Chapter 4
Treatment for scrupulosity: Exposure and Response Prevention (ERP)
“Gold standard” treatment of a high dose of an SSRI plus exposure and response prevention (ERP) is effective in approximately 70% of people
SSRIs are first line treatment and need to be at a high dose to be effective for most people
Exposure and response prevention is a form of cognitive behavior therapy (CBT)
Exposure refers to practicing confronting the thoughts, images, objects and situations that trigger anxiety and/or obsessions
Response prevention refers to making a choice not to perform compulsive behaviors once the anxiety or obsessions have been triggered
Considerations for exposures
- Appropriateness of intensity and the exposure hierarchy
- Cultural appropriateness of exposures
- Emphasis on uncertainty
- Frequency and duration of exposures
- Typical duration of treatment
Treatment for scrupulosity: Inference-based Cognitive Behavioral Therapy (I-CBT)
Evidence-based treatment for OCD that helps people understand how doubt and obsessional thinking take hold in the first place.
I-CBT helps individuals recognize when they have moved away from reality and become caught up in imagined possibilities and "what if" scenarios.
Well suited for situations in which exposures are less readily available or where clients are not willing or able to do exposures.
I-CBT teaches people how to trust their direct experience, common sense, and lived reality rather than OCD's hypothetical stories and doubts.
As individuals learn to identify and step out of OCD's reasoning process, they can respond to uncertainty with greater confidence and live more fully according to their values and faith.
Treatment advantages for Latter-day Saints
➔ Comparatively small, centralized group with relatively homogenous religious beliefs
➔ Largely lay church leadership eliminates need for consultation with ecclesiastical leaders during treatment with Latter-day Saint therapists
➔ Tend to have higher than average levels of family and community support
➔ Typically very strong parental involvement for adolescents and young adults (critical factor for treatment success in pediatric anxiety and OCD)
Treatment considerations
Most people with scrupulosity are very worried before they seek treatment, particularly ERP, that they will be told that they need to something that will violate their personal ethics, Church teachings, or even require them to leave the church
As a result, many will only pursue treatment with a therapist who is active in the church and willing to disclose their status to clients