Most cases of OCD are effectively treated with ‘direct exposure’—purposefully immersing oneself in the real-life situations that are associated with obsessional fears. But some are not. For example, when obsessions deal with spiritual issues. How are you going to put yourself in the situation of losing your salvation, or of committing the ‘unpardonable sin’? You can’t, and that is where imaginal exposure comes in.
Imaginal exposure involves purposefully bringing to mind your frightening ideas and images. Typically, therapy involves making a list of situations to be imagined that would evoke obsessional fears. Then you select one to work on, and to sit down every day and immerse yourself in it. Often the preferred strategy is making up a scenario in which feared consequences occur in sequence, then recording it and listening to it over and over. As a result of this process, habituation to the fears occurs. It is difficult therapy, and the process of purposefully bringing obsessional material to mind must be planned carefully and started slowly.
In my experience, in order to use this technique the Christian needs to understand that obsessional fears come from the enemy. Only the recognition that they are from outside of our true selves allows us to muster the courage to expose ourselves to them. You can look on the enemy as the world, the flesh, the devil, or the ‘old self’. Many of the Christians I work with find it most helpful to simply view the enemy as OCD. The critical issue is that the intrusive fears must seen as issuing from a force that is bent on compromising our trust in God.
Martin Luther, who knew a lot about fearful thoughts, offers this advice in one of his spiritual counsels:
To those who are tempted by doubt and despair…Let them persuade themselves that such thoughts are really not theirs but Satan’s. Our own powers and ideas are not sufficient to cope with such matters. Satan knows this very well. Therefore, he suggests such thoughts and makes them seem so important to us that we are unwilling to leave them or turn aside from them but wish to scrutinize them and think them through to the end. To do so is to surrender to Satan and let him reign.”
God’s entire purpose in allowing the painful trial is to teach us to fully trust in him. We can’t do it if we continue to rely on ourselves to deal with obsessions. We need to stand up to the fears, but at the same time let God deal with them. That’s what is practiced in imaginal exposure. We willingly suffer the distressing ideas and images that the enemy puts in our mind, and we don’t do anything about them. Rather, we leave them to God, and depend on him to take care of us. The problem is, of course, that when the enemy is attacking we lose our confidence in all of this. That’s why OCD is, for the Christian, a trial of faith.