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Using PsychoEducation with Moral Scrupulosity and OCD: Breaking Free from the Chains of Doubt

Living with moral scrupulosity and obsessive-compulsive disorder (OCD) can be an overwhelming experience. The constant need to prove one’s value to a higher power can be mentally and emotionally exhausting. However, with the right knowledge and therapeutic interventions, it is possible to break free from the chains of doubt and find peace within oneself. In this article, we will explore the concept of moral scrupulosity and OCD, and discuss one of the fundamental interventions that can help individuals regain control over their lives: psychoeducation.

“The goal in treating Religious OCD is not in taking away the religion. It’s to give it back.”

Dr. Jed Siev

Understanding Moral Scrupulosity and OCD:

Moral scrupulosity is a subtype of OCD characterized by an intense preoccupation with morality, religious or spiritual beliefs, and a constant fear of committing moral transgressions. Individuals with moral scrupulosity often feel an overwhelming responsibility to demonstrate their worthiness to a higher power. This can lead to the development of intrusive thoughts, doubts, and the need to engage in compulsive behaviors or rituals to alleviate the anxiety associated with these thoughts.

According to studies, moral obsessions, which include excessive guilt, fear of committing immoral acts, and an overemphasis on religious or moral rules, are present in approximately 25% to 50% of individuals with OCD. However, it is important to note that not all individuals with moral obsessions meet the diagnostic criteria for moral scrupulosity.

It’s worth mentioning that OCD as a whole affects about 2% to 3% of the general population, making it a prevalent mental health condition. While specific data on moral scrupulosity may be limited, these numbers indicate that a significant number of individuals with OCD experience moral obsessions and may benefit from targeted treatment approaches.

The Power of Psychoeducation:

Psychoeducation plays a crucial role in the treatment of moral scrupulosity and OCD. It involves providing individuals with information and understanding about their condition, which can be empowering and liberating. By gaining knowledge about the nature of their thoughts and behaviors, individuals can begin to challenge the distorted beliefs that contribute to their suffering.

Breaking Down the Beliefs:

A key aspect of psychoeducation is helping individuals identify and challenge their distorted beliefs associated with moral scrupulosity. Together with a therapist, individuals can examine the evidence supporting their beliefs and explore alternative, more balanced perspectives. This process involves recognizing that OCD thoughts are not reflective of one’s true moral character, but rather a product of the disorder itself.

Here are a few common distorted beliefs seen in moral scrupulosity:

  1. Black-and-White Thinking: Moral scrupulosity often involves rigid thinking patterns, where individuals perceive actions and thoughts as either entirely good or completely evil, with no room for gray areas. This all-or-nothing mindset can lead to excessive guilt and anxiety. For example, a person may believe that any impure thought or minor transgression makes them inherently evil or unworthy.
  1. Exaggerated Responsibility: Those with moral scrupulosity tend to excessively assume responsibility for their thoughts, actions, and even the thoughts and actions of others. They may believe that they are solely accountable for preventing harm or ensuring perfection. For instance, someone might feel personally responsible for the moral choices of their loved ones, believing that their actions could lead to dire consequences.
  1. Hyperfocus on Intentions: Moral scrupulosity can involve an intense fixation on the purity of intentions behind actions. Individuals may believe that unless their intentions are entirely virtuous and selfless, their actions are morally flawed. This can lead to constant doubt and second-guessing of their motives. For example, a person might question whether their act of charity was driven by a genuine desire to help or if it was simply for personal recognition.
  1. Overemphasis on Rituals: Moral scrupulosity often involves a heightened focus on performing religious or moral rituals perfectly. Individuals may believe that the slightest deviation or omission from prescribed rituals can result in divine punishment or moral failure. For instance, someone may feel compelled to repeat prayers multiple times or perform rituals with excessive precision to ensure correctness.

By challenging these distorted beliefs and exploring alternative perspectives, individuals with moral scrupulosity can gradually develop a more balanced understanding of their thoughts and actions. They can begin to separate themselves from the grip of OCD and embrace a more compassionate and accepting relationship with themselves and their moral beliefs. Remember, this process takes time and patience, and professional guidance can provide invaluable support along the way.

Recognizing the Patterns:

Through psychoeducation, individuals can gain insight into the patterns of their thoughts and behaviors. They can learn to identify the triggers that lead to their obsessions and compulsions, as well as understand the temporary relief that comes from engaging in these behaviors. By recognizing these patterns, individuals can begin to disrupt the cycle and develop healthier coping strategies.

Recording or listing the patterns of thoughts and behaviors associated with moral scrupulosity can be a helpful practice in gaining awareness and identifying triggers. Here are some ways to record or list these patterns:

  1. Thought Journal: Keep a journal specifically dedicated to recording obsessive thoughts related to moral scrupulosity. Whenever a distressing thought arises, write it down along with any associated triggers, emotions, and the compulsive behaviors that follow.
  2. Behavior Log: Maintain a log to track the compulsive behaviors you engage in. Note the specific actions, the context or situation in which they occur, and any immediate relief or anxiety reduction experienced as a result.
  3. Trigger Diary: Create a diary to record triggers that prompt obsessive thoughts or anxiety related to moral scrupulosity. Note the circumstances, events, or situations that initiate distress and contribute to the onset of obsessions and compulsions.
  4. Digital Apps: Utilize mobile applications designed for tracking thoughts, emotions, and behaviors associated with OCD. These apps often include features for recording patterns, triggers, and monitoring progress over time. Examples include nOCD and MindShift.
  5. Checklists or Worksheets: Use checklists or worksheets specifically designed for tracking patterns in OCD and moral scrupulosity. These resources often provide prompts and categories to help individuals identify triggers, thoughts, emotions, and behaviors associated with their condition.
  6. Visual Representation: Some individuals find it helpful to create diagrams or visual representations of their thought patterns and behavioral cycles. This can be done through flowcharts, mind maps, or diagrams that connect triggers, thoughts, emotions, and compulsions.

Developing Coping Mechanisms:

Psychoeducation also involves equipping individuals with practical coping mechanisms to manage their moral scrupulosity and OCD symptoms. This may include learning relaxation techniques, mindfulness exercises, and strategies to challenge and reframe negative thoughts. Mindfulness techniques can help individuals observe their thoughts without judgment, cultivating a greater sense of acceptance and reducing the urge to engage in compulsions.

A relaxation technique that can be helpful for coping with moral OCD is Progressive Muscle Relaxation (PMR). PMR is a method that involves systematically tensing and relaxing different muscle groups in the body to induce a deep state of relaxation. By practicing PMR regularly, individuals can experience a sense of calm and reduce overall anxiety levels. Here’s a step-by-step guide to practicing PMR:

  1. Find a Quiet and Comfortable Space: Begin by finding a quiet and comfortable space where you can sit or lie down without distractions.
  2. Deep Breathing: Take a few deep breaths, inhaling slowly through your nose, holding the breath for a few seconds, and exhaling gently through your mouth. Focus on allowing the breath to fill your lungs fully and releasing any tension with each exhalation.
  3. Systematic Muscle Tensing: Start with your feet and work your way up through different muscle groups in your body. Tense each muscle group for 5 to 10 seconds and then release the tension. Focus your attention on the sensation of tension and relaxation in each muscle group. Here’s a suggested sequence: a. Start with your toes and feet: Curl your toes tightly and then relax.
    b. Move to your calves: Flex your calf muscles by pulling your toes towards your knees, then release the tension.
    c. Progress to your thighs: Tighten your thigh muscles by pressing your thighs together, then release.
    d. Proceed to your abdomen: Tighten your abdominal muscles by pulling your belly button towards your spine, then release.
    e. Move to your hands and forearms: Clench your fists and tense your forearms, then release the tension.
    f. Proceed to your upper arms and shoulders: Raise your shoulders towards your ears and tense your upper arm muscles, then release.
    g. Move to your facial muscles: Scrunch your face tightly, including your forehead, eyes, and jaw muscles, then release.
  4. Focus on Relaxation: After tensing and releasing each muscle group, focus on the sensation of relaxation and the contrast between tension and relaxation. Notice any sensations of warmth, heaviness, or comfort as you let go of tension.
  5. Repeat the Process: Repeat the process of tensing and relaxing each muscle group, gradually moving up through your body, until you have gone through all major muscle groups.
  6. Full Body Relaxation: Once you have completed the muscle groups, take a few moments to enjoy the overall relaxation in your entire body. Allow yourself to fully experience the deep state of relaxation.
  7. Practice Regularly: To experience the full benefits of PMR, make it a regular practice. Set aside dedicated time each day to practice PMR, especially during times of heightened anxiety or distress.

Building a Support System:

In addition to providing information, psychoeducation emphasizes the importance of building a support system. Connecting with others who understand the challenges of moral scrupulosity and OCD can provide validation, encouragement, and a sense of community. Support groups or therapy sessions can be invaluable resources, offering a safe space to share experiences, gain insights, and receive support.

Here are some ways to establish and nurture those connections:

  1. Seek Professional Help: Reach out to mental health professionals who specialize in OCD or anxiety disorders. They can provide guidance, therapy, and support tailored to your specific needs.
  2. Join Support Groups: Look for local or online support groups specifically focused on OCD or moral scrupulosity. These groups provide a safe space to share experiences, gain insights, and receive support from others who understand your struggles.
  3. Involve Loved Ones: Share your experiences with trusted family members or friends. Let them know about your condition and how it impacts your life. Their understanding and support can be invaluable in your journey towards recovery.
  4. Engage in Online Communities: Connect with online communities or forums dedicated to OCD or moral scrupulosity. Platforms such as Reddit, OCDforums.org, or the IOCDF website provide spaces to connect with others facing similar challenges, ask questions, and receive support.
  5. Explore Religious Communities: Engage with religious communities or organizations that promote understanding and support for individuals dealing with moral concerns. Seek out spiritual leaders or mentors who can offer guidance and a compassionate perspective on your struggles.
  6. Utilize Helplines and Hotlines: Many mental health organizations and helplines offer confidential support and guidance. Consider reaching out to helplines dedicated to OCD or general mental health support in your country or region.
  7. Attend Workshops and Events: Look for workshops, conferences, or events focused on OCD or mental health. These gatherings provide opportunities to learn from experts, hear personal stories, and connect with others on a similar journey.
  8. Online Therapy: Explore the option of online therapy platforms that connect you with licensed therapists through video sessions. This allows you to receive support from the comfort of your own home.

Remember, establishing and nurturing support systems may require time and effort, but the benefits of connecting with others who understand your experiences and can provide support and encouragement are invaluable. Reach out, seek connections, and don’t hesitate to lean on your support system when you need it.

Books on OCD and Moral Scrupulosity:

Here are some popular books that address moral OCD or OCD in general, which can provide valuable insights and support for individuals dealing with moral scrupulosity:

  1. “The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts” by Lee Baer, Ph.D.
  • This book delves into the nature of intrusive thoughts, including moral obsessions, and provides practical strategies for managing and overcoming them.
  1. “Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty” by Jonathan Grayson, Ph.D.
  • Dr. Grayson, a renowned expert on OCD, offers a comprehensive guide to understanding and treating OCD, including moral scrupulosity, through Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP).
  1. “Overcoming Obsessive Thoughts: How to Gain Control of Your OCD” by David A. Clark and Christine Purdon
  • This book provides evidence-based strategies and practical exercises for managing obsessive thoughts and breaking free from OCD patterns, including moral obsessions.
  1. “The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder” by Bruce M. Hyman, Ph.D., and Cherry Pedrick, R.N.
  • A widely recognized resource, this workbook offers step-by-step guidance, including specific chapters on moral scrupulosity, to help individuals understand OCD, challenge distorted beliefs, and implement effective coping techniques.
  1. “Brain Lock: Free Yourself from Obsessive-Compulsive Behavior” by Jeffrey M. Schwartz, M.D.
  • Dr. Schwartz presents his Four-Step Self-Treatment Method to help individuals with OCD rewire their brains, regain control, and reduce the impact of intrusive thoughts and compulsive behaviors.

It’s important to note that while these books provide valuable information and strategies, they are not a substitute for professional help. For a comprehensive understanding of moral scrupulosity and personalized guidance, it is recommended to consult with a mental health professional specializing in OCD or anxiety disorders.

Online Resources:

Here are some online sites and resources that provide information and support specifically focused on moral OCD (moral scrupulosity) and OCD in general:

  1. International OCD Foundation (IOCDF) – The official website of the IOCDF offers extensive information on OCD, including moral scrupulosity. It provides educational resources, articles, personal stories, support forums, and a directory to find specialized therapists: https://iocdf.org/
  2. OCD Action – OCD Action is a UK-based charity that provides information, support, and advocacy for individuals affected by OCD, including moral scrupulosity. Their website offers resources, a helpline, online support groups, and a forum: https://www.ocdaction.org.uk/
  3. OCD-UK – OCD-UK is another UK-based charity dedicated to supporting individuals with OCD. Their website provides information, resources, personal stories, and a forum to connect with others: https://www.ocduk.org/
  4. Reddit OCD Community – The subreddit r/OCD offers an online community where individuals can connect, share experiences, ask questions, and provide support to one another: https://www.reddit.com/r/OCD/
  5. NOCD – NOCD is an online platform that specializes in OCD treatment, including moral scrupulosity. They offer teletherapy services, self-help tools, and a community forum: https://www.treatmyocd.com/
  6. IntrusiveThoughts.org – Intrusive Thoughts is a website that provides information, resources, and support for individuals dealing with intrusive thoughts, including moral scrupulosity. It includes articles, personal stories, and a community forum: https://www.intrusivethoughts.org/
  7. Beyond OCD – Beyond OCD is a nonprofit organization that offers education, resources, and support for individuals with OCD. Their website provides information, self-help tools, articles, and personal stories: https://beyondocd.org/

Remember, while these online sites can be valuable sources of information and support, they should not replace professional help. If you’re struggling with moral OCD or any mental health condition, it’s essential to consult with a qualified mental health professional for proper diagnosis, guidance, and treatment.

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How To Be A Worry Warrior And A Fear Fighter!

Do you spend a lot of time worrying about “what if” instead of enjoying the moment of “what is” right now? This is what happens when we worry about being hurt by other people if we get too close to them. It is also what happens when we fear something dangerous might occur, in the future, to us or someone we care about.

The emotional result of living in the “what if’s” is often anxiety and panic. I have worked with individuals who worry that they will have a car accident, choke on food, be publicly humiliated, or that someone will enter their house and hurt them or their family members. The list of possible “what if’s” could go on and on…

This worry prevents people from enjoying life in the moment. They are unable to go to parties or attend weddings and they avoid certain foods and even check doors repeatedly every night before going to sleep (if they are able to go to sleep). Their fear robs them of self-confidence and security.  In order to cope, they  avoid any potentially uncomfortable,  painful situation.

Often these “what if’s” situations come into our lives because of traumatic events in the past. Maybe we did get sick from expired milk and threw up in the cafeteria in front of all our friends. Perhaps we did have a tragic car accident that resulted in a terrible loss! Perhaps we have had our home invaded or someone assault us. While there may be many realities to our anxieties, we don’t have to let them continue to control our lives.

We can become worry warriors and fear fighters!

The secret to making this change is to understand the true nature of emotions. Anxiety is an emotion as is anger or excitement or happiness. All emotions are “energy in motion” or e-motions.

The word “motion”, in Latin, means “to move” as in “it’s time to move out” on a trip or journey. It also means “to excite” or take action.

Additionally, e-motions are temporary. They come without warning and they will leave just as quickly, if we let them. They will stay longer if we complicate their “movement” by holding on to them with our beliefs about ourselves and the world. If our experiences are negative and our beliefs follow with more negativity, then our e-motions stop their normal movement and become frozen in our psyches.

Typical negative beliefs that can result in anxiety include:

I am a failure.

I have to be perfect.

I should have done something.

I am not good enough.

I am not safe.

I am stupid.

I am bad.

I am not lovable.

I can’t bear the pain of _____.

I am not in control.

I am weak.

I am fake.

I am ugly.

It is my fault.

There may be more but that is enough to make you feel anxious! Imagine what it must be like to live with those negative beliefs all the time. Underneath all of those negative beliefs is the idea that they cannot change and we are destined to suffer under them forever. That is not true. You can fight back!

I’ll be honest. The fight can be hard but the prize (YOU) is worth it. This the only way to deal with anxiety. You can’t continue to avoid it and hope it goes away and you can fight it directly.

That’s right, you are NOT fighting anxiety head on. You are fighting your beliefs about anxiety and how you view yourself/your world. That is what keeps it frozen and stops it natural movement away from us. Another problem with fighting anxiety is that people try to measure success based on whether they FEEL anxious or not instead of whether they are able to LIVE productively or not. You will always feel anxious from time to time. It is a natural e-motion that wants to move on. Focusing on living life is a much better measuring stick.

Use these positive thoughts instead:

I deserve to be happy.

I am great just as I am.

I am in control now.

I can do the best I can.

I am good.

I am smart.

I am beautiful inside and out.

I can make mistakes.

I am lovable.

I am strong.

It is not my fault.

I can succeed.

I am safe now.

Just like any good fighter, you have to take care of yourself. Regular exercise, good nutrition, relaxation and rest are important strategies to winning the worry war.

To help you visualize yourself as a worry warrior or a fear fighter, imagine wearing the following pieces of armor as you go into the battle:

Helmet of happy thoughts.

Breastplate of perfect love (that protects against fear).

Shield of self-confidence.

Boots (to stay grounded and moved you through the fight).

Sword of truth (that breaks irrational lies).

Chainmail of support (from family and friends).

Make up your own ideas with the following image as you become a worry warrior and a fear fighter:

knight-coloring-page

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What Is Sensory Processing Disorder? How To Diagnose Children With Sensory Issues

Sensory Issues

Written by Beth Arky.

This story is part of Speak Up for Kids, an annual public education program held during National Children’s Mental Health Awareness Week (May 6-12, 2012).

It usually happens in the preschool years. You notice that your toddler seems to have an unusual aversion to noise or light. A teacher observes that, compared to other kids her age, your daughter is clumsy and has difficulty with fine motor skills like wielding a pencil. You’ve noticed that she is very, very picky about shoes, which are often deemed too tight, and clothes that are “too scratchy.”

More baffling – and alarming – to parents are their children’s meltdowns over things like their faces getting splashed or being dressed. Or a child might crash into walls (and people), touch everything or put inedible items, including rocks and paint, into his mouth.

These behaviors are all signs of problems with what’s known as sensory processing, found in children who have difficulty integrating information from their senses. In its extreme form, when it interferes seriously with a child’s functioning, it’s called Sensory Processing Disorder, or SPD, although it’s not recognized by the psychiatrists’ bible, the Diagnostic and Statistical Manual.

Sensory issues are associated with autism because they are common in children and adults on the autism spectrum, though most children with SPD are not on the spectrum. They can also be found in those with ADHD, OCD and other developmental delays – or with no other diagnosis at all. In fact, a 2009 study suggests that one in every six children has sensory issues that impede their daily functioning, socialization and learning.

What parents often notice first is odd behavior and wild, inexplicable mood swings. For instance, a first-grader may do fine in a quiet setting with a calm adult. But place that child in a grocery store filled with an overload of visual and auditory stimulation and you might have the makings of an extreme meltdown.

“These kids’ tantrums are so intense, so prolonged, so impossible to stop once they’ve started, you just can’t ignore it,” notes Nancy Peske, whose son Cole, now 13, was diagnosed at 3 with SPD and developmental delays. Peske is coauthor with occupational therapist Lindsey Biel, who worked with Cole, of “Raising a Sensory Smart Child.”

Another response to being overwhelmed is to flee. If a child dashes out across the playground or parking lot, oblivious to the danger, Peske says that’s a big red flag that he may be heading away from something upsetting, which may not be apparent to the rest of us, or toward an environment or sensation that will calm his system. This “fight-or-flight response is why someone with SPD will shut down, escape the situation quickly, or become aggressive when in sensory overload,” she says. “They’re actually having a neurological ‘panic’ response to everyday sensations the rest of us take for granted.”

Children, teens and adults with SPD experience either over-sensitivity (hypersensitivity) or under-sensitivity (hyposensitivity) to an impairing or overwhelming degree. The theory behind SPD is based on the work of occupational therapist Dr. A. Jean Ayres. In the 1970s, Dr. Ayres introduced the idea that certain people’s brains can’t do what most people take for granted: process all the information coming in through seven – not the traditional five – senses to provide a clear picture of what’s happening both internally and externally.

Along with touch, hearing, taste, smell and sight, Dr. Ayres added the “internal” senses of body awareness (proprioceptive) and movement (vestibular). When the brain can’t synthesize all this information coming in simultaneously, “It’s like a traffic jam in your head,” Peske says, “with conflicting signals quickly coming from all directions, so that you don’t know how to make sense of it all.”

What are these two “extra” senses in Dr. Ayres’ work?

Proprioceptive receptors are located in the joints and ligaments, allowing for motor control and posture. The proprioceptive system tells the brain where the body is in relation to other objects and how to move. Those who are hyposensitive crave input; they love jumping, bumping and crashing activities, as well as deep pressure such as that provided by tight bear hugs. If they’re hypersensitive, they have difficulty understanding where their body is in relation to other objects and may bump into things and appear clumsy; because they have trouble sensing the amount of force they’re applying, they may rip the paper when erasing, pinch too hard or slam objects down.

The vestibular receptors, located in the inner ear; tell the brain where the body is in space by providing the information related to movement and head position. These are key elements of balance and coordination, among other things. Those with hyposensitivity are in constant motion; crave fast, spinning and/or intense movement; and love being tossed in the air and jumping on furniture and trampolines. Those who are hypersensitive may be fearful of activities that require good balance, including climbing on playground equipment, riding a bike, or balancing on one foot, especially with eyes closed. They, too, may appear clumsy.

To help parents determine if their child’s behavior indicates possible SPD, Peske and Biel have created a detailed sensory checklist that covers responses to all types of input, from walking barefoot to smelling objects that aren’t food, as well as questions involving fine and gross motor function, such as using scissors (fine) and catching a ball (gross). The SPD Foundation also offers a litany of “red flags.” The list for infants and toddlers includes a resistance to cuddling, to the point of arching away when held, which may be attributed to feeling actual pain when being touched. By preschool, over-stimulated children’s anxiety may lead to frequent or long temper tantrums. Grade-schoolers who are hyposensitive may display “negative behaviors” including what looks like hyperactivity, when in fact they’re seeking input.

Peske sums up the way sensory issues can affect kids this way: “If you’re a child who is oversensitive to certain sensations, you are not only likely to be anxious or irritable, even angry or fearful, you’re likely to be called ‘picky’ and ‘oversensitive.’ If you rush away because you’re anxious or you’re over-stimulated and not using your executive function well because your body has such a powerful need to get away, you’re ‘impulsive.’ If you have trouble with planning and executing your movements due to poor body awareness and poor organization in the motor areas of the brain, you’re ‘clumsy.’ Because you’re distracted by your sensory issues and trying to make sense of it all, you may be developmentally delayed in some ways, making you a bit ‘immature’ or young for your age.”

Amid this confusion, there may be relief for more than a few parents in recognizing what may be causing otherwise inexplicable behavior – and in the potential for kids to get help in the form of specialized occupational therapy and what are called sensory gyms.

“When I describe sensory issues to parents whose kids have it,” Peske says, “the usual reaction is ‘Oh, my gosh, that’s it!’ They’ve been trying to put a finger on ‘it’ for many months, even years! The sense of relief that they finally know what ‘it’ is is humongous.”

Child Mind Institute’s Speak Up for Kids is an annual public education program held during National Children’s Mental Health Awareness Week (May 6-12, 2012) aimed at ending the stigma, lack of awareness, and misinformation that cause children to miss out on treatment that can change their lives.

Read more articles about children’s mental health here.

via huffingtonpost.com