In effective treatment for OCD, the most commonly used clinical technique is ‘direct exposure,’ sometimes also called ‘in vivo’ or ‘real life’ exposure. Here, an individual purposefully puts herself in situations that are associated with obsessional fears, and refrains from performing acts (compulsions) that would lessen her fear. For instance, in the case of a person with contamination fears, exposure might include touching objects or going to places that are irrationally feared as unclean. Most good OCD treatment involves constructing detailed lists of dozens of situations that cause obsessional anxiety, and figuring out ways to methodically expose oneself to them.

The therapeutic rationale is straight forward. It is exactly the same as in the treatment of simple phobias. If you have a terrible fear of cats, you must work towards the goal of picking up and holding a cat. Eventually, you will get used to cats. Likewise, if work towards exposing yourself to obsessional fears, you will ‘habituate’ to them.

Suppose a young mother develops the obsessional fear that she will drop her baby. In her mind’s eye, she sees herself picking up her child and then twitching, or suddenly jerking her body, or losing her balance in some way. As a result of the fear, she goes to great lengths to avoid picking up her baby. When she must do it, she seeks endless reassurance from her husband.

What’s the treatment here? The mother must be encouraged to take the risk of picking up her baby without asking for reassurance. This will almost surely need to be accomplished in small steps. First, only a short distance up from the crib, and then higher and higher. First with her husband present, then alone. If the mother can be persuaded to do this, she will overcome her fear.

The question for Christians is this: How does God fit in? The answer: In every way, for the basic problem in OCD is a lack of faith in God’s mercy and providence. If we would truly trust in Him, we would not fear anything at all. God promises that “all things work for the good,” and that he will “not test us beyond what we can bear.” The King James Bible uses the exact words “fear not” or “be not afraid” more than a hundred times. That’s because faith—trust in God’s mercy—is what God wants from us more than anything else. God wants us to be at peace through faith.

God has designed OCD specifically in order to strengthen our faith. Our intention in using exposure exercises is, from the clinical perspective, to induce habituation. From the Christian perspective, our intension is to grow in faith. In this particular case, what was most helpful to the mother was remembering: “It’s more important for me to trust God, than to be completely sure that I won’t drop the baby.” After suffering through her difficult trial, her fear normalized and her faith grew stronger.

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9 Response Comments

  • Cynthia  August 1, 2017 at 10:33 am

    Awesome!!
    Development of an unshakable, childlike faith in God, that I once had, is what I strive to do on a daily basis!!

    Reply
  • Mike  August 1, 2017 at 4:51 pm

    This was such a Blessing! I suffer primarily from Scrupulosity so it is encouraging to view Trusting (literally not trying even a “perfectly said prayer” but just being silent and kept by HIM) is both Theologically Sound and also therapeutically correct.

    Reply
    • Tara  August 18, 2017 at 2:16 pm

      I struggle with Scrupulosity too. Constant doubting my salvation.

      Reply
  • Marie  August 17, 2017 at 10:44 pm

    As always, a thought-provoking and encouraging post. Thank you Dr. Osborn!!

    Reply
  • Tara  August 18, 2017 at 2:15 pm

    I just started following these posts. I have recently been diagnosed with OCD mostly Scrupulosity. My scrupulosity hits the most with doubting my salvation and the question…..how do I know that I know that I really believe and am trusting. I also struggle with guilt and feeling not good enough for God. I am in counseling, an integrated approach, using ERP. Want to buy Dr. book bc I want to tie my faith into this bc I am not really sure how to trust the Lord with my doubts and fears.

    Reply
  • G  August 27, 2017 at 3:51 am

    How to apply direct exposure when the fear is religious? Eg fear of not praying sincerely or blasphemous or bad thoughts about God and saints?

    Reply
    • admin  August 27, 2017 at 6:44 am

      In order to apply direct exposure to religious fears, a person must purposefully put himself into a situation where the fears occur. For instance, when praying. Of course, it is critical to prevent using compulsions to deal with the fear at that time. This can be difficult, particularly if mental compulsions are strong. Sometimes imaginal exposure works better with religious fears. Stay tuned for next blog.

      Reply
  • KR  August 31, 2017 at 2:54 pm

    Hi,
    I’ve been reading your blog. I suspect I have OCD tendencies at least. I was wondering if you have ever encountered a person who excessively worries about other people going to hell. And how would you suggest they cope with that?

    Reply
    • admin  August 31, 2017 at 3:54 pm

      Yes, that is very common! OCDers are always worrying about other people. From a therapeutic standpoint, all obsessions are the same. One would treat that obsession the same as any other.

      Reply

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