Two times are important when dealing with OCD: the moment an obsession hits (when we must attempt to gain a therapeutic perspective), and the time spent on exercises designed to lessen OCD’s strength. Of the various exercises that are helpful, the most proven is “exposure and response prevention,” or ERP. It employs the process of habituation. The idea is that if you purposefully expose yourself to an irrational fear, and do nothing to escape from it, you will “habituate” to it — that is, you will get used to the fear and it will no longer cause alarm.
ERP is always difficult. For instance, an unusual amount of willpower is necessary for a person with hand washing compulsions to purposefully dirty her hands and refrain from washing. That’s why therapists are often necessary when employing ERP. They help design appropriate exposure tasks, and support the individual through them. In the case of religious obsessions such as the unpardonable sin, ERP is especially difficult. Indeed, sometimes it seems impossible to design a workable ERP program for a person whose obsession is, say, a sinful, blasphemous image.
I recently worked with a young woman, a strong believer active in her evangelical church, who suffered intensely from intrusive, images depicting Jesus involved in sexual acts. She saw a therapist who suggested the ERP strategy of purposefully looking at sexual pictures, in order to lessen her fear of these sorts of images. The patient, however, was shocked by this assignment, and found it completely unacceptable. She did not see the therapist again, and as a result continued to suffer severe OCD for several more years.Many Christian OCDers are, indeed, unwilling to do an assignment such as this one. While it is true that many others are willing–as no sin is necessarily involved if the exercise is put in proper therapeutic perspective—it is easy to understand and sympathize with the young woman’s concern. Christian OCDers such as her, however, should not give up on ERP!
An important distinction can made: While many would regard purposefully looking at explicit sexual pictures as sinful, it is clearly not a sin to have an unwanted thought, to refrain from fighting it, and to allow God to take responsibility for it. In the case of the young woman, therefore, ERP can simply involve allowing the repugnant image stay in mind when it occurs, and doing nothing purposeful to get rid of it. No counter images, prayers, or seeking reassurance. Just bearing the anxiety full force and leaving the dealing with it to God.
This can be accomplished several ways. When the image occurs on its own, one can go to a quiet place and allow the image to be there full force, causing as much havoc as it wants, perhaps for 30 to 40 minutes. Or, one can go to a place that provokes the image (perhaps a church), and do the same thing. Another strategy is to turn the focus to uncertainty about the image. Often OCDers get to the point where they say, as did a patient of mine, “Okay, maybe it’s OCD–but maybe, too, I’m just a sinner!” The goal in ERP then becomes to tolerate painful uncertainly for a certain period of time, rather than anxiety.
The important point is that it is not necessary to do anything that could be considered sinful in order to proceed in ERP. One way or another, we Christian OCDers need to learn to tolerate blasphemous thoughts or images. If we don’t, they’ll just become stronger. In the last analysis, we need to leave to leave the dealing with them to God, and not worry about them.