ERP for Scrupulosity OCD Can Feel Like a Sin

Exposure and Response Prevention (ERP) is one of the most popular treatment modals for Obsessive-Compulsive Disorder (OCD). It involves the OCD sufferer systematically facing the fears that drive their OCD cycle. For instance, if the individual often completes the compulsion of hand washing, the ERP that individual would be subscribed could involve going 15 minutes without washing their hands, touching a “dirty” object without washing their hands, etc.

ERP is always difficult – but additional care is needed when Scrupulosity OCD is involved. That’s because oftentimes, the exposures the sufferer is asked to do could involve tasks that may be deemed sinful in the individual’s religion.

For example, during Scrupulosity OCD treatment, individuals may be asked to skip church one week, not apologize when they think they have offended someone, listen to “inappropriate music,” or other behaviors that they believe require repentance. 

Of course, therapists who are guiding Scrupulosity OCD sufferers through ERP are always advised to be sensitive to an individual’s religious beliefs, but that doesn’t mean there isn’t an entire layer of difficulty surrounding ERP for Scrupulosity OCD. So how can you navigate it?

A helpful way to approach Scrupulosity OCD ERP that feels like you’re sinning

I’ve found that when doing ERP for Scrupulosity OCD, it works best to start small with the “less scary” exposures, and then work up to the bigger, “more scary” ones. 

For reference, this is how I navigated doing exposures in my own experience with Religious OCD:

1. First, I tackled my fears around wasting time that were rooted in believing that being unproductive was sinful. The exposures I did included:

   1. Writing a to-do list and then not completing it

   2. Taking a longer lunch break than I normally would

   3. Not completing any work on a work day

2. Next, I addressed the way that I prayed. My OCD caused me to be afraid of asking for God’s help without first repenting and expressing gratitude. So, my ERP consisted of me saying prayers in an “incorrect” way or even occasionally skipping my daily prayers.

3. By then, I had built up some momentum. I did exposures surrounding the way that I studied scriptures by skipping scripture study, only reading one sentence, or closing my scriptures even if I didn’t feel I had had a productive study.

4. Next, I attempted to conquer my fears about what would happen if I didn’t go to church for any reason other than I didn’t want to. This one was very difficult and made for very anxious days. 

5. And then came the big one: facing the intrusive thoughts I had surrounding my doubts regarding my faith without doing compulsions. I had to expose myself to what it would be like to not have a strong testimony. This one was messy. It was one of the hardest things I have ever done. 

During this journey, I found it helpful to tell myself that if I didn’t want to, I didn’t even have to do the big, scary ones. I leaned into the uncertainty of whether or not I would ever end up doing it. Approaching ERP as a staircase, where I only ever had to take one step at a time, was the only way I was able to complete it.

ERP works hand-in-hand with I-CBT for Scrupulosity OCD treatment that feels like sinning

My journey with Scrupulosity ERP is layered because as I worked through each exposure, I got more and more to the root of the issue.

It was only when I combined ERP with another treatment modal, Inferential Cognitive-Based Therapy (I-CBT) that all the pieces of my OCD puzzle started to fit together. I learned that ERP was vital for learning to sit with anxiety without doing compulsions, and I-CBT helped me learn where my fears were coming from.

And for me, most of my Scrupulosity OCD fears came from avoiding becoming a prideful and selfish person. This understanding helps make ERP feel much lighter. It gives it a purpose. 

So, if doing ERP for Scrupulosity OCD just feels like you’re sinning over and over and over again, perhaps combining it with I-CBT could be another way to lighten the load.

Leaning into uncertainty about whether or not Scrupulosity OCD treatment is a sin

It’s true – doing ERP with Scrupulosity OCD feels like a sin. And on top of that, you may worry that God might think you are using your OCD as an excuse or worry that your (or your family’s) eternal salvation is at risk. But by approaching OCD treatment in a multi-faceted way and starting small, anyone can do it.

Ultimately, at the heart of every exposure is uncertainty. There’s no way to know whether or not you are really sinning by doing OCD exposures. All you can do is the best you can with the information that you have, and that information is that it’s time to take your life back from Scrupulosity OCD.