Scrupulosity: When religion and morality become impairing

Scrupulosity: When religion and morality become impairing

Although most people are familiar with Obsessive Compulsive Disorder (OCD)—or at least have a general idea and may even feel that they personally have some OCD tendencies—a lesser known form of OCD exists called scrupulosity. Scrupulosity involves obsessions related to religious or moral ideals which cause an individual to be overly concerned that their actions are sinful or are violating religious or moral doctrine (International OCD Foundation, 2010). This concern is so great that it often leads to excessive praying or trips to confession, repeating rituals involving cleansing and purifying, and avoiding situations where some religious or moral error may occur (IOCDF, 2010). One effective and recommended treatment for scrupulosity is Exposure and Response Prevention (ERP); however, another form of treatment, Acceptance and Commitment Therapy (ACT) was shown to be another effective form of treatment in a recent study by Dehlin, Morrison, and Twohig (2013). Acceptance and Commitment Therapy traditionally involves accepting undesirable thoughts and feelings, reducing the meaning of and attachment to these thoughts and feelings, and working toward acting in a way that fulfills one’s values in life and has been used in the treatment of OCD.

Dehlin and colleagues (2013) evaluated the effects of ACT on scrupulosity with five adults (three females and two males) across eight treatment sessions. In order to measure the effects of treatment, researchers tracked the participants’ compulsive behaviors as well as engagement with valued activities. In addition, researchers had participants complete assessment questionnaires. Treatment sessions were 1-1.5 hours each week and consisted of activities that helped the participants incorporate the core processes of ACT. Participants also completed weekly homework assignments. Throughout treatment, participants learned to accept unwanted thoughts, separate themselves from obsessive thoughts, view the self as a context in which thoughts occur, contact the present moment, and commit to actions in alignment with values. Results of the study showed a 74% reduction in compulsions and a 79% reduction in avoided valued behaviors, and these reductions were maintained during a 3-month follow up. In addition, participants reported high levels of treatment acceptability which, combined with the positive results of treatment, makes this a promising treatment for individuals with scrupulosity.

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. DOI: 10.1177/0145445512475134

International Obsessive-Compulsive Disorder Foundation (2010). Retrieved from https://iocdf.org/wp-content/uploads/2014/10/IOCDF-Scrupulosity-Fact-Sheet.pdf

Social Anxiety: Making a difference with exposure and Acceptance and Commitment Therapy

Social Anxiety: Making a difference with exposure and Acceptance and Commitment Therapy

According to the National Institute of Mental Health, 12.1% of adults experience social anxiety disorder (SAD) at some time in their lives. Social anxiety disorder is characterized by a high degree of fear related to social situations which usually leads to avoidance of situations involving other people (National Institute of Mental Health). Several treatments have been evaluated for SAD including Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Cognitive behavior therapy emphasizes changing beliefs about negative thoughts as well as exposing the person to unpleasant thoughts and situations, and although CBT is effective for the majority of patients, about 25% do not respond to treatment (Dalrymple & Herbert, 2007). Acceptance and Commitment Therapy is different from CBT in that it encourages acceptance of negative thoughts instead of focusing on changing the thoughts. In addition, ACT promotes the use of mindfulness, which aids the patient in fully experiencing the present moment without judgment. The results of ACT have been positive for a number of conditions including depression, substance abuse, chronic pain, and psychosis; however, less research has been conducted evaluating ACT for social anxiety (Dalrymple & Herbert, 2007). Therefore, a recent study by Dalrymple and Herbert (2007) examined a treatment package that included exposures combined with various components of ACT to treat SAD. In this study, the authors recruited 19 adults with social anxiety disorder and provided individual treatment for 1 hour per week. Initial sessions focused on aiding participants in recognizing that attempts to control the past have no value. Later sessions focused on accepting undesirable thoughts and acting according to personal goals while being exposed to challenging social situations which caused some anxiety. Mindfulness was also incorporated to help participants become aware of undesirable thoughts without making judgments about their thoughts or trying to control their thoughts in any way or make them go away. Throughout treatment, participants also completed homework outside of scheduled treatment time. At the end of the study, 17 participants had completed treatment and on average, their levels of fear decreased by approximately 30% and levels of avoidance decreased by approximately 60%. In addition, 93% of the participants were highly satisfied with the treatment.

Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for Generalized Social Anxiety Disorder. Behavior Modification, 31, 543-68.

National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml