How do we battle spiritual obsessions and compulsions? What practical steps can we take to fight through the fog of scrupulosity?
The most commonly used therapy for OCD is known as exposure and response prevention (or ERP), which ideally should be practiced in the context of professional help (i.e., a counselor or therapist trained in OCD).
Exposure and Response Prevention
The first step of ERP is exposure. The goal is to purposefully expose ourselves to a triggering situation. The next step is response prevention. While exposing ourselves to an anxiety-triggering situation, we must refrain from responding with compulsive behavior.
How can we apply this to a real-life obsession and/or compulsion? I’ll use a personal example of my fear of taking communion.
1. I’m sitting in church and communion is being served. I have thoughts condemning me, questioning if I’m saved and therefore have a right to take communion.
2. I have anxiety at the thought of not being saved, and I try to do something to rid myself of this.
3. One way I may engage in compulsive behavior is by avoiding communion (yes, avoidance is a compulsion, too!). I just won’t take it.
4. When I give in to this compulsion, the anxiety lessens, because at least I don’t have to face my fear of taking communion. But what happens next week? In the same situation, I have the same thoughts, same anxiety. The compulsion (avoidance) only helped in the moment, but not long term.
In this case, exposing myself looks like going to church each week, where I will then be exposed to communion. Response prevention looks like sitting in the service, not getting up and leaving the sanctuary, and taking communion. It looks like participating in the Lord’s supper with the rest of the church body.
While we refrain from doing compulsive behavior, we also must not mentally resist the obsession. That’s our knee-jerk reaction to an obsession—we either want to avoid it, ruminate over it, or quench it with a compulsion. However, the more we mentally try to resist the obsession, the more it insists that we pay attention. Yet the more we ruminate and obsess, the worse it gets. And the more we give in to a compulsion, the easier it is to do it again next time. Through exposure and response prevention, we have to stop fighting and just let the anxiety be. We must call quits to the endless problem-solving of compulsive behavior. We must short-circuit step 3 above by refraining from the compulsion and not trying to diffuse the anxiety.
“Do the Opposite”
Fifteenth-century priest Ignatius of Loyola, who many believe suffered from scrupulosity, coined the phrase “do the opposite.” This is a simpler way to explain the method for fighting OCD: whatever you feel like doing in the moment, do the opposite. Expose yourself to a trigger and do the opposite of whatever your compulsion compels you to do. For me, this looks like taking communion every Sunday. My doubts tell me I should wait until I’m sure I’m saved before I take it, so I do the opposite (ideally, that is).
Another example is rumination (which is also a compulsion!). In my obsessive doubts about my salvation, I will begin to turn over evidence in my mind, build a case, and make an argument. I think, think, think. While an intense resistance and fight against these thoughts feels like it’s doing something, it’s actually only making it worse. But that—the rumination—is just another compulsion, another way that I’m trying to rid myself of obsessions and anxiety.
Perhaps the steps of ERP in this example are a bit harder to identify, but the principles are the same. Instead of exposing myself to a physical situation, I let myself sit with a thought or doubt. ERP, or “doing the opposite,” would look like resisting from ruminating (easier said than done). I would try not to figure it out, but instead, actually think about all the implications of the accusatory thoughts without trying to resolve them by rumination.
Isn’t That Counterproductive?
The scenario described above leads (at least in the moment) to more anxiety. The discomfort increases as the obsession is allowed to just be without me trying to fix it. And that’s why it’s so hard to follow through. Not only do we have to refrain from giving in to the compulsion, but we have to sit with the ensuing anxiety. This seems so counterproductive! Don’t we want anxiety to decrease? Yes, but to get there, we need to sit with the anxiety until we realize it doesn’t equal death. Professionals call it “habituation,” the naturally dropping anxiety that is the result of ERP. This doesn’t mean it won’t happen again next time—it just means that we’ve taken one more step to “do the opposite.”
Doing exposures doesn’t change our feelings. By exposing myself, I don’t subsequently feel peace, joy, and assurance of salvation, but rather, my anxiety in the moment rises. When I take communion, the thoughts become more persistent: Am I sure this is wise? What if I’m directly defying Scripture’s guidelines surrounding communion? But I take it anyway. I don’t try to reassure myself with counterarguments (that would be giving in to the compulsion of rumination), but rather I sit with the anxiety. Yeah, maybe I am defying Scripture. But maybe I’m not. I can’t say either way, and that is tortuous for OCD, which demands certainty.
In this way, doing the opposite is risky. Saying no to OCD means taking the risk of being wrong. It means being willing to face the uncertainty without the promise of resolution in this life. What if I’m actually not a Christian, and taking communion could be bringing harm upon myself? What if these thoughts are true, and therefore choosing not to engage in a debate with them is as good as resigning myself to an eternity in hell?
How can we take the risk of being wrong without losing heart? Moreover, how does the Lord—who has given us the common grace of counseling and therapy techniques—come into play in the struggle and the fight against it? That is the topic of next week’s post.
For further reading, I have found this description of ERP to be helpful and clear.