OCD. . .Can biblical counselors help people who suffer from obsessive-compulsive disorder? Find out as you read this article by Lucy Ann Moll, D.Min. candidate. Her article appeared first here at The Biblical Counseling Coalition and is used by permission.
Glenna[i] twists a Kleenex in her hands and looks out the window of the counseling office. The Crayola-blue sky belies the storm within her. “I have these awful images,” she whispers. “I see children and they’re being hurt.” Her voice breaks off. “What kind of person am I? If I have these disgusting thoughts, then I, I must like them, right? There’s something terribly wrong with me.”
A Christ follower in her early-30s, Glenna shows telltale signs of Obsessive- Compulsive Disorder (OCD). In a few words, OCD is an anxiety problem characterized by recurrent, intrusive thoughts (termed obsessions) and repetitive behaviors (called compulsions). OCD is a label used among psychotherapists; no equivalent term appears in Scripture.
First, let’s look at a secular understanding of OCD. Then we’ll look at a biblical view and approach. You’ll also hear a bit about brain research showing a physiological component of OCD.
The Secular Take on OCD
The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes the behaviors associated with OCD and lists it as a common disorder affecting one in 50 people worldwide. It also describes four major types of obsessions: contaminations, aggressive impulses, sexual content, and the need for symmetry.
In response to an obsession, a person with OCD typically feels compelled to ease their anxiety through performing a compulsion. Common compulsions include:
- Excessive cleaning and/or hand washing.
- Arranging and ordering items in a particular, precise way.
- Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off.
- Counting and/or making sure numbers end on a “good” digit.
Like obsessions, compulsions are unwanted — and they are exhausting. But to not perform them is even worse. “Their anxiety goes off the chart,” says biblical counselor Elyse Fitzpatrick.[ii]
Psychologists typically prescribe an SSRI to help OCD sufferers. However, 30 percent of those treated don’t improve.[iii]And among those who do respond, when the pills stop, the symptoms return. This is why doctors often recommend Cognitive Behavioral Therapy (CBT).
Physiological Component of OCD
OCD has a strong physiological basis. Among the scientific evidence are twin and family studies that show people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. But the most important physical component is the brain itself. By using Positron Emission Tomography (PET), researchers have discovered intriguing differences between the brains of people with OCD and other people. Says leading researcher Dr. Jeffery Schwartz, “The problem is a faulty brain circuit in OCD sufferers.”
Also, it appears that the physiological problem may be a malfunction in a brain structure called the caudate nucleus. This structure is like a processing center for complicated messages generated by the front part of the brain. The caudate nucleus and the putamen, which lies next to it, take in messages and function in unison, smoothing transition from one behavior to another. Typically, a person makes many rapid shifts of thoughts and behavior, smoothly and easily, and usually without thinking about them.
But in OCD, the problem may be that the smooth shifting of thoughts and behavior are disrupted by a glitch in the caudate nucleus. This may cause the frontal lobe to become overactive.
Think of a car stuck in a ditch. The wheels spin and spin but the car goes nowhere without traction. With OCD, too much energy is being used in a frontal part of the brain called the cerebral cortex. It seems that due to malfunction in the caudate nucleus and other brain structures, OCD sufferers might be flooded with, and act on, thoughts and impulses that enter their mind.
A Biblical Approach to Helping OCD Sufferers
To help OCD sufferers, biblical counselors John and Janie Street, authors of The Biblical Counseling Guide for Women, developed a biblical method based on Schwartz’ four steps described in his book Brain Lock. His research shows before-and-after PET scans of actual change in the brain. Streets’ method focuses on biblical renewal of one’s thoughts. Below are two of the foundational verses they utilize:
“Do not be conformed to the pattern of this world but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect” (Rom. 12:2).
“…put off your old self, which belongs to your former manner of life and is corrupt through deceitful desires, and to be renewed in the spirit of your minds, and to put on the new self, created after the likeness of God in true righteousness and holiness” (Eph. 4:22-24).
The 4 Steps
The Streets suggest these four steps for OCD sufferers:
- Repent: Identify and confess all obsessive thoughts that control you because they sinfully presume your ability to live by rigid rules of thoughts and behaviors, supposedly filling you with peace and joy (Rom 14:17, 1 John 1:9-10).
- Re-label: These recurring thoughts and behaviors are anxious and fearful. They are the source of your sinful fear. Choose to fear God only (Psa. 34:9, Prov. 1:7, 2 Cor. 5:9).
- Replace: Substitute anxious thoughts with thinking that fully trusts a good and loving God. You may also choose to hold and look at a happy photo, adding both visual and tactile senses to thinking (Psa. 18:2, 2 Cor. 4:5, 1 Tim. 6:15).
- Re-focus: Devote yourself to loving God and loving others. Do not remain self-focused (Matt 22:36-40, James 2:8, 1 John 4:18).
As Glenna applied these four steps to her own obsessive thoughts, she experienced improvement almost immediately. The thoughts reduced in frequency and intensity. However, when under stress, she sometimes failed to repent, re-label, replace, and refocus. The hope is, as she perseveres, her brain might change just as the ones in Schwartz’ PET scans changed. In the past few decades, brain science is finally recognizing what the Bible has said for millennia. That is, the renewing of one’s thoughts can create real, measurable, and observable changes in the brain.
OCD is a horrible lot. This is true. Ever since the Fall (Gen. 3), our brains have been compromised. And the good news is God can restore the fallen brain in people like Glenna, who now has hope.
Questions for Reflection
What approach have you taken with counselees who have obsessions and compulsions? What was the outcome? How are you becoming more knowledgeable about brain science that supports the truths of the Bible?
[i] Glenna’s name and some details have been changed.
[iii] Janet Singer, “ERP Therapy: A Good Choice for Treating Obsession-Compulsive Disorder,” MentalHealth.Net. https://www.mentalhelp.net/blogs/erp-therapy-a-good-choice-for-treating-obsessive-compulsive-disorder-ocd/