Lesson 6 of 6 · When it is an illness
What the treatment is, and why it is not in this course
For this presentation the treatment with the best evidence is exposure and response prevention. In plain words, it means working out with a trained person how to change what you do when the thought arrives, in steps you agree together, so that the loop stops being fed.
It is the standard treatment for obsessive compulsive disorder, and the trial evidence for that is strong. For religious content specifically the picture is thinner and worth stating honestly: clinicians use the same approach adapted to religious material, and there are published accounts of how, but the trials are of the treatment in general rather than of this content in particular. Good clinicians do this alongside a scholar where the person wants that, so that what is genuinely required in the religion is never mistaken for a symptom and nothing gets treated that should have been left alone.
If you expect a religious authority to object to any of this, it is worth knowing that a conservative fatwa institution has published a long piece of its own treating this as an illness that arrives without a person's choosing, telling the sufferer to seek treatment, and naming cognitive behavioural therapy among the treatments. Reported here, not ruled on.
We are not going to walk you through it, and you should not assemble it from an article. Done alone it commonly goes wrong, in one of two directions. People avoid inside their own exercise without noticing, so nothing changes and they conclude they are beyond help. Or they overshoot into distress they cannot manage and stop everything.
Naming a treatment raises the chance somebody gets it. Instructing it from a website does not.
What the research says
Two decades of randomised trials establish facing the fear without performing the ritual, and the therapy built on it, as effective for this condition across a large trial base. This is among the better evidenced treatments in mental health.
Pools two decades of randomised trials and establishes exposure and response prevention, and cognitive behavioural therapy built on it, as effective for obsessive compulsive disorder across a large trial base.
Ost LG, Havnen A, Hansen B, Kvale G (2015). Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993 to 2014. Clinical Psychology Review, 40, 156 to 169 doi
The honest counterweight: presentations built on unacceptable thoughts, which is where religious content sits, responded somewhat less well than washing or checking. It still worked, and it worked less well, and you should know both halves.
The counterweight, printed rather than left out. Presentations built on unacceptable thoughts, which is where religious content sits, responded somewhat less well than washing or checking presentations. It still worked. It worked less tidily.
Abramowitz JS, Franklin ME, Schwartz SA, Furr JM (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71(6), 1049 to 1057 doi
Clinicians adapt this approach to religious content by working with your religious authority rather than around them. This is clinical guidance and case material rather than a trial, which is why the paragraph above claims less than a trial would let it.
Sets out how clinicians adapt the approach to religious content, including working with the person's religious authority rather than around them. This is clinical guidance and case material, not a trial, which is why the paragraph above says so.
Huppert JD, Siev J (2010). Treating scrupulosity in religious individuals using cognitive-behavioral therapy. Cognitive and Behavioral Practice, 17(4), 382 to 392 doi
A widely read religious reference site carries a clinical section opening with the statement that this is a known psychological illness which afflicts a person without will or choice, like other bodily and mental illnesses. Reported because you may already have read it.
Reported, not endorsed. Not a fatwa but a long piece with a clinical section, which opens by calling obsessive compulsive disorder a known psychological illness that afflicts a person without will or choice, like other bodily and psychological illnesses, a trial the servant is rewarded for bearing. It says the sufferer must seek treatment for his illness, that medicine was made for the benefit of the sick and not their harm, and it names cognitive behavioural therapy among the treatments.
IslamQA. al-Waswas al-qahri, research 12. IslamQA, Arabic, islamqa.info/ar/researches/12