Treating Scrupulosity — Therapy, Faith, and Hope

Series Introduction: Faith, Doubt, and OCD — Scrupulosity Across Traditions

Article 1: - When Faith Meets Fear — Understanding Scrupulosity in OCD

Article 2: Judaism and Scrupulosity: When OCD Becomes Entangled with Faith

Article 3: Christianity and Scrupulosity — Fear of Sin and Salvation

Article 4: Islam and Scrupulosity — Purity, Prayer, and Identity

Article 5 in a 5 Part Series

Although scrupulosity takes different forms across religious traditions, effective treatments exist — and they do not require people to abandon their faith.

Gold-Standard Therapy

The primary, evidence-based treatment for scrupulosity—like other forms of obsessive-compulsive disorder (OCD)—is Exposure and Response Prevention (ERP), a specialized form of Cognitive-Behavioral Therapy (CBT).

CBT focuses on how thoughts, emotions, and behaviors influence one another. ERP applies these principles in a targeted way, helping individuals gradually face feared thoughts or situations while resisting the urge to perform compulsions.

Over time, this process reduces anxiety and weakens OCD’s hold on daily life.

Other supports may also play an important role in treatment. Medication — particularly selective serotonin reuptake inhibitors (SSRIs) — can help reduce symptom intensity and make it easier to engage in therapy. Involving family members or trusted supports can also be beneficial, helping reduce reassurance and other patterns that may unintentionally reinforce OCD.

Although the content of fears may differ, treatment targets the same underlying cycle across all forms of OCD.

“With religion in particular, we’re going to pick things that are really values-based that you want to be doing but OCD is preventing you from doing,” said Rev. Dr. Katie O’Dunne, an interfaith chaplain and OCD specialist. In practice, this might mean leaving a Bible open in a place that feels “contaminated,” resisting the urge to repeat a prayer until it feels perfect, or allowing intrusive thoughts to be present without trying to cancel them out. In some Christian contexts — including Catholic settings where confession and moral certainty can carry particular weight — treatment may also involve learning to live with doubts about whether one confessed correctly or committed a sin, without repeatedly seeking reassurance.

Similar principles apply across faith traditions. In Muslim contexts, therapy might involve performing wudu once and tolerating uncertainty about whether it was done “properly,” rather than repeating the ritual. In Jewish settings, someone might practice saying a blessing once without checking or repeating it, or sit with doubts about whether a religious obligation was fulfilled perfectly. Research on religious OCD shows that exposure-based approaches can help people reduce compulsive behaviors while continuing to participate in meaningful spiritual practices.

Many clinicians also incorporate acceptance-based approaches such as Acceptance and Commitment Therapy (ACT). Rather than trying to eliminate intrusive thoughts, ACT helps individuals notice those thoughts without becoming controlled by them — and to keep acting in line with their values. For people with scrupulosity, this may mean continuing to pray, attend services, or observe rituals even while feeling uncertain or uncomfortable.

Importantly, treatment is not about weakening faith. It is about helping people reconnect with religious practice as a source of meaning and connection rather than fear. As Rabbi and psychotherapist Noah Tile emphasizes, this process often begins with clarity—distinguishing what is OCD from what is not, and returning to one’s underlying beliefs rather than those shaped by anxiety. He encourages individuals to ask, “Do I want to live like this?”—shifting the focus from fear to values. Even in the face of uncertainty, the goal is not to prove or disprove every possibility, but to choose how to live in alignment with one’s values. At its core, this approach shifts the focus from achieving certainty to learning how to live meaningfully in the presence of uncertainty.

Courage, Faith, and Community

For Tile, OCD treatment mirrors Jewish theology: faith is “the courage to live with uncertainty.” For O’Dunne, it also means protecting what matters most: “Never let OCD take something away from you that’s meaningful.”

Imam Aslam, Muslim Chaplain at Rutgers University, highlights the importance of support networks in recovery. “...asking questions can strengthen faith, [it] doesn't necessarily decrease from it,” he said. He added that a key element of healing is recognizing that religious communities are not there to judge those who are struggling, but to help. Alex’s experience reflects many of these themes. As Alex became more religiously observant in high school, he began to notice his OCD showing up more within his religious practices. Over time, he has found support through a network that includes a therapist, rabbi, and family members.

“Ever since my initial onset, it's sort of been something I've dealt with on and off for my entire life,” said Alex. “And it just pops up in different places. And I've got good therapy, and I've got great resources and strategies, but it's not something that you're ever cured from per se.”

His experience underscores a reality many people with OCD describe: recovery is often less about eliminating doubt entirely and more about learning how to live with it while continuing to engage in meaningful aspects of life, including faith and community.

Alex also found that speaking openly about his OCD helped reduce some of the fear surrounding how others might respond. While disclosure requires judgment and trust, he said that conversations often went better than he initially imagined.

Evidence and Outcomes

Research supports the experiences described by clinicians and patients alike. Studies show that ERP is effective for many individuals with scrupulosity, leading to significant reductions in compulsive rituals and intrusive fears. Evidence also suggests that collaboration between clinicians and clergy can improve treatment outcomes. When religious leaders understand OCD, they are better able to support recovery without unintentionally reinforcing compulsions.

Some research and clinical experience further suggest that a meaningful religious identity — when not driven by fear — can serve as a protective factor, offering purpose, structure, and community support that may strengthen recovery.

Living With Uncertainty

Recovery from scrupulosity is not about eliminating faith or doubt. It is about learning that uncertainty can coexist with devotion, and that spiritual life does not require perfection. Healing is not about losing one’s religion, but about reclaiming religious life from the grip of OCD — and finding the freedom to practice faith with greater trust, flexibility, and meaning. Across traditions, the goal is not to eliminate doubt entirely, but to learn that doubt does not have to define one’s relationship to faith. What emerges is not a loss of faith, but the possibility of practicing it with greater freedom, flexibility, and trust.

Looking Ahead

In this five-part series, the articles that follow look more closely at how scrupulosity appears in specific religious contexts and how faith communities can support healing alongside clinical care.

Interviews Conducted by Abby Shapiro

Scrupulosity Blog Series - The following sources informed the content of the Scrupulosity Blog and provide additional context on OCD, scrupulosity, and evidence-based treatment approaches. See HERE. Key Terms Appendix - HERE.

Coming soon: A clear, practical guide to understanding OCD — and what helps.