was practicing ERP or thinking about practicing ERP all day. So it was like my life was OCD. That was it. And it was just so draining, and also so boring.

It’s like, I don’t want OCD to be my life. My life is so much bigger and richer than this. I thought it was, and now it was just this.

Carrie: When you were going through that level of intense suffering with the OCD, how did you remain hopeful to keep going? Yeah. Because I think a lot of people just say, “ERP is the gold standard.

It didn’t work for me. I’m just giving up. I’m tapping out right here.” And there are some people that just say, “Well, I’m just OCD. You gotta live with me. Like, this is all there is to it.” Like, how did you keep pushing or keep going?

Dr. Alan: That’s an excellent question because there were times when despair was tapping at my door when I thought that exact question.

I thought, “Okay, this is the gold standard. This is what I’ve been told. I’ve heard all the podcasts I’ve done. I’ve read all the books. They’ve said this is it. This is how you get better, and I’m practicing this religiously, and I’m not getting better. I’m not seeing these results.” Maybe this is as good as it gets.

Maybe I’m not gonna see any more improvement over this, and I just have to come to peace with this. And a couple of things gave me hope. One is in Romans 8:28, Paul tells us that God works together all things for our good. So just believing that God is somehow working my good through this suffering, and I didn’t know how.

I didn’t know the particulars of what that good looked like. I didn’t know how he was redeeming that good, but I knew that he was working my good through that suffering and just resting in that. Also having a group of friends and family who are cheering me on and telling me, “Don’t give up. Keep going Keep fighting, keep pressing on, keep striving for wellness.

Because God desires our good, because we are given stewardship over our body, which includes our mind- Yeah … it is honoring to God for us to desire recovery. We’re not gonna get perfect bodies and minds until the resurrection, but it’s good for us in this life to fight for, to strive for, to work towards healing.

So I was committed to that, and I would look at my kids, I would look at my wife, and I would say, “I have a duty to do this. I don’t get to roll over and give up.” The other thing is that even though these therapists, these ERP therapists, they were great therapists. They were just wonderful therapists. They weren’t seeing the results that they wanted to see in me, but they were great therapists who were using all the tools that they had, and they didn’t give up on me.

They said, “What is it gonna take to see you get better?” It was the last therapist I was working with who actually introduced me to iCBT- Okay … who said, “Allen, this isn’t working” What we’re doing isn’t giving you the relief and the progress that we need to see, that we want you to see. Why don’t we try something different?

And if I can’t provide that for you, maybe somebody else can, because I don’t want you to give up. I know that you can improve. And hearing that meant a lot because, like I said, I wanted to give up. I did wanna roll over. Maybe I’m still gonna have some intrusive thoughts, but it doesn’t have to take up hours and hours and hours and hours of my day.

That’s what I needed to hear.

Carrie: Therapeutically, I’ll just say from the therapist side, that’s a really hard conversation to look at somebody and say, “I believe in you and I believe in your health, and I am in the way of that now.” Like, “I have-” Yeah “… literally given you every tool I have in the box, and I want you to succeed, and that means that you have to kind of fly on away from me.”

Because sometimes people can take that personally of like, “Oh, you’re giving up on me?” It’s like, “No, that’s not what I’m saying. I’m saying you need a different toolbox than what I have-” Yeah “… right now. And for your best interest, it’s not good for us to keep on clients for long periods of time that are not making progress.”

That’s not ethical.

Dr. Alan: Yeah. It was a hard transition, and starting iCBT was hard too, but it was what I needed, and that’s what made the difference for me. I still clung onto that hope. I needed that hope, that belief. What I’ve come to realize myself is that desire for recovery, in my opinion, is the most important key to recovery.

It was at least the most important key to my own recovery because all throughout this journey that I just described, the ups and downs, if I gave up desiring to recover at any point, it would’ve stopped. I had to have this drive to recover. I had to have this belief that it’s my responsibility before God and before my family and before my friends, before my church, and before myself.

Like, I owed it to all those individuals and myself to get well, as well as I could get. I had to have a hunger for that. I had to advocate for myself. I had to keep looking for therapists, the right therapist, the right medication, and that took a drive.

Carrie: Yeah. I think the beautiful thing about living in Christian community is there are days where we don’t have it for ourselves, but somebody else can have it for us.

Yeah. And in your book, on getting out of bed, you talked about this guy that you just kept calling him- Yeah … all the time and felt bad, “Sorry, I’m calling you all the time to help me through these dark places,” and he’s like, “That’s what I’m here for.” And we need that inside ourselves, that drive to get better, but we also need other people to hold us up on the days that we just don’t have it.

Dr. Alan: Yes, absolutely. There were definitely many, many days where my desire was not there, and it was other people carrying me. Three or four friends, plus my wife and my children in their own way, and who I would contact when I was in despair or tempted to despair, and they would give me the hope, comfort me with the comfort of Christ when I didn’t have that comfort, as Paul talks about Corinthians, I believe.

Just give me that comfort when I felt like I didn’t have it, and they would share that with me, not to reassure me, but just give me that comfort so that I could move forward.

Carrie: Was there a particular concept in ICBT that stood out for you or that you found particularly helpful?

Dr. Alan: Just the basic premise that there are reasonable doubts and obsessive doubts.

Just that basic premise itself is really powerful for me, I think. So there are a couple things. That one’s really powerful for me, that I can look at my doubts and say Based on my senses, is this a reasonable doubt? Do I have sense information based on, including my common sense, to evaluate this as a reasonable doubt?

Is this relevant to the here and now? And that kind of rocked my world and flipped it upside down and made it seem like, well, okay, this makes a lot more sense, as opposed to just seeing things in terms of, well, just not even thinking in those terms at all. That really helped me, I think especially because I’m somebody who thinks a lot, and so just having that ability to use my mind without getting stuck in the weeds of the content- Yes

was really powerful. Another really important concept is the feared possible self. Just that idea that this is coming from somewhere, that these thoughts aren’t random. That’s another thing that ERP always felt like it was lacking that didn’t make sense to me from ERP, is that the content is totally irrelevant.

Well, is the content totally irrelevant? Because it seems like it has a pattern. It seems like it all stems from somewhere. So like for me, like it all centers around being a negligent self. Well, that tells me something, and that probably points to something, and that probably matters. So why aren’t we talking about that?

That seems worth poking at, and why aren’t we poking at that? And so ICBT does a good job of addressing that, of bringing that elephant into the room. I really appreciated that.

Carrie: Yeah. And I like that spiritually in the context of the- Yeah … real self. If we’re saying the content doesn’t matter at all, then the content is connected to things that you value.

So it’s like, well, so you’re saying my values aren’t important- Right … versus recognizing like, okay, this is a lie, a false self, and then this is who I really am. What are your thoughts about this spiritually, just in terms of like sense data evidence? ‘Cause we have a lot of people that wrestle with things like sin.

Yeah. Did I sin versus not?

Dr. Alan: That’s a great question. I think we can trust our senses. I think that God has given us senses to use as reasonable tools as best we can to make sense out of the world, and I think that our senses can be fallible. I think there are two things to think about. One is that it’s reasonable for us to trust our senses unless we get evidence otherwise, and that’s what ICBT teaches, right?

If you get data that says that the video you watched was AI, then you change your information, right? Mm-hmm. But otherwise, you trust your senses. But for the person with OCD, the analogy I always like to use is they come up to the street corner and instead of crossing the street, looking once, checking for cars, I know for me, I wanna check like a million times before they cross the street, over and over and over again, instead of trusting their senses, right?

Right. Normal person trusts their senses. They look once, they trust their senses, and then they cross the street if there’s no cars coming. It’s reasonable. God has given us good senses. It’s reasonable for us to trust our senses. And the other thing we can do is, and James talks about God giving us wisdom, and I think that we can pray for wisdom and clarity and trust that God gives us those things, and trust that our senses are good, and let it go at that, and not doubt our senses.

I don’t mean that compulsively. I’m not saying compulsively pray for wisdom, but just in general, pray that God gives you wisdom and trust that He does that, and then move forward in confidence, resolute.

Carrie: How have you wrestled at all, like, with the concept of healing and desire for healing and recognizing, like, okay, God allowed this intense suffering as a part of my story?

Dr. Alan: Yeah, that’s hard. There have been a couple of things that I’ve thought about. What’s hard about this, it’s not just my suffering, but it’s affected other people, right? Sure. That’s the reality, is it’s affected my family, it’s affected my friends. It has ripple effects. Even if you’re living alone, it’s gonna affect your coworkers, your neighbors.

Suffering always ripples. That’s what makes it so difficult, is that you can’t say, “Well, my suffering taught me this lesson, and so it’s been redeemed.” You also have to acknowledge that other people were hurt by it. But I’ll say a few things. I’ll say, one, Paul teaches as a truth, in Romans chapter five, I believe, “Through suffering, I’ve been taught perseverance, I’ve been taught endurance.”

And he says, “Endurance builds character, and character builds hope.” And that’s been true for me. When I look back at what I have been through, this just hit me a couple of days ago. I was just walking along or driving or something was happening, and I just thought, “Allen, do you remember how much despair you were in?”

Just sitting on the edge of a bed crying, just hopeless, just the OCD, just absolute control, feeling like you were the worst monster in the world. You made it through that. Isn’t that amazing what God has taken you through? I didn’t mention this, but thanks to iCBT, through the last year and a half or so, my wife calls it miraculous, the change that has happened because of iCBT compared to ERP.

“It’s just been miraculous,” she says, and I agree with her, and I thank God for it. Yeah. But just seeing that change, part of what I’m looking back at is I’m looking back the change that’s happened in me, the hope that I have, knowing that God can do miraculous things, that He can take me through hard times and bring me through them, and I’m not the same person Another thing that’s happened is that I have been able to help a lot of other people through my own suffering, and Paul again talks about this when he talks about comforting others with the comfort of Christ.

It doesn’t mean that my suffering isn’t serious. It doesn’t mean that my suffering didn’t happen. It doesn’t mean that other people didn’t suffer because of me. But it does mean that that suffering has meaning, that it does something. I have been able to walk with other people who have OCD and tell them that they have hope, that they can get help, that they can do something, that they have agency in their lives, that they can advocate for themselves and get the proper therapy, whether it’s ERP or iCBT, whatever it is, get the proper help.

I can pray for them. I can encourage them. I can teach them not to get reassurance. I can do these things because I have been there, and I can love them. The gratitude I’ve received from that is just so powerful. And then finally, again, I just go back to Romans 8:28. Somehow, God is working my good through this suffering, and He’s working the good of my family through their suffering that they experienced through my suffering and my friends and anyone else who was affected by this.

I don’t know how God is weaving that But I know that God is good. I know that He loves us. I know that He’s just, and I know that He’s caring for us, and I know that He’s almighty, and I know that He’s a good God, and I know that He’s gonna work these things out. I have hope that somehow He’s working these things for the good.

And somebody could look at that and say, “Well, it’s just wishful thinking,” but I would say, “No, I’ve seen Him work miracles.” Yeah. I, I have hope.

Carrie: I think that one of the biggest lies that people believe when they’re in the midst of suffering is it’s always gonna be this way.

Dr. Alan: Yeah. It’s

Carrie: always gonna be this bad.

I’m never gonna be able to get out of this. And that’s the lie, and we know that God can use anything and to change and transform people. And I’m glad that you got over that hurdle of getting into, quote, “secular therapy from a Christian person.” Yeah. And you went on that journey and eventually found the right help.

And the idea behind having podcasts like this and people finding your writings is to get people in good treatment faster so that they don’t have to- Yeah … go through that long journey where everything is just- Getting more and more difficult, and think that this is very hopeful for our audience. Yeah. I think sometimes people think the goal is, like, to never have another intrusive thought again.

Mm. And so we just wanna debunk that as well. Yeah. When you think about recovery- Mm … what does it look like for you today?

Dr. Alan: Yes. I mean, even for today, I still have intrusive thoughts. I still have things that come up, and I use my tools, and I apply them. So today, intrusive thought hit me, and I used the bridging tool that it, ICBT teaches, and visualized myself on a bridge, and made a choice not to go into the bubble, and moved on with my day.

For today, it took me about three minutes to make that choice. Now, later on today, I might not make that choice. I might slip up and make the choice to go in the bubble, and that might happen. But overall, my recovery looks like making that choice less and less and making the choice to move towards my family and what I believe is the life that God has given me, has called me to over and over again.

As I said, overall, this change has been miraculous. There have been bad days. There have been bad weeks. Sure. There have been bad months. That is a reality, and a reality that I work on with my therapist still. But the overall trajectory has been so much better that it is still amazing. Thank you for bringing that up.

Yeah, that’s a really important point. It’s not that I don’t get intrusive thoughts. It’s that they don’t run my mind anymore. I have tools that I can use to choose what I’m going to do next, and most of the time now, I can choose to move toward my life.

Carrie: Awesome. I know a lot of people have told me that they found the bridge exercise very empowering.

It’s like, “Oh, I feel like, hey, there’s a pause here.” If I can find that pause, right? And you don’t always find it, but the more that you become aware of how you get there, the more you find it, and then I feel really empowered to know, “Hey, I found the pause. I have a choice right now.” Yep. Yep. I can either go right or I can go left, and I know what the consequences are gonna be depending on what I choose.

Awesome. Tell us a little bit before we go about your latest book that just came out.

Dr. Alan: Yes. It is called To Live Well, and it is a book about the seven virtues, prudence, justice, temperance, fortitude, faith, hope, and love. It’s about how to live well in a chaotic time. I think we live in very chaotic times. I don’t think that’s too debatable.

It feels very confusing to live in the modern world. It feels like everybody’s values are up in the air. It feels like the definition of love and of justice and of what is true is constantly being contested, and that makes it hard to move, hard to act, and very easy to get stuck. And so this is a book about how to move, how to live well, how to act in the modern world, the contemporary world.

And so I move through these classic virtues Grounding them in the Gospels, because it’s a biblical book, and grounding them in Jesus and His actions in the Gospels, and work through what it looks like to be a virtuous person for God. Not to earn God’s favor, because we already have that, but because God loves us, we wanna act virtuously and understand what it looks like to live virtuously in, uh, chaotic times.

Carrie: Yeah. It’s a crazy world out there. There’s a lot that gets thrown at us, and things are changing all the time, so any help for how we can live out Jesus in this environment I think is helpful, for sure. Yeah. Thanks. Thank you for sharing today. I’m really thankful for Dr. Noble for sharing his story, because I think there are many other people out there with this story that feel like they’re doing all the right things that they’re supposed to be doing and just aren’t getting better.

It’s important for people to know that there is hope out there, and to not give up, to keep going. I think for a long time in my own life, I was like, “Yeah, God has a plan for all this craziness,” but I really doubted whether or not it was a good one. And looking back, I can now see, like, God’s goodness in the course of my life, and I’m so thankful for that.

If you’re in the midst of just a really dark place with your OCD, I want to remind you that God hasn’t given up on you, and just encourage you not to give up on Him, to keep leaning in even when things are hard and they don’t make sense. I am currently working my way through to live well, and it’s been a slow go for me because I keep having to stop and think about things.

Definitely challenging in a good way, for sure. I hope that you guys will come back next week and join us as I interview a pastor about his OCD journey. 

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. 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.

223. How Mindfulness is Helpful for ICBT

In this episode, Carrie shares how mindfulness and Inference-Based Cognitive Behavioral Therapy (ICBT) can come together in a powerful way to support your OCD recovery journey. 

Episode Highlights:

The difference between mindfulness and meditation, and why it matters

How mindfulness helps you create space from intrusive thoughts

Why building distress tolerance is key for OCD recovery

What ICBT is and how it reveals what’s really happening behind OCD

How faith, Scripture, and staying present support your healing journey

Episode Summary: 

How Can Mindfulness Actually Help Me Break Free from OCD Thought Loops?

I used to think mindfulness was just about calming down, but I’ve seen it become something much deeper. It creates space between you and the intrusive thoughts that feel so real. And in that space, something begins to shift. Instead of reacting, you start noticing. That small change can open the door to a different kind of peace, especially in the middle of OCD struggles.

Why Do I Keep Getting Stuck in Worst-Case Scenarios Even When I Know They Aren’t True?

Your mind can take one moment and turn it into a future disaster that feels completely real. But what if the issue isn’t the thought itself, but how we respond to it? I’ve seen how OCD pulls us out of the present and into imagined fear. When we gently return to what’s actually happening right now, things begin to loosen, even if just a little.

What Happens When I Stop Fighting My Thoughts and Just Sit with Them?

This is where it gets uncomfortable, but also where growth begins. Instead of pushing thoughts away, mindfulness invites you to stay present with them. To notice without judgment. And over time, you may begin to see that thoughts don’t hold as much power as they once did. That shift can feel quiet, but it’s meaningful.

How Do Mindfulness and ICBT Work Together to Rewire My Thinking?

When mindfulness and ICBT come together, something powerful happens. ICBT helps you understand the story your mind is telling, while mindfulness helps you slow down enough to see it. Without awareness, it’s easy to stay stuck. But once you begin to notice the patterns, you’re no longer completely led by them.

Why Does OCD Feel So Real in My Body Even When I Know It Doesn’t Make Sense?

OCD doesn’t just live in your thoughts. It shows up in your body, your emotions, and that sense of urgency. It feels real because your body believes it is. Mindfulness helps you stay present with those sensations without reacting right away. And over time, that builds trust that you can handle what you feel.

How Can My Faith Support My Healing Instead of Adding Pressure?

Faith was never meant to increase fear. When we come back to stillness, daily dependence, and God’s presence, it aligns beautifully with mindfulness. God meets us in the present moment, not in imagined fears. And learning to sit with Him there can bring a deeper, steadier kind of peace.

If this stirred something in you, there’s more waiting for you in the full episode. Listen now. 

209. Three Common Objections to ICBT 

Carrie explores three common objections to Inference-Based Cognitive Behavioral Therapy (ICBT) and explains why OCD treatment is not one-size-fits-all. 

Episode Highlights:

  • Why OCD treatment is not one-size-fits-all and must be tailored to the whole person
  • How ICBT addresses the unique reasoning process behind OCD obsessions
  • Why struggling with OCD does not mean you’ve lost the ability to think or reason well
  • The difference between obsessional reasoning and everyday, present-moment reasoning
  • How trusting sensory data can help break free from “what if” thinking
  • Why ICBT is not about arguing with OCD, but expanding beyond its narrow story
  • How faith, identity in Christ, and ICBT work together to bring hope—especially for scrupulosity

Episode Summary:

Today’s episode came straight out of real conversations I have with clients and listeners—especially those of you who have been told, “ERP is the gold standard for OCD treatment,” and now you’re wondering what it means if ERP didn’t work for you… or didn’t feel like a good fit.

Maybe you’ve tried Exposure and Response Prevention (ERP) and felt overwhelmed, discouraged, or even ashamed when it didn’t bring the relief you hoped for.

Maybe you’ve been curious about ICBT, but you’re thinking, “Is this really legitimate?” or “Am I just avoiding the hard work?”

We talk about all of that in this episode.

I share why OCD treatment is not one-size-fits-all, why ERP can be helpful for many people and still not be the right approach for everyone, and how labeling one method as the only “right” option can quietly leave people feeling broken when they’re not getting better.

We also unpack a big misconception—that ICBT is just “arguing with OCD” or trying to think your way out of a disorder. Instead, we talk about how OCD uses a very specific reasoning process, and how ICBT helps you recognize when you’ve slipped into OCD’s imagined future instead of living from the present moment—where God’s grace actually meets you.

This episode is especially for you if:

  • You’ve done ERP and are wondering what other options exist
  • You struggle with scrupulosity or faith-based OCD
  • You’re asking, “Will anything ever work for me?”

I want you to hear this clearly: ERP not working for you does not mean you’re hopeless. There is still a path forward.

🎧 Tune in to the full episode and let’s walk through these objections together.

 Welcome back OCD Warriors. Today we’re talking about three common objections to ICBT, so let’s get into it. 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. Number one that I often hear is, well, I’ve been told that ERP or Exposure and response prevention is the gold standard of treatment for OCD. Can I just tell you that I’m so tired of hearing that.

I’m so tired. I’m so done. I’m so over it. We’ve gotta stop saying that there is no one size fits all for OCD treatment. I have met many, many people struggling with OCD. Some of them need a little bit of DBT skills woven in because they just have no tolerance for any kind of emotional distress. I’ve met people who have had just very poor relationship skills.

They struggle in their family relationships. They struggle with boundaries, communication, assertiveness. I’ve met with people with trauma. His trauma is feeding into their OCD. We’ve got to stop acting like if OCD is the nail, then ERP is the hammer. I’m done. Now, this has been said many times over and over, and quite frankly, to throw them out on Front Street io.

CDF is responsible for a lot of this language. Now we know that there have been many, many studies done that have shown exposure and response prevention to be effective. We also know on the flip side. That ERP has a high dropout rate. It’s very difficult. I’ve talked with many of you who are looking for alternatives and who have done some ERP and really didn’t feel either that it was effective for you or didn’t feel like that was a road that you wanted to go down because of your spiritual beliefs and how exposing yourself to certain things did not align.

I do think there is a way to do ERP that’s spiritually and religiously sensitive and sound hats off to the many, many clinicians out there who are doing that. What happens when you tell someone that something is the gold standard of treatment? And then it doesn’t work for them or they don’t find it effective.

Creates a lot of hopelessness. It creates a lot of shame. It creates a lot of, what in the world is wrong with me? Because if this is the gold standard and I did the gold standard, then shouldn’t I be better? And so I really wish that they would adjust that language to say that people with OCD. Have complex things going on and they need to find possibly a blend of treatments that will work the best for their unique situation.

They’re coming from a good place because they want people to get evidence-based care, and I understand that and I do appreciate the promotion of evidence-based care, but I also know that people are people, they’re not study participants. Many, many of them are not study participants and many, many of them would not qualify for an OCD study due to the massive other things that they have going on in their life or in their clinical presentation.

I’ve talked about that on the podcast before, so I won’t be labor that point either. ICBT has also been researched. ICBT is being used by many clinicians. Are having great success, and I see this all the time, not only with my own clients and my own students, but from talking with other ICBT clinicians who have been able to help many, many individuals.

There is no one size fits all for OCD treatment, whoever you decide to seek help from, please make sure that they have the training and experience needed in OCD to be able to treat you. If you are going to seek, whether it’s E-R-P-I-C-B-T, or some other form of therapy, ask the questions, ask the hard questions.

Ask your therapist, what percentage of their caseload do they see? Who has OCD? Ask them what kinds of themes they’ve worked with, if that’s something that’s a concern for you, or how they might treat your particular theme. The second objection that I hear pretty frequently is people say, well, wait a minute.

I have a mental health condition and you’re telling me that I need to use my brain. To reason my way out of OCD, well, you have the ability in your everyday reasoning process to reason many different types of things. I have seen people who are struggling with OCD, who are incredibly successful. They’re problem solvers, they’re engineers, they’re in tech.

They’re doing just amazing things, super smart, and they have the ability to reason a variety of different ways. Yes, of course. Your brain has that ability to be able to change and shift the way that you’re thinking about things. That’s the beauty of neuroplasticity. Also, we know that there is a OCD way of thinking.

And an everyday reasoning process way of thinking that we talk about in Icbt. So people will say things to me like, yeah, and I do this and I have to do this compulsion because of this. And I’ll say like, I mean, I know it doesn’t make sense. I’m like, well, it does like in OCD world, it makes complete sense to me what you’re saying because I understand that obsessional reasoning process.

But we also know that we’re in everyday reasoning processes. All day long day where we are determining if situations are safe or not, and we’re not using those same rules that OCD uses. So the key thing is if you can start to recognize when you’re in a non obsessional reasoning process, like what’s the difference?

ICBT says you’re able to really trust your sense data of what’s happening. In the present, in the here and now without going into this land of imagination of all kinds of what if hypotheticals, and you do that on a day-to-day basis. When you get in your car, when you look both ways across the street when you go into a store or you’re kind of like scanning the environment, okay, there’s somebody over there that’s loitering or I’m not really sure what they’re doing, they’re kind of out of place.

Maybe I’ll just kind of walk the other direction. You might have had situations like that, I know I have, where you have to be on a little bit more high alert for your safety based on the location that you’re in or what you’re doing, and you’re able to use your sense data to determine that. There may be times where you’ve looked at packages of food and it was just very clear that for whatever reason it was spoiled.

You didn’t get to it fast enough in the refrigerator. Senses of sight and smell are able to tell you like, Hey, that food is not any good. What OCD does is it’ll read the tag on the package of chicken that says it expires tomorrow. And OCD will say something like, what if it actually expires today? And what if that means that there might be some harmful bacteria in this chicken and we could cook it all the way?

How do I know if it’s really done? It’s still may. Maybe it’s a little pink in the center. I might really need to look at like that’s the obsessional reasoning process versus just really trusting in your senses and not going into the land of futuristic thinking, I’m gonna be sick all of a sudden from this chicken, which is perfectly fine for me to cook in a normal, healthy way.

So yes, you do have the ability, even though this is a disorder that affects your thought process, you have the ability to think differently about it, to look at alternative narratives. The third objection that I hear about I ccbt is that it’s really just arguing with your ocd. That’s all you’re doing.

You’re saying, well. You’re writing some type of alternative narrative, and that’s just engaging with the Ooc D in a way that you shouldn’t, and you should just be disconnecting from that and being able to move towards your values or expose yourself to things that are scary. And we’re not arguing with OCD, we’re not saying that some of these things are not possible.

We are saying that not everything that’s possible is probable. OCD doesn’t really care if it’s a 0.0001% chance it will still convince you that this is going to happen. So we don’t worry as much about probability because many, many different things are probable. What we’re saying is what data do we have to show that is going to happen?

If we don’t have any data to show us that that’s going to happen, our real sensory information, then that’s not something that we need to be concerned about. It’ll almost be like saying that you’re preparing for a rainy day when it’s completely sunny outside and you look at the weather report, it looks like it’s gonna be sunny or maybe partially cloudy, and you say, well, I really need to put on my boots and my raincoat because theoretically it could potentially rain today.

What we’re doing with alternative narratives in I CCB t is we’re not trying to argue with the obsessional story. We’re not trying to say, oh, this alternative narrative, it’s right and the obsessional story, it’s wrong because that is too black and white in itself. There may be some genuine uncertainties that OCD latches onto and that makes things really confusing.

There are some things that you might not be able to know right now. Like for example, should I marry this person? Maybe you haven’t been dating them or knowing them long enough really to make some type of determination about that, but you could make some determinations about what you’ve seen in terms of how they act or their character.

If nothing else, you can make a determination about, yes, I wanna continue getting to know this person, or no, I don’t. But the general, like, where is this gonna go in the future? Might be a true uncertainty that you have to live with. And when we look at that alternative narrative, we’re just trying to like debunk the obsessional story as like the only story in your brain.

Like this is the only possibility of something that could happen. It’s almost a way of just being creative and expanding your mind to say, yeah, that could happen. Things could go terribly horrible, awful, and all of my deepest fears come true, or things actually could be okay. Maybe, I don’t know in this situation, but as Christians, we can rest and we can trust God.

That comes from knowing that God loves us, that God cares about us, that God has our best interests at heart. If you’re struggling with scrupulosity, those things may be really hard to grasp ahold of right now. That’s one of the reasons that I’m really trying to incorporate more and more tools for Christians in my online course Empowered Mind.

We are getting ready to start up on Monday, this kind of last call, if you wanna get in there and be involved, but I would love to have you. So you are all invited. If you’re just done kind of fighting with OCD and you’re unsure of what to do next, but maybe you’ve tried some different things and, and what you’ve tried hasn’t worked, I just encourage you to try ICBT to just go in.

I’ve yet to have a person who dropped out because they were absolutely terrified or just felt like they needed to avoid all the content. There’s a way to practicing with your particular theme, feels too scary or too daunting. You can certainly look at some other examples and practicing with maybe a past theme that you’ve been able to work through that doesn’t bother you anymore.

Or just a complete different story, something maybe that isn’t emotionally charged for you. So that’s one thing that I really love about it. You don’t have to necessarily use your own stuff in the beginning until you feel more comfortable and more confident in being able to apply the skills. One of the things that I really want to shake up, as I talked about in the beginning, is this idea that there is a one size fits all.

Really have to look at people as unique individuals, what their needs are, what they’re most struggling with, how things have worked or haven’t worked over time, and develop a solid plan for that. So I really encourage all of you to look at what your options are, but hopefully this episode helped you. I recognize or work through some objections that maybe you’ve had to engaging with Icbt, whether you are a clinician or a therapist listening.

Ultimately, your big question may be, will this work for me? Will this work for my particular theme? Will this work if other things haven’t worked for me in the past? In other words, is there any hope of me being able to develop some skills to deal with this ocd? As I always say, I believe that there is hope for you regardless of what you have been through or how severe things are looking right now.

This treatment has been shown to work across a variety of different themes. I feel like ICBT is great for scrupulosity because of the emphasis on identity and focusing on your true self versus this feared false self that OCD has convinced you that you are or you’re going to become if you don’t engage in compulsions.

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

207. Increased Confidence in Who God Created Her to be: A Personal story with Ashley Lawrence

In this episode, Carrie sits down with Ashley Lawrence, a wife, mom, homeschooler, and artist who shares her journey with OCD, and how God met her in the middle of years of fear, doubt, and unanswered questions.

Episode Highlights:

  • How scrupulosity can mimic a “faith problem” when it is actually OCD
  • What mental compulsions can look like, including rumination, internal checking, and reassurance seeking
  • How warning passages in Scripture can become triggers for obsessive doubt and fear
  • How ICBT helps “disarm” OCD’s reasoning and make intrusive thoughts feel less convincing
  • How identifying the feared self versus your real identity in Christ can support recovery and peace

Episode Summary:

Have you ever opened your Bible hoping for peace, only to walk away feeling more anxious than comforted, then quietly wondered what that means about your faith?

I sit down with Ashley Lawrence, who shares her personal journey with scrupulosity and OCD and how she spent years believing she had a spiritual problem rather than a mental health one. Like so many Christians, Ashley loved the Lord deeply, yet felt trapped in cycles of doubt, fear, and constant mental checking that never seemed to bring relief.

In this conversation, we talk about how OCD can latch onto Scripture and deeply held beliefs, turning faith into a source of fear instead of rest. Ashley shares how learning about Inference Based Cognitive Behavioral Therapy (ICBT) from a Christian perspective helped her begin to understand the OCD reasoning process, separate fear from truth, and loosen the grip of obsessive doubt. We explore how ICBT does not ask you to abandon your faith, but instead helps you live more fully from the truth of who God says you are.

My prayer is that this episode reminds you that struggling with scrupulosity does not mean you are failing God. It means you are human, and God is patient, compassionate, and present with you in the middle of the struggle.

Share this episode with someone who may be silently wrestling with spiritual anxiety or intrusive thoughts.

If you are prayerfully considering next steps, I invite you to learn more about Empowered Mind and see if it may be the support you have been asking God for.

You do not have to walk this journey alone. Healing takes time, grace, and support, and God is with you every step of the way.

205. You’re Not Alone in Your OCD: Survey Results and Upcoming Episode Plans! 

In this episode, Carrie reflects on insights from the listener survey and shares how that feedback is shaping the direction of the show in 2026. She also explores what healing can look like for Christians with OCD and how to take meaningful steps forward.

Episode Highlights:

  • What the listener survey revealed about where listeners are in their OCD journey
  • How listener feedback is guiding the podcast’s direction in 2026
  • A preview of upcoming topics
  • How the podcast is intentionally designed to support your specific questions and struggles
  • Why evidence-based treatment matters for OCD and what to look for in a therapist

Episode Summary:

What if your voice and your story mattered more to this podcast than you ever realized?

One of the greatest gifts of hosting Christian Faith and OCD has been the opportunity to hear directly from you. 

In this episode, I share insights from the listener survey we conducted around the podcast’s 200th episode and explain why your responses meant so much to me. Hearing your stories offered a clearer picture of the real questions, struggles, and experiences so many of you are carrying, often quietly and for a long time.

I also walk through what many of you have tried in the past, what has and hasn’t helped, and why evidence-based treatment for OCD matters. 

As we look ahead, I share what’s coming in 2026, including a deeper focus on scrupulosity and other listener-requested topics. I also provide updates on my course, Empowered Mind: Christian ICBT for OCD, created to help you build a healthier relationship with intrusive thoughts and grow in confidence, clarity, and peace.

This episode is also an invitation to pause and consider your own journey. What might your next step be? Whether that step feels big or small, my hope is that you’ll feel encouraged to move forward with intention, prayer, and grace. You don’t have to have everything figured out, and you don’t have to take that step alone.

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

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:

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

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

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

 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.

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

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

162. Hope for Scrupulosity with Dr. Constance Salhany

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!

Related Links and Resources:

cognitivetherapysi.com

Explore Related Episode:

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.

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