A difficulty may occur when Christians attempt to treat OCD with behavior therapy. It involves the use of a technique called  “exposure and response prevention in the imagination.”  (Readers unfamiliar with this form of therapy, please see Behavior Therapy for OCD and Example of E/RP in the Imagination.)

This technique involves purposefully bringing to mind certain obsessional ideas, images, or urges in order to habituate to the fear of them. So far so good. But what if the “bringing to mind” involves thoughts that are in themselves sinful? The difficulty lies here.

For instance, individuals with obsessions of violence, blasphemy, or sexual perversion may be asked to write a story that describes in vivid detail their perfomance of a hugely immoral act.  They are instructed to read this over and over, bearing the anxiety that ensues. For anyone, attempting such an exercise is very difficult; but for some Christians it is not an option at all, because they believe that to bring to mind purposefully such awful thoughts is contrary to scripture.

Indeed, the Bible does take our thoughts seriously.  We are told to “take captive every thought to make it obedient to Christ.” (2Cor 10:5).  We are reminded, “As he thinks in his heart, so is he” (Prov 4:23 NKJV). We are worned that the one thing that will not be forgiven is “blasphemy against the Spirit.” (Matt 12:31).

These are powerful verses.  I know that, because people quote them to me when they refuse to do the exposure and response prevention exercises that I recommend.  It can seem to OCDers that the last thing they would ever want to do is purposefully think ungodly thoughts.In my view, however, it is definitely not a sin to bring to mind even the most terrible, blasphemous thoughts if done within the specific context of OCD therapy and if it is  done correctly.  Here’s the reason.  These thoughts, even though they reside in the OCDers mind, are not from the OCDer. Obsessions are unwanted intruders into consciousness.  They do not represent a person’s true self, because they are from a place external to the self (psychiatry even recognizes this, defining obsessions as “egodystonic.”)  Indeed, for Christians the tormenting thoughts called obsessions issue from the enemy, who is vexing us with them in order to take us away from God.

The question then becomes, what is the best way to fight this enemy?  Surely, it is not by running away. Yet, that’s what we do when we perform compulsions.  We are escaping from the battlefield of OCD through compulsions that comfort us.  Furthermore, the escape is short lived, because performing the silly acts only makes obsessions even stronger.  No, the way to fight the battle, which is a spiritual one, is like this: Have the courage to stay on the battlefield and rely on the Spirit for victory (Eph 6:17).Consider:  What if you were terrified of going down a certain street because people there yelled obscenities at you, and yet in your Christian walk you needed to go there?  Would it be a sin to muster up your courage, go down the street, and ignore the obscenities?  Of course not, and this is all that happens with correctly prescribed exposure and response prevention.  The OCDer is simply having the courage to stay in the battlefield and put up with the blashpemies thrown at him by the enemy, while relying on the Holy Spirit to deal with them.

Admittedly the way that some therapists prescribe this form of exposure and response prevention can be too much for Christians.  The therapist may instruct a person to “put yourself fully in the story, and believe that it is real.”  To be asked to believe that a thought with sinful content is actually a part of you… that would seem to be against Scripture.  But that’s not the right way to present the exercise. For instance, I often start by asking a person simply to make a loop tape that begins “my obsession is…”, and to listen to that repeatedly.  This in no way encourages the idea that a horrible obsession is actually a part of a person (which it most certainly isn’t!). The assignment is simply to put up with a thought from without, which is just like a voice from without, and then to trust in God.  There is no sin in this.

My OCD friend, I encourage you to be open to considering difficult exposure and response prevention exercises.  They are not sinful if prescribed correctly.  In all honesty, I know from experience that they can be amazingly helpful.   When an obsession strikes, a short time is available for straight thinking before it overwhelms us and we start doing compulsions.  Maybe, there are a couple of seconds in which to do something really good and worthwhile.  What we must do is put the obsession in a different perspective so that its fear is lessened and we escape the cycle of compulsions.

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