Recognizing and Treating Scrupulosity

Camille McDaniel, LPC (00:28)
Welcome back to another episode of the Summer Faith Integration Skills Lab through Christ in Private Practice. Yes, we are making our way through the summer and during Christ in private practice, and we are doing skills lab episodes for this summer. And so if you are new here, welcome. it’s nice to have new people along for the ride. And if you have been here, then welcome back.

Because we have an episode that hopefully will give you another skill set, another thing to think about as you are moving forward in your practice, helping whoever the Lord sends your way. So today’s topic of discussion on our podcast is going to be about scrupulosity. And as with all of the summer skills lab episodes,

We’re going to be able to offer one CE credit and that is listed on the website so there’s no confusion. If you happen to go on our website, Christinprivatepractice.com. But if you happen to be watching from YouTube or if you’re listening on Spotify or Apple, you may not necessarily catch that. So all of our Summer Faith Integration Skills Lab episodes are going to qualify for one continuing education hour.

So, as I said, today we are going to be talking about scrupulosity, and it is sometimes referred to as religious OCD. So, if you have been in practice for any length of time, then, or even if you are new to the field and maybe saw this during your internship and practicum, you may have had clients who repeatedly questioned whether they had.

Committed a sin or whether the Lord had forgiven them. whether their motives and their forgiveness was genuine enough when they were asking for forgiveness. They may have wondered if they had disappointed God. There just may have been a lot of different challenges that you had noticed in their conversations as you were sitting in front of them for counseling sessions and it.

really kind of the the things that they were saying really sat almost at a crossroads between their faith and the theology, right? And and mental health. So as Christian counselors, we don’t want to dismiss any genuine conviction from the Holy Spirit that someone is experiencing, right? At the same time, we don’t want to mistake an anxiety disorder for

spiritual maturity because it may present as though individuals are really assessing their situations, their experiences, their reactions to their experiences, weighing out whether they did the right thing according to their faith or not. So it can present as though you are witnessing a very mature and thorough approach to looking at our

our lives and looking at our lives according to our faith in christ but we want to also be careful because sometimes those can get confused and so in this episode i don’t want to at all bring into question people’s genuine conviction because again we are all different and just as we are all different as human beings we all have different way of expressing

our love, our commitment, our faith. And so we want to just be real careful because one person’s conviction doesn’t look like another person’s conviction. And so we want to make sure that we are determining whether this is actually faith and their faith walk and their journey and Holy Spirit conviction, or is this a mental health disorder? Are we dealing with something along the lines of

religious OCD or scrupulosity as it is referred to. So by the time we get to the end of our episode today, hopefully you’ll be able to you know, talk, talk about more, recognize, you know, just the different clinical characteristics of scrupulosity and distinguish it from healthy spiritual conviction and other clinical representations and just understand, you know, evidence based

treatment approaches and to be able to think through how biblical integration can support treatment without becoming part of the obsessive compulsive cycle. So let’s let’s kind of get started and jump right in with a counseling scenario. Let’s open up with that. All right. So let’s just think about a client that may come into your practice.

Okay, so let’s say this person happens to be a woman in their 30s, and they’re coming to counseling because they’re really feeling exhausted spiritually. And they tell you that they accept Jesus Christ as their Lord and Savior, that they made this decision when they were a teenager, matter of fact, and they have been active in their church and they serve faithfully and they spend time reading their scripture.

almost every day. All right. And then they say to you, I ask Jesus to save me almost every night. And that gives you pause. And let’s just say, in this scenario, you ask them, you know, a clarifying question, very compassionately, very respectfully, right? You just ask them why? Why do th why do they do this, right?

And let’s say that they respond and just say, Well, I I’m afraid that maybe like I wasn’t sincere enough when I asked before, you know, so I just make sure to ask every night, just to make sure I get it right. And so as the conversation continues, they kind of tell you how they repeatedly confess the same sins because they are just worried that maybe they forgot something. And

You know, if an intrusive thought enters their mind while they’re praying, they start the prayer all over because they believe that that previous prayer then doesn’t count because it was interrupted by an intrusive thought. Let’s say that that they met with pastors at their church and they’ve read books

about you know salvation to reassure them friends family have reassured them and you know everything helps for a little while okay and then doubt returns and they’re really not sure that they are saved. They’re really not sure that the prayers actually stuck. All right. So let’s pause right here. Okay.

I want for you to think about what you’re hearing in this example. is this a theological problem? Is this poor discipleship? Is this a misunderstanding of what grace actually looks like? Or maybe this is unresolved guilt? What do you think?

Or are we looking at obsessive-compulsive disorder that is presenting through religious content? All right, so whatever we determine as is the answer is going to then lead how we respond to this particular person. So if we assume that this is just simply a lack of biblical knowledge that is leading them to participate.

in this mode of prayer and repeated prayer and starting over with prayer and asking for, you know, the Lord to come into their heart every single night. You know, if we think that well, maybe this is them just not having biblical knowledge about how this works, then we might actually continue to assure the client that they are actually doing all they need to be doing.

And we might, you know, with their permission, ask them, would you like to know what the Lord says about it? And we might move forward with giving them some information. And that actually might temporarily reduce their anxiety. And it might also strengthen the obsessive-compulsive cycle. if we assume, on the other hand, that every spiritual concern is OCD.

Then we run the risk of minimizing some genuine experiences with conviction or overlook legitimate spiritual struggles. And so neither approach really is serving the client well because it’s it’s too extreme. Both avenues kind of are a little too narrow focused. So we have to make sure that.

Proper assessment comes first. Okay. And this is where we’re going to go into why Christian counselors need to understand scrupulosity. Especially because, you know, this is actually OCD and religious scrupulosity. These are things that people actually specialize in. It’s not something that all of us work with regularly, and so we may have seen it, and we may have not.

And it might come up as we are working with our clients in other areas of their life. So this is really good skill for us to be knowledgeable about. So this is a good topic, I think, because I do believe it does come up. And we just may not all have a lot of awareness or a lot of experience working with this particular challenge. So scrupulosity is not a diagnosis that’s separate from obsessive compulsive disorder.

instead it is actually a presentation of OCD in which the obsessions and the the compulsions they focus primarily on religious or moral concerns. And because faith is central to many clients’ lives, it’s not really surprising that the anxiety sometimes attaches itself to spiritual matters.

And the presence of like religious thoughts does not make something scrupulosity.

we have to be careful that we don’t pathologize faith, because that sometimes can also happen when when people are not as familiar. And I’ve actually been in circles where sometimes for those clinicians who may not have been very familiar with Christian beliefs or you know had some understanding, but they

They themselves were not practicing Christians. And when certain symptoms would come up, sometimes they thought, this must be religious psychosis, or I wonder if this is scrupulosity, and you know. So instead, we want to just carefully assess whether anxiety has begun influencing how the client is experiencing their relationship with the Lord or not.

Research over the past several decades.

Has consistently shown that OCD themes oftentimes center on what an individual values the most. I want to make sure I don’t mess up the this person’s last name, but Jonathan Abramowitz and his colleagues have noted that intrusive thoughts tend to involve areas of personal significance rather than just random topics. So for Christians,

Concerns related to God, related to morality, salvation, or sin may therefore become the focus of obsessive doubt without indicating a lack of faith or commitment, and these findings really help explain why deeply committed Christians can experience scrupulosity. The content of the obsession reflects what the prophet

Person actually values greatly. So the disorder is not created by having this faith. The disorder just uses the faith as its focus for creating the anxiety. Now, what makes scrubulosity difficult to recognize? Okay, because

One reason that scrupulosity is frequently overlooked is that many of the behaviors involved are not inherently unhealthy. For example, prayer is healthy. Research has shown even, I mean, we as believers may already have known without the research, right? But research even backs up the benefits of prayer.

We know that confession, confession of those things that are on our heart, whether it be our troubles, whether it be our wrongdoings, whether it be our questions, whatever it is. Confession is very healthy. Reading scripture is healthy and seeking wise counsel and all of that is very healthy. So the challenge is that the same behaviors can actually then become compulsive.

And so the behavior itself is not what determines whether something is obsessive compulsive. It’s the function of the behavior that matters.

So consider two individuals who pray for forgiveness. One prays because they recognize that they have sinned. They receive God’s forgiveness and they continue with their day. The other prays repeatedly for the same issue because the anxiety never feels resolved.

And then 10 minutes later, they pray again. And then later that evening, they pray again. And the next morning, they begin wondering whether or not that was really a sincere enough prayer. And so then they start over again. So externally, both individuals appear to be praying. And again, prayer is healthy, right? But clinically,

Clinically, something is actually very different that’s happening. So we want to just kind of ask ourselves throughout this episode, what function is this behavior serving? So just because someone is like, yeah, I pray regularly, I’m I pray all the time, I pray, you know, in the morning, I pray in the afternoon, or I talk to God throughout the day, that’s great. Okay, wonderful.

And again, outwardly, it may just seem like somebody who has a very close relationship with the Lord. And that person may very well have a very close relationship with the Lord. They may also find themselves in a cycle of behaviors where maybe they are praying because they are struggling with doubting there’s effectiveness in their prayer or there’s effectiveness in their prayer for some forgiveness or for something that they feel has been done wrong and they can’t get rid of it. So they continue.

the prayer process in order to try to find relief on that same issue. Okay. So let’s talk a little bit about the OCD cycle before we kind of focus specifically on scrupulosity. Let’s let’s do like a little bit of a review. And again, for some you all will already know. For others, this is not your area of specialty. And so we can all kind of get a little bit more information under our belt.

So according to our DSM5, OCD is characterized by obsession obsessions, compulsions, or both, and obsessions are intrusive and unwanted thoughts, images, or urges that create significant distress. And then compulsions are repetitive behaviors or mental acts performed to reduce the distress or prevent a feared outcome. So the key feature is not the content.

Of the thought. It is literally the cycle. Like there’s an intrusive thought that occurs, anxiety then increases, the person performs a behavior that’s intended to reduce the anxiety, and then they feel relief. But the relief is temporary. So then the next intrusive thought appears. The brain has learned something. They learn that this particular ritual.

reduces anxiety. And so as a result, the brain brings up that ritual and then the ritual becomes more likely to occur again and again and again. And this process is called negative reinforcement because the compulsion removes an unpleasant emotional state, making the behavior more likely to be repeated again. One of the reasons why

OCD becomes persistent, is that the compulsion works for a short period of time. It does reduce the anxiety for a short period of time, but the compulsion does not resolve the uncertainty. Okay. When a client’s coping strategy consistently provides only temporary relief.

We want to ask ourselves whether the strategy is solving the problem or maintaining the cycle. And that question really applies beyond OCD, but it is especially important when we are working with scrupulosity. So again, we’re going to ask if the coping strategy that’s being used does provide.

Relief, but only temporarily, then is this strategy really solving the problem or is it maintaining the cycle? Okay, yeah. All right, so let’s consider reassurance. because reassurance is frequently something that may appear in our counseling spaces.

And sometimes it might actually, well, we’ll we’ll talk about what it might actually do. Okay, so we’re gonna imagine another another client in our counseling area, our counseling space, whether it happens to be in office or telehealth. But imagine that you have a client and they ask, Do you think that God has forgiven me? And let’s say

The answer that is given by the the clinician is, well, yes, scripture tells us that if we confess our sins, he is faithful and just to forgive us. And let’s say the client then looks very relaxed. And then five minutes later, within the session, they ask, but what if I wasn’t really sincere enough when I asked for forgiveness?

And and then the clinician answers again, right? And then let’s say next session, the client asks the same question again. Notice what is happening. The reassurance, it wasn’t necessarily it wasn’t like inherently wrong, right? It was accurate biblically. The issue is not whether.

the answer is true or whether the answer is accurate biblically. The issue in this particular case is whether the reins reassurance becomes part of the compulsive pattern.

So research, okay, research that has examined reassurance seeking in OCD suggests that repeated reassurance often functions similarly to other compulsions. And it reduces anxiety briefly, but it does not address the underlying intolerance or uncertainty. So as a result, the client becomes increasingly dependent on reassurance.

Rather than developing the ability to tolerate the uncertainty. So that doesn’t mean that we should never reassure. That doesn’t mean that at all. But it does mean that we need to be asking ourselves whether reassurance is functioning therapeutically or is it functioning compulsively when working with clients that might be struggling with this type of OCD?

So now that we’ve established kind of an understanding

what does scrupulosity actually look like in a counseling room?

well, one of the challenges with scrupulosity is that clients rarely walk into the office with an understanding that this is what they could be struggling with. Because you know, clients will call or email you s wanting to schedule an appointment, and there’s a lot of things that they will share with you are going on with them. But it is really rare that someone will say, I think I have religious OCD.

Or I think I’m struggling with scrupulosity. But instead, they might actually present with concerns about whether or not they have sound like spiritual footing. So they might say something like, I don’t know if my repentance was really genuine, or I keep asking God to forgive me because I’m afraid that I forgot something. They might say every time that I have a blasphemous thought.

I think I’ve offended God or I’ve lost my salvation. They might feel distant from God or they may describe themselves as wanting to get closer to God, but just don’t feel like they’re doing it right. So other people might have constant fear, constant guilt. Those and those are concerns that we definitely want to we want to honor, we wanna hear, we wanna understand, because our first responsibility

It’s not going to be to to determine whether the client has scrupulosity. It’s really going to be just understanding the client’s experience. You know, what all is surrounding them displaying these symptoms? How did we get here? What is going on? You know, what are their perspectives? What are their understandings as it relates to their faith? We’re going to do a full assessment. We’re going to ask.

Clarifying questions so that we can just get a deeper understanding of their worldview and experiences so that we can then put it together and kind of see what’s going on there. One of one of the important things in assessing is not to focus only on the behavior, but but how does this behavior function? You know, what what purpose is it serving? Let’s let’s take the example of.

Prayer. So prayer is a spiritual discipline, right? Prayer moves things in the heavenlies, right? Many of our clients pray. And so that alone, prayer alone, doesn’t really tell us anything about OCD. But instead, what we’re going to ask ourselves is why is this client praying? Not are they praying? Now, not how often are they praying?

But why? Are they praying because they desire fellowship with God? Are they praying because there is anxiety that is telling them they have to do it? Because those are two different motivations, right? The same can be true with regards to confession, like confessing to the Lord in prayer.

About something that is on your heart, on your mind, or of a behavior that was done or not done. healthy confession can restore our relationship with Christ, but compulsive confession can eliminate uncertainty and create an OCD pattern in our life. From the outside, though, looking in, the behaviors might look the same.

you know, they like to talk to the Lord. They like to pray a lot. they talk about how they confess things to the Lord and all Yeah, yeah, that looks great. But upon further examination, when we see that one individual is just talking, they’re confessing, they feel relieved, they leave it alone, they’re done, they’ve given it up to the Lord, and they go on about their way after they have had their time with the Lord.

Versus the other person who might confess and they feel fine and they move on about their way, but soon after they feel like it wasn’t enough. It didn’t erase enough. It didn’t erase anything. And now they have to do a few more prayers in order to make it right.

And so we want to know the why. We don’t want to just look at frequency because it could be that somebody has a lot to pray for or a lot to pray about. Maybe there’s a lot of good things and concerning things going on in their life. And so they do pray a lot. But that’s different from the person who continues to pray over and over because they have to.

In order to fulfill some kind of quota, some kind of need in order to be safe, in order to be comfortable, in order to keep the anxiety at bay. Okay. Here are some common obsessions as it relates to scrupulosity. Okay, so

again, obsessions being those intrusive thoughts or intrusive images or urges that create significant anxiety. So a client doesn’t really enjoy these thoughts at all. They don’t enjoy these urges or images. They usually find it all to be quite disturbing. Some of the most common religious obsessions might include, what if I’m really not saved?

What if I committed an unforgivable sin? What if my motives were sinful? What if I accidentally lied? What if I didn’t confess everything? I missed some things? What if I wasn’t sincere enough? What if I offended God without realizing it? What if I misunderstood his will and I’m doing the wrong thing?

What if this intrusive thought means I secretly wanted to do it? There is something that lies as a theme within all of these questions, and almost every one of them begins with what if? Okay. That is one of the key things with regards to obsessive thinking, that the mind continually

searches for certainty where it really can’t fully be obtained.

So, research on OCD consistently identifies an intolerance of uncertainty as one of the factors that maintains obsessive-compulsive symptoms, such that individuals with OCD often experience an intense need to resolve doubt before they can move forward. And unfortunately, because absolute certainty is rarely possible.

The search for certainty becomes just overwhelming and endless. And for clients with scrupulosity, the uncertainty often centers on spiritual questions rather than like some of the other things that we’re familiar with as it relates to obsessive-compulsive disorder, like, you know, cleanliness or contamination fears or safety concerns, you know, or like checking behaviors. So

Once we we’ve already talked about like the obsessions and some common obsessions, right? Now what about some common compulsions? So once the obsession comes forward, it creates anxiety, right? And then the client has to look for relief. And this is where the compulsion emerges. And some compulsions are observable. So

You know, we’re going to go over some compulsions. There are some compulsions that are just within the client’s mind, but many compulsions can be observed. So some common compulsions are repeating prayers, confessing the same thing multiple times, whether it is a a sinful behavior or confessing something else, you know, but confessing it multiple times.

Rereading Bible passages until they feel right. They feel like they’ve done it enough to maybe get God’s approval. some additional compulsions are replaying past events, looking for moral mistakes that they made, mentally reviewing conversations to determine whether they sinned within that conversation.

Seeking reassurance from pastors or spouses, friends, or counselors, constantly researching theological questions online.

Avoiding church leadership because they fear that they may be making spiritual mistakes that the church leadership can kind of spiritually see. they might even repeat salvation prayers, like a specific prayer that they repeat over and over and over again.

in order to make sure that they’re not losing their salvation. Some fear that they are losing their salvation with every wrong thought, every wrong word, every misstep. They feel like they lost their salvation. So they have to say a prayer in order to gain their salvation back. there may be repeated asking God for confirmation before making just regular decisions, like ordinary decisions, like should I

Should I go to the supermarket first or should I finish checking my emails? And so then asking the Lord for confirmation, you know, to the point where they’re not making just everyday normal decisions without first checking God. Should we go to this restaurant or should we stay home? Should we go to this vacation spot or should we go to that one? Again, there is nothing wrong.

With asking the Lord for direction. We obviously do that regularly. We lean on Him. However, this is taking it way beyond that, to the point where an individual may not even be able to make decisions on their own. They do not trust their own decision making ability. They ask the Lord for everything. What should I wear today? What should I eat today? Which place should I go first today? Where should we go on vacation? Should I call this person or should I send them an email?

those types of things. So it can actually become quite extreme.

as we’re putting all of this together, as we assess our clients, we are going to ask ourselves four questions. The first thing we’re going to ask is: what is driving this concern? Is it fear, conviction? Is it shame? Is it trauma? Is it anxiety? Is it something else?

Second, we’re going to ask: what is the client doing to reduce the distress? So are they praying? Are they doing certain checking behavior? Are they researching things? Are they seeking reassurance? Are they avoiding? Or are they repeating behaviors? The third question: how long does the relief actually last?

Is this relief that they get minutes, hours, days? Or is this like a peace that just like literally they have peace for months and you know long periods of time? the last question, the fourth question that we’re going to ask: what happens if the client chooses not to perform the behavior? And that

That answer often tells you whether you’re looking at a healthy spiritual practice or looking at an obsessive compulsive cycle.

once that once you’ve identified that it’s scrupulosity, what

Does treatment actually look like?

We want to establish shared goals very early. One of the first conversations that I recommend having is about treatment goals. Clients with scrupulosity often come to counseling and they believe that the problem is their relationship with God. As treatment moves forward, they may discover that the larger issue is actually how anxiety.

has begun to influence that relationship. And rather than immediately introducing treatment, you know, techniques and modalities, we might want to spend a little time developing a shared understanding of the problem. You know, we might talk to them about what they shared. We may talk to them, you know, about

how that is presenting as it relates to their faith and their relationship with God and, you know, how they seek to honor Him, but also feel trapped by some fear and some anxiety and just kind of explore with them, you know, how anxiety has become part of the picture of their relationship with the Lord. Because clients can sometimes experience relief to hear that you’re not dismissing

their spiritual concerns, but instead you’re, you know, you’re open to helping them consider whether anxiety may be distorting how they actually experience those concerns and the relationships that they feel might be impacted. So what we’re going to do use some psychoeducation in the treatment.

Because helping clients to understand the obsessive compulsive cycle often helps to reduce their shame. It also helps them to have answers, gives them like hope. Like, my goodness, there is something that that people have identified that look like what I am experiencing. And my goodness, there is research behind it. And there are ways that we can move forward and you know, trying to work through this. So

It helps when we explain, you know, the idea of intrusive thoughts and how that creates anxiety and then, you know, how the mind tries to help us to lessen the anxiety and how we then do certain behaviors or compulsions, you know, in order to work through it and how it only temporarily gives us relief and just continuing to give some psychoeducation on the process really for

For a lot of clients, it can help them to understand what exactly is happening and help them to even recognize within themselves when it’s happening and knowing that, okay, this is just not me totally losing it and no one knows why I’m losing it, but there actually is a process and a cycle and names for what’s happening within the cycle.

Let’s also talk about something else that has been actually approved as a a very effective way of treating OCD, and that’s exposure and response prevention or ERP for short. it remains actually the treatment with the strongest research support as it relates to working through and treating OCD.

So if you’ve never used exposure and response prevention, the name may sound like a lot going on, but at its core, ERP is about helping clients to face anxiety-provoking situations while resisting the urge to perform the compulsive behavior. The goal is not to increase the client’s suffering. The goal is to help the client discover.

that anxiety can rise up and anxiety can remain uncomfortable for a little while, but anxiety can eventually decrease without having to complete the ritual. So that is really the very the very different experience from what OCD has actually been teaching them all along because OCD says once you have this thought

Then what you do is you get comfort by completing this behavior, this cycle. And if you keep on doing it, you’ll be safe, you’ll be okay, you’ll experience relief. There’s no other way, right? That’s what OCD tells them. But what ERP might look like if you happen to be using exposure and response prevention, it might look like let’s say a client usually confesses the same thought repeatedly.

But rather than confessing 10 times, the treatment plan may involve confessing once and then resisting the urge to repeat confessing. Now, will the anxiety increase? Yes, it’s very likely that the anxiety will increase. That isn’t the treatment failing. That is the treatment actually working because you want for the client.

to learn a new response. You want the client’s brain to start to adjust and conform to a new way of handling the situation. And over time, many clients then discover with ERP that the feared outcome, whatever catastrophe, whatever horrible thing, it never occurs. And the anxiety then naturally decreases.

So ERP is it’s not asking clients to, you know, abandon their religious beliefs. That the goal is not to expose clients to anything harmful or hurtful. The goal is going to be to reduce the compulsive behaviors that has really attached itself to a healthy spiritual practice and then made that healthy spiritual practice

Unhealthy.

Another possibility is collaboration with pastoral leadership. So there is a possibility to collaborate if you’re able to with pastors or trusted spiritual leaders such that when the client actually allows, you know, gives consent for this to occur.

This collaboration can be really beneficial for the client because the pastor can provide the theological guidance and all the spiritual care, but then the clinician can address the psychological process that is maintaining the obsessive-compulsive disorder.

So each professional brings a different level of expertise to the situation, and working together can also provide more consistent care.

more community around their their challenges and therefore have the support as they are moving forward in their treatment. And then as treatment continues, sometimes clients will ask, Well, how will I know that I’m better? And sometimes the answer will be that the the goal is not like to eradicate a hundred percent right away all the intrusive thoughts. I mean that

That may happen for some, it may not happen right away for everyone. So what we want to be able to do is just explain that, you know, for most people, the intrusive thoughts are going to lessen significantly. And then every blue moon, something could pop up. But instead, we’re going to kind of reflect on how the client is responding to those thoughts.

So you will know that you’ve worked through it based on how you’re able to respond. Because life will happen. We cannot ensure that nothing ever comes across your mind that you don’t want to come across your mind. But what we can do is work so that your response is different. And that will inform you of the change that has occurred within you.

When it comes to should we use scripture when treating scrupulosity, yes, we can definitely use it, especially if the client is explicitly asking for that to be integrated into their treatment.

There’s great value in prayer. There’s great value in faith integration. I wouldn’t say that you should stay away from it, but we want to look at how to use, you know, use it well. Okay. And we’re going to start with the client’s goals. That’s, you know, that’s exactly where we’re going to go because this is going to be, again, the client’s decision.

How their faith is integrated into their experience. And some clients want explicit Christian counseling. And others just want their faith to be respected, but they don’t necessarily want it to be explicitly talked about throughout the time that they’re in counseling. So we’re gonna start with what the client’s goal is for how they want their faith integrated into the sessions.

And then we’re going to make sure that when we are using the scripture, we’re just going to be mindful and watch out that scripture doesn’t turn into a reassurance cycle, like with OCD. We just want to make sure that as we are using it, it is to inform, it is to is is to support the the treatment that we are doing with them. But if we recognize that it is being used like a reassurance cycle where it temporarily gives some relief.

But then the person needs more reassurance on going over and over and over. Then we’ll just watch out for that cycle. And then that’s where we can add some psychoeducation and being aware to make the person aware of how that cycle can present itself and how it might be presenting itself in the session right then and there. And we can then process with the client what’s going on with them.

And we can ask some clarifying questions and then we can move on to see, you know, what was behind the use of that scripture in the moment to decrease the anxiety as in what was coming up for them at that time that they needed to use this as reassurance as they move forward. So it can definitely be something that we do not have to shy away from, especially because oftentimes the clients have asked for it. We just want to be mindful.

of how it can sometimes get sucked into an OCD cycle so that we are careful to observe if that’s happening or not within our session.

So as we come to the end of this episode, you know, our clients who are coming to us struggling with religious scrupulosity are not necessarily asking about theology. Many are really asking questions that are driven by anxiety. And those questions are often sounding spiritual and they may involve salvation and forgiveness or blasphemous thoughts, sin.

motives, you know, so if we’re not careful, we might actually, you know, just miss that part and and give answers to questions without recognizing that these questions themselves have become part of an OCD cycle. And so we want to be able to just recognize that and understand what’s maintaining the client’s distress and then we’ll know how to respond and go from there.

If you happen to be using this episode to get a continuing education credit, then you will also see when you log in that there’s just some additional information for your for your observation, for your viewing, for taking with you to clinically look over as it relates to just some

some other diagnoses to consider when scrupulosity might not be the primary diagnosis. But outside of that, I thank you for joining me for this particular episode on religious scrupulosity, which is part of the OCD family. And until we meet again, again, I hope these are

Going to bless you, bless others that might be listening to this, that might just want some information about how they might move forward as it relates to faith and mental health diagnoses that we see within our practices, or some that we may not come across as frequently. Until we meet again, God bless.