Religious OCD and exposure therapy

This is me at an old abbey recently. The last time I was there I had to leave because of the overwhelming obsession I had.

I had reached a crossroads

When I first sought treatment for OCD I suffered with religious scrupulousity. My obsession was the “unpardonable sin” (see here). In simple terms, this is blasphemy against the Holy Spirit (which has different interpretations) and in theory could cause someone to suffer eternal damnation depending on a person’s belief about the nature of salvation (there is a lot of complex theology and philosophy that goes alongside all this).

I had arrived at a crossroads in my life at that point. Either I fought to get better with every ounce of strength I had, or I don’t think I could have carried on living. I was backed into a corner, I had nothing to lose. Well, apart from my eternal soul, but hey ho. In reality I just wasn’t functioning anymore and I had to do something.

Following a number of CBT interventions and learning the basics about OCD over a few weeks I travelled over to the UK for face-to-face therapy with the main emphasis on Exposure Response Prevention (ERP). I had to pay privately due to the infamous lack of support available publicly. Fortunately my family helped to support me with this, a privilege I am well aware that many do not have – which seriously upsets me and is one of the main reasons I do this blog.

What did the exposures look like?

Before getting started we met with a local Vicar from the Church of England, he was a very understanding and kind man. His daughter was suffering with an eating disorder and he at least had some empathy and understanding with regards to the suffering I was enduring, even if he didn’t know much about OCD. My therapist explained to him that I would be doing things that might appear “sinful” and explain the process behind exposure therapy – he was accepting of the premise behind the approach. The Vicar told me that I couldn’t carry on the way I had been and even said we were welcome to use the church for the exposures. He told me that in order to get a connection to God I had to do whatever necessary to get better. This definately helped give me the courage to get started, but at the same time this also caused additional problems further down the line which I will cover shortly.

With ERP you start off small and work your way up a hierarchy of difficulty. We therefore started with “simple” things such as writing 666 or “Satan is awesome” on paper over and over (I cannot remember exactly what we did as I was so unwell that period of my life is a bit of a blur). We progressed on to watching triggering videos, sermons, and even writing nasty comments in an old bible.

You have to be honest with your therapist about what you fear the most and push the exposures as far as possible. OCD compulsions can be highly complex, and oftentimes we are reluctant to face the worst fears and relinquish all the compulsions. However, as Fred Penzel argues:

Those who believe they can take on only those symptoms they feel comfortable facing soon find themselves back at square one. Untreated symptoms have a way of expanding to fill the space left by those that have been relieved.  When explaining this to my patients, I liken it to getting surgery for cancer.  I ask them, “Would you want the surgeon to remove it all, or leave some of it behind?” 

Beyond OCD

It might sound ridiculous [to those who haven’t struggled with scrupulousity] but the 10 out 10 exposures for me was writing or saying statements surrounding the unpardonable sin verses in the New Testament i.e. Mark 3:20-30 where the pharisees said Jesus was evil and had an unclean or impure spirit. Yep, it was those words that terrified me the most.

Such phrases tortured me day and night and caused me indescribable amounts of distress. I hated those words, but my brain was locked. They go against everything I believe and even the thought of them made me feel sick. The nature of OCD is egodsytonic which means the obsessions target the opposite of who a person is (hence the distress).

Exposing myself to triggering phrases was the ultimate exposure for me, it caused me to feel sick with anxiety for days on end, but I knew in my heart I had to face them because I couldn’t even look at a bible at that point. Looking at them now, such phrases have minimal effect on me, apart from mainly sadness at what this horrible period of my life took from me and my family. But that’s the point, the exposures are supposed to make the obsession lose its power and its ability to lock the brain in the OCD cycle. Ultimately they are just words or thoughts, but at the time I felt like even thinking or looking at them, let alone writing or saying them would send me straight to hell. That is the power that obsessions can have. Words and images can become all consuming.

I remember praying to God beforehand saying something like the following: “I am not sure what this unpardonable sin is, or whether I have committed it. I am also not sure if you will forgive me for exposing myself to the fears and the bad thoughts. However, I have to take this chance to save my life and to get better for the sake of my family“.

I took a massive leap of faith, literally. My brain was such a mess at the time I felt like I dived off the top of the highest mountain expecting an angel to catch me on my way down to prevent my death. That is seriously the amount of risk I felt facing this obsession.

Following the exposures

ERP helped me tremendously with recovering from OCD. However, I often describe it as basic training like one receives in the military. It gets you up to a decent standard, and gives you the leg up you need to move forward, but it isn’t some kind of miracle cure. Ultimately, it gives you tools to manage and “become your own therapist” as is often said.

In some senses ERP is giving your brain a bit of a reset. It pushes the anxiety so far that you give the brain no choice but to adapt. I cannot remember who said it but someone once described ERP like trying to correct a bent metal flag pole. It’s not enough to bend the pole to the middle, you have to over-compensate and bend the pole right to the other side to get it back to being straight. 

So, yes, my brain was given a good reset and gave me the foundation to build upon and really start my journey of recovery. Over time, the spikes were becoming less frequent and I even found myself laughing out loud at some of the phrases that formerly terrified me (laughter of relief!). I was even reading theology for fun again and attending church the odd time. I had learnt a lot of skills to help me cope, many of which I am still mastering nearly 10 years later. Recovery can be a long road for many of us, particularly those with severe OCD that was left untreated for many years.

When I got OCD about ERP

Some time after all this the OCD decided to latch on to making me think the ERP I performed, particuarly the aforementioned phrases I repeatly exposed myself to (in thought, word or vocally) was now the main concern with regards to me committing the unpardonable sin.

What if God didn’t understand? What if my therapist tricked me and he was a minion of the anti-Christ? If the Vicar truly knew what I said surely he would have condemned me? What if this was a test and I failed? What’s the point in living any more if I cannot know if I am okay?

I then got OCD about OCD therapy and ERP. I started to repeat some of the older exposures to reassure myself that I was still okay with God. However, the exposure exercises had ultimately become compulsions themselves. The insidious nature of OCD means it can take any part of your life, including therapy itself, turn it on its head and use it against you.

I was a mess again. Not as bad as before, but I was struggling significantly. Whats worse, many OCD books/resources recommend consulting with a religious professional to decide which exposures are sinful and which are not (which I kind of did).

I started to ruminate regularly: “But wait, crap, why didn’t I read this before? I didn’t tell him [the Vicar] the exact exposures. Noooo, why didn’t I do this, now I am truly doomed”.

Not only that, but some experts explicitly say that you don’t have to do anything you feel might be “sinful” in order to take part in ERP. Fabulous advice that guys. I mean seriously, of course the OCD will tell you certain things are sinful. Just like with exposures for ANY theme, the brain is going to feel like you are doing something terrible. This is especially true for mental obsessions where the fears are mainly words or images.

Religious OCD misunderstood by experts?

You see, there are many great OCD experts out there, but I have to say that some just simply do not understand religious OCD and more often than not they give questionable advice. I’m not going to name individuals and give examples from books or articles, but they are plenty trust me. It amazes me that time and time again I see the same ignorant and politically correct approach to religious OCD. Not only do they hold back and taper approaches to this theme at times, but they show a serious lack of understanding and naivety about theology and the faith based systems obsessions infiltrate.

OCD doesn’t care about political correctness!

The logical amongst us might be asking: but surely religious OCD is no different to any other form of OCD right? Exactly! So what’s with this politically correct approach to this particular theme that some experts seem to tout? If I am being honest I think part of the problem lies with the state of discourse in the general public with people constantly worried about offending someone’s culture or religion. I cannot say this loud enough: OCD is a serious illness, OCD does not care about political correctness! And as OCD is egodsytonic the exposures are, of course, going to be facing concepts that (on the face of it) go against that person’s actual beliefs. If the thoughts didn’t bother the person then it wouldn’t be OCD. It truly astounds me that so many experts don’t see the problems with their reasoning here. Fortunately there are a few who approach this topic with the nuance and OCD-first approach so desperately needed.

The point is, there are many people struggling out there with scrupulousity that are being told frequently to consult with their respective religious leader and/or to formulate exposures based around what is acceptable in any given context. This is almost certainly going to pose a number of problems with ERP, not to mention starting off with a massive reassurance that you are safe. Doesn’t that defeat the whole purpose of exposures to begin with?

And more importantly why is it only religious based obsessions where we have to consult with a [religious] professional related to the theme anyway? Fortunately for me I have always been a fairly liberal Christian and the Vicar I spoke with, from Church of England, tend to be quite liberal and understanding in their faith also. But what if I was part of a fundamentalist evangelical church? Or a strict orthodox Catholic church? I can tell you with almost certainty that they would have labelled this as a spiritual problem requiring prayer. Worse still they might put it down to being caused by a literal Satan or demonic possession. For those towards the more conservative end of Christianity (without a specific knowledge of OCD), some don’t even believe in mental illness in the first place. Science isn’t exactly high on the agenda for some, hence why millions of Christians still believe the earth is 6000 years old. For example, if someone has violent sexual obsessions and comes to a pastor who believes the bible is the literal and inerrant word of God, do you really think they would give their blessing to a congregant to potentially commit “adultery of the heart” by viewing provocative images? No, no they wouldn’t.

To me this is no different than asking someone with POCD to consult with social services as to what exposures might be okay.  Or for someone with harm OCD to pop down the police station to ask the sergeant about whether carrying a knife through town thinking about killing people is fine. A) They are unlikely to understand and B) Your concerns might be taken further due to lack of awareness C) It’s reassurance and undermines the process from the off.

If OCD is barely understood by most mental health professionals, how on earth do we expect lay people to understand and give the appropriate guidance when it comes to something (which at first sight) almost seems counterintuitive (ERP)? Seems like a massive gamble to me.

Now, I am not saying that a bit of encouragement from people isnt a good thing (religious or otherwise) nor am I saying that exposures are limitless, of course they aren’t. If you have harm OCD of course you are not actually going to harm someone as an exposure. If you have HOCD of course you don’t have to exposure yourself by sleeping with someone of the same gender. The battle lines are fairly easy to draw with these more physical or material based obsessions. Contamination OCD is another that is generally quite straight forward to generate exposures for. However, for those of us with more mental based obsessions drawing those lines becomes more challenging.

Research has shown that one of the main pitfalls of ERP is that exposures are not taken far enough (Gillihan 2012). Well, if you go down the consult religious professional/avoid anything potentially sinful approach, I’m not sure where that leaves us, apart from lying at the bottom of a massive pitfall. The whole idea is to reach 10 out of 10 on the hierarchy. With this reassurance based method I’d be surprised if people got passed 4-5. Some refuse to even start the process altogether because they are trapped within a rigid theological system.

Not only is consultation with a religious leader potential reassurance (undermining the process?) and in some cases extremely limiting (especially conservative types) but no one has the ultimate truth when it comes to spiritual matters. I say this as a Christian myself: there is not a single concept in Christianity that is agreed upon by everyone. None. In other words, whilst many claim to have the proper beliefs and understanding (of course we all do right?), you will quickly come across someone with the same amount of confidence who holds contradictory beliefs. All the way from Jerry Falwell to Bishop Shelby Spong and everything in between.

I’m quoting Fred Penzel again as he seems to be one of the few who understands what he is talking about when it comes to religious OCD:

If God or one’s particular deity sees and knows everything, then they would have to know that the person is doing these exercises as treatment, and not to be irreligious.  They would understand that the person is simply trying to break out of OCD in order to become closer to their God and more appropriate in their observance.

Penzel WSPS

The above quote was essentially what grounded me and gave me the courage to take a leap of faith into the unknown. As someone who had severe OCD with a religious theme, I cannot tell you how important this quote was for my recovery.

The better approach as I see it

When it comes to belief based metaphysical obsessions none of us have any concrete truth on these matters. Hence why it is called faith. Therefore, unless you are talking about physical rituals such as avoiding eating pork, or praying excessively, exposures are going to be incorporeal and intangible in terms of their link with physical reality. In other words exposures become faith based, and risk levels are incaluable because we are not dealing with physicalism. For example, if you eat a sandwich from a toilet seat, there is a very small chance you will get a stomach bug. But if you are a Buddhist obsessed about being reincarnated into some undesirable form, where do you even start with that in terms of a risk assessment?

In my personal opinion religious OCD is the same as any other. OCD is a severe mental illness. An omniscient being would understand this and know we are only trying to get ourselves better.

Could I have jeopardised my soul via ERP and inevitably end up in hell? Maybe. But with all the religions in the world that have ever existed, all the God beliefs, not to mention all the denominations within Christianity itself, I’m still playing faith based roulette like anyone else, at least in an absolute sense. Therefore, I have to live with that uncertainty, with or without OCD, and that is part of the exposure in and of itself.

Similar to Desmond Tutu who said he wouldn’t want to worship a homophobic God, I too wouldn’t want to worship an ERP-phobic God – a God who would condemn someone for trying to recover from an illness.

Fortunately, I believe in a loving God who is proud of me for what I have overcome and continue to battle, and now I finally have some semblance of peace, and more importantly my children have their Father.


Additional comments

Remember, these are my personal and non-professional views. I do not claim to be an expert, but I believe that feedback from OCD sufferers is essential to improve services and experiences for those who have the disorder. I do not claim to have all the answers, I give my opinions the way I see it based on my personal experiences. Everyone can follow their own path and I could be wrong about my take on these matters. Ultimately some people of faith will disagree with such a process and instead argue these matters are spiritual in nature. I do not personally think OCD is a spiritual or religious problem, I think it is a mental illness that requires science based interventions. I would ask that we all show empathy and respect towards one another with such conversations and refrain from judgement. OCD is hard enough as it is and regardless of our views on faith we should be kind towards one another.

5 thoughts on “Religious OCD and exposure therapy”

  1. I am sorry. I can’t do that. I get tremendous amount of exposure with those horrible thoughts enough by simply enduring my own brain. The only only solution is to trust the Lord. Handball all of it off on Him. If we trust Him with this problem and believe that He loves us and knows the situation better than anyone, these thought patterns begin to disappear. If He knows we don’t really believe these things nor want them. It doesn’t a 100% solve it as it will always try to come back with things like “you are just deluding yourself!!!” But I take that as an improvement and handball that off to the Lord as well.

    All God has ever asked of us was to love Him with all our being (which entails trusting and obedience- like a little child- and countering the Accuser by going to Jesus) and to love our neighbours as we would love ourselves. And we do this by His Spirit. He is still helping me understand scripture, even when I have the bad thoughts blast through at the same time, so I just try to treat it as spiritual Tourette’s. Oh, the Lord is teaching me, BadThought says: “leavemealone. Ihateyou” and other things I don’t want to type. Why? Immediately after all this. Why would I be doing this if I truly wanted Him to leave? Well, I don’t. I just have that horrible fear and for some reason my mind fixates on the fear. So, you know, it just gives me more impetus to push through it, despite the loud cacophany in my ears telling me it is useless and I should just quit. I had one try to tell me that God is a child abuser and my life would be easier if I gave up – which, you know, if that isn’t a demon, I don’t know what you would qualify as “demonic”.

    Look, I read two of your blog posts. I am happy you are functional in “the real world”. That is good for your kids.

    Sir, my goal, my number one desire is to serve and know God, to seek Him and worship Him all my life and forever. It is not to “feel better”. I just try to follow what God says. I am not concerned with labels and whatnot. I want to know Him and grow deeper in Him. I know I don’t have everything perfectly understood but I believe Him when He says to ask, seek, and knock and not to give up.

    I believe in a God who still works in the “real world”, who still communicates with His children when He wants to, who walked in the garden in the cool of the day and they heard His voice. My desire for Him is … unquenchable.

    And so this situation is completely disturbing and distressing to me. And I know we all must be tested. And I sometimes wish He would just tell me that everything is ok and then I can continue.

    But here is the awful truth, sir, coming from a very conservative (as you would call me) Christian, if He told me to the sound of trumpets and a company of angels, it might hold for a day, and then the next day, something would happen, a bad thought, whatever, and then I’d be back to square one.

    So, this is the necessity of faith. He wants us to have faith. He came to the children of Israel and ten times delivered them with huge miracles, and they still didn’t believe in Him. They still complained. They were still fearful. And it was because of their lack of faith that He grew angry and He didn’t allow them to enter into rest.

    So, I/we may get a lot of silence in the midst of a lot of suffering. But that is because the Lord wants us to have faith. You talked about “Divine Hiddenness”. I believe He likes it when we chase Him. He likes it when we reach out and up and demonstrate the faith of a little child. What does a child do when he is afraid? We have a good Father. He rests in his Daddy’s arms. King David talked about that. When I am afraid, I will trust in you.

    All this time, when I pray, sometimes I have received responses. Sometimes I still don’t know whether it was my own mind. But one thing is that He just wants me to rest. When I have those bad thoughts and stress about them, shhhhhh. And when I still worry, “you are just going to have to trust me”

    I appreciate your empathy and concern for “conservative evangelicals”, but at the end of all this, I still believe in my heart that the Lord my God is with me. Sometimes, I think He must be angry at me that this is a problem, but then I am reminded that He is also merciful and gracious and that He wants to forgive me. I had an experience when I perceived the Lord didn’t like me complaining about this and asking Him why He has to continue to test me…but as soon as I said I was sorry, He forgave me instantly. I just knew that I knew He did. It was so immediate that I thought..He must really want to forgive us.

    But, you know, we can have that sort of experience but it doesn’t make the scrupolosity go away. It just comes back another day.

    I don’t understand it. I just know the only solution is to trust Him. Focus on quieting the mind. It’s not easy. I just visualise it like resting on the couch. Saying that I am completely unable to do this by myself. Sometimes when you do this, the thought comes “it’s too late. God has left you” I just praise Him and thank Him even through the pain, and I might throw a scripture at it. Because one of the deceptions is “because the bad feeling is still there, God is no longer with you” But that is not so. Feelings don’t dictate reality. No matter how strong they are. I forgave someone by faith. The bad feeling was still there. I just said, as far as I’m concerned, feelings or not, the debt is released. The feeling came in about ten minutes – and it was a sense of relief.

    It is a rough slog. Uphill. If I have several good weeks, I might still get the occasional blast in my mind, “but you committed the unpardonable sin”. I know what it is. Calling the Holy Spirit an evil thing. I don’t believe that. In the midst of all this, I am reminded that a sin starts in the heart. If some statement comes out in fear or panic or just as some floater-thought that means nothing to you, is it a thought you really believe?

    I had a horrible thought the other day because I just wanted to forget about this subject entirely, “ok. And then during the judgment, He will tell me that if it weren’t for blaspheming the Holy Spirit, all would be well”.

    Ok. Well, if that is the end of that, then what sense is there in even worrying about this. What is done is done and if it’s unforgivable, then…well…that is even less reason.

    “But it’s right to be afraid of God!”

    So, now this comes with moral force. “you are a bad person and you’d be an even worse person if you stopped thinking about this”

    Dude, for something that is a mere mental imbalance, it certainly acts like a personality. Here, I’ll hold you down in these chains of darkness and you’ll never escape. This is your prelude to hell, which is infinitely worse.

    But there is an escape. And so I reach out to Him and I choose to trust Him despite the never ending legal pushbacks telling me I am doomed. Christ died for all of my sins on the cross, and He promises that His burden is light. So, I will grab a hold of Him and Him alone no matter what.

    This might be a bad period, but I will grit my teeth and look straight at Him and say, I love You. I trust You, my deliverer, Who never lets me go

    And I recognise that this can be a daily struggle. After all, He said that. Daily. Daily. Like the children of Israel taking their Manna in the desert every morning.

    And I am hurting as I type this, and the thought, “you wrote too many words and probably said something wrong. What is *wrong* with you??!!”

    I don’t want to use God’s grace as an excuse to do wrong, but maybe this will help someone and I would sin by deleting it all?

    Do you know what I am reminded of as a response to that? *Love*. If we do it from love of God and His people, then that is His desire. To love God and to love. That is how we are known. By our love. It is not about obeying a bunch of rules, but from the heart love. When we love God, we won’t sin against Him. When we love others, we won’t sin against them. That is what it means to walk in His Spirit, to be filled with His love and to walk in His love. That is the beauty of the gospel. We are liberated to love. We become slaves of love and righteousness and God, where the greatest love and joy is.

    Ok. Done.

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    1. Also, I agree with a lot of what you say. Trust and faith are key components to manage and overcome this horrible disorder.
      My point was not to insist on one way or one interpretation – I might be wrong. If you read my bit at the end I was careful to say that.
      Ultimately, I personally decided to face the words and thoughts head on with evidence based therapy so they would lose their power in my brain (same as any obsession). That meant I could actually have a relationship with God again.

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  2. Dear Richard,
    Thank you for a thoughtful post – it is to the point; I am looking forward to read the rest.
    May I send you an email?
    Please could you remove this comment and not to make it public?
    Best wishes,
    Gary

    Like

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