When Brett was young, he would frantically search his pockets, desk, and backpack whenever someone in his school class complained of missing money, doubting himself and worrying if he was to blame for others’ misfortunes.

Growing up, his family was strict not only about following rules but also about faith. Despite his efforts to be “good,” he felt like he always fell short. By the time he finished high school, his anxiety and guilt were weighing heavily on him. It wasn’t until later that he and his family realized these feelings were related to OCD.

Upon starting college, Brett decided to break away from his family’s rules and religion, seeking a sense of freedom. However, feelings of guilt and anxiety soon resurfaced, along with his deep sense of responsibility for others’ well-being. Constantly questioning his kindness, respect, and care for those around him added to his distress.

Struggling with sleepless nights, persistent anxiety, and guilt, Brett eventually sought treatment. He discovered that his doubts and unpleasant emotions had a name—scrupulosity OCD.

Although Brett’s suffering stemmed from religious scrupulosity since childhood, abandoning his faith didn’t vanish the OCD. Many individuals facing ongoing emotional struggles related to their faith, without knowing it is religious scrupulosity OCD, may choose to leave their religious community to find peace of mind. Yet, quite often, OCD morphs. In Brett’s case, his religious scrupulosity shifted to moral scrupulosity.

ACT and ERP

ACT (acceptance and commitment therapy) is an exposure-based model and has ERP (exposure and response prevention) built into it. ERP is the gold-standard treatment for OCD, including religious and moral scrupulosity OCD.¹ ACT has been shown to be effective in promoting and enhancing the success of ERP in individuals struggling with obsessive-compulsive disorder.²

In treatment, Brett learned that he could apply ACT psychological flexibility skills to any themes of OCD and any challenges he faced in life.

Engaging in ACT and ERP³ allows individuals to:

• Focus on neglected aspects of life due to OCD such as relationships, education, work, personal growth, health, spirituality, recreation and leisure.  
• Identify their values (what matters most) to lead a purpose-driven life rather than one centered on scrupulosity.
• Develop an open mindset to unpleasant internal experiences (e.g., thoughts and emotions). Apply skills to become unstuck from them and letting them pass naturally; thus, being able to focus on what matters most instead of getting trapped in the OCD cycle.

• Heighten awareness through the senses, enabling a deeper connection with the present moment and enhanced enjoyment of life despite obstacles.

• Discover they have the choice of what exposures they’ll engage in based on what they want their lives to be about in the life domains they neglected because of OCD.

Through treatment, individuals realize they can choose their responses to internal and external experiences, empowering them to steer their lives according to their values and aspirations.

The skills acquired during therapy are transferable to other OCD themes and life challenges, fostering flexibility in responding to thoughts, judgments, memories, feelings, sensations, and urges.

As individuals re-engage with the life they desire, they encounter countless opportunities to either yield to OCD thoughts or move towards their deepest values despite discomfort.

Life is full of possibilities!

References

1. Jonathan S. Abramowitz and Joanna J. Arch, “Strategies for Improving Long-Term Out- comes in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Insights from Learning Theory,” Cognitive and Behavioral Practice (February 2014), 20–31, http://dx.doi.org/10.1016/j.cbpra.2013.06.004; Michelle G. Craske, Michael Treanor, Christopher C. Conway, Tomislav Zbozinek, and Bram Vervliet, “Maximizing Exposure Therapy: An Inhibitory Learning Approach,” Behaviour Research and Therapy (July 2014): 58, 10–23, https://doi.org/10.1016/j.brat.2014.04.006.
2. Michael P. Twohig, Jonathan S. Abramowitz, Ellen J. Bluett, Laura E. Fabricant, Ryan J. Jacoby, Kate L. Morrison, Lillian Reuman, and Brooke. M. Smith, “Exposure Therapy for OCD from an Acceptance and Commitment Therapy (ACT) Framework,” Journal of Obsessive- Compulsive and Related Disorders 6 (July 2015): 167–73, http://dx.doi.org/10.1016/j.jocrd.2014.12.007; Michael P. Twohig, Jonathan S. Abramowitz, Brooke. M. Smith, Laura E. Fabricant, Ryan J. Jacoby, Kate L. Morrison, Ellen J. Bluett, Lillian Reuman, Shannon M. Blakey, Thomas Ledermann, “Adding Acceptance and Commitment Therapy to Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Randomized Controlled Trial,” Behaviour Research Therapy 108 (June 2018): 19, doi:10.1016/j.brat.2018.06.005, https://pubmed.ncbi.nlm.nih.gov/29966992/.
3. Annabella Hagen, Imperfectly Good: Navigating Religious and Moral Anxiety to Release Fear and Find Peace. (Provo, UT: Mindset Family Therapy, 2023).

Photo by Ante Hamersmit on Unsplash