By HALLE SCHNACKENBERG
“If it’s out of your hands, it deserves freedom from your mind too”
Dealing with something mentally that you don’t understand or can’t identify can be extremely frustrating. It is common to have thoughts like, “Why doesn’t anyone else seem to be struggling with this?” or “I wish I knew how to help myself.” I experienced thoughts like these before I learned about scrupulosity. As I was working through my own experience with mild scrupulosity, I practiced multiple components of acceptance and commitment therapy (ACT), which made my thoughts much more productive and manageable.
What is Scrupulosity?
Scrupulosity is a psychological disorder “primarily characterized by pathological guilt or obsession associated with moral or religious issues that is often accompanied by compulsive moral or religious observance and is highly distressing and maladaptive” (Miller & Hedges, 2008). It is a form of obsessive-compulsive disorder (OCD), and thus is characterized by obsessions and compulsions. For example, an individual might experience intrusive doubts about whether they put enough effort into their worship. They might repetitively think that their efforts are worthless. They might be consistently unsatisfied with their completion of religious duties. They also might seek excessive reassurance from religious figures (Myers et al., 2021). Symptoms can often manifest themselves in various forms.
In my experience, I sought excessive reassurance from church leaders. I consistently undervalued my efforts and felt like my worship was never good enough. I had a flawed perception of God’s character; I thought that God was always ashamed of my imperfections and my inability to follow religious teachings flawlessly. My negative self-image in this aspect of religious worship led me to feel hopeless and inadequate. These self-deprecating thoughts permanently lived in my mind. It became difficult to do my homework, have meaningful conversations with my friends, and find peace in God.
Scrupulosity and ACT
ACT focuses on various psychological processes. It helps individuals learn to accept the presence of unwanted and intrusive thoughts, disempower language in certain situations, view the self as the context where thoughts occur, make contact with the present moment, identify core life values, and act in alignment with these values (Dehlin et al., 2013; Twohig, 2009). Although limited research exists on scrupulosity compared to other disorders, there are a handful of studies that have investigated the relationship between ACT and scrupulosity symptoms. Some studies have shown that compulsive behaviors that extended beyond traditional religious norms or expectations decreased significantly after ACT (Dehlin et al., 2013; Lee et al., 2018; Twohig, 2009). Additionally, avoidance of activities like church attendance or prayer, for fear of triggering obsessions and compulsions, decreased significantly after ACT (Dehlin et al., 2013). Although more research is needed to examine this relationship, these findings suggest that ACT is an effective treatment for many forms of OCD.
After reading the results of these studies, I tried incorporating ACT into my own life. I learned to acknowledge my self-defeating thoughts with detachment. This helped me observe my thoughts without being controlled or defined by them. I continually reminded myself of what was most important and what I stood for. I would say “God loves and accepts my effort,” and “I am God’s daughter, and God is patient with me.” I set reasonable and achievable goals based on my values. I encouraged myself to express pride in my effort daily and tried turning outward to relieve the suffering of others.
The thing that helped me the most was gaining contact with the present moment through practicing mindfulness. Once I began objectively observing my thoughts and feelings, I recognized how often my mind got lost in the past or future. When I wanted to obsess over and harshly critique my religious efforts, I tried to remember that “now” is the only time I have any power. In Dr. Jared Warren’s positive psychology course at Brigham Young University, I learned to stop throughout my day to notice five things I can see, four things I can touch, three things I can hear, two things I can smell, and one thing I can taste. This practice helped me remember my place in the world; it helped me remember that I am human, and that perfection cannot be achieved in this life. I practiced nonjudgmentally accepting unwanted thoughts that arose during this time I took to connect with the world around me. I tried to remember that thoughts are not facts; they are simply appearances in consciousness, and I did not need to be ruled by them. I learned to take a step back and realize when I was getting lost in a movie that my mind was creating. Being satisfied with my honest efforts to follow God required much practice until it became a habit. I was able to reduce the reassurance I excessively sought from church leaders because I felt more at peace with myself. Appreciating the present moment helped me defuse my self-deprecating thoughts so they had less influence on me. I am still navigating this process; however, many of the components of ACT that are linked to mindfulness have helped me manage scrupulosity more effectively.
The following are some mindfulness practices that have helped me better manage scrupulosity and the feelings that come with it:
Accept unwanted thoughts and feelings: make room for difficult emotions and urges and let them run their course
Step back: objectively observe thoughts. Say “I am having the thought that [I am not good enough]” rather than “I am [not good enough]”
Mindful breathing: sit upright and relaxed, get grounded, relax bodily tension, notice your breath
Mindful walking: feel the weight of your body as you walk, focus on your weight shifting, notice textures of the ground under the soles of your feet, keep with your pace
Connect with your senses: stop and notice 5 things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste
Self-evaluate: ask yourself, “Does this thought or behavior take me in the direction I want to go?”
Practice self-compassion
Make goals: make achievable goals for future action that align with your values
“No matter how difficult the past, you can always begin again today”
References
Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification, 37(3), 409-430. https://doi.org/10.1177/0145445512475134
Lee, E. B., Ong, C. W., An, W., & Twohig, M. P. (2018). Acceptance and commitment therapy for a case of scrupulosity-related obsessive-compulsive disorder. Bulletin of the Menninger Clinic, 82(4), 407-423. https://doi.org/10.1521/bumc.2018.82.4.407
Miller, C. H., & Hedges, D. W. (2008). Scrupulosity disorder: an overview and introductory analysis. Journal of anxiety disorders, 22(6), 1042–1058. https://doi.org/10.1016/j.janxdis.2007.11.004
Myers, S. G., Pirutinsky, S., & Rosmarin, D. H. (2021). Implicit and explicit beliefs about God and scrupulosity symptoms: A prospective study. Journal of Obsessive-Compulsive and Related Disorders, 28, 1-6. https://doi.org/10.1016/j.jocrd.2021.100621
Twohig, M. P. (2009). The application of acceptance and commitment therapy to obsessive-compulsive disorder. Cognitive and Behavioral Practice, 16(1), 18-28. https://doi.org/10.1016/j.cbpra.2008.02.008