Ever worry about every little religious thing?
Like, whether you’ve committed the unforgivable sin?
Or whether you’re really a Christian because you said XYZ?
Or did something so small, yet it eats at you so deeply that it’s made you question whether God could ever love you again?
We feel alone, spinning our spiritual wheels on an endless cycle of, “How could God love me if I did this or that…” and we go from there and don’t stop until we realize, well, that we don’t stop.
Those are common fears for Christians with clinical anxiety and OCD.
I recently had the chance to chat with licensed therapist and owner of Trailhead Counseling Services, Michael Schiferl, about this spiritually draining phenomenon, known as religious scrupulosity, and so much more.
Here’s a transcript of our conversation, which has been edited for brevity and clarity.
HEINZE: You specialize in treating men. Why is that?
SCHIFERL: I think men are underrepresented when it comes to people who seek mental health services. And just because they seek therapy less than women doesn’t mean they need it less than women.
I try to create a safe place for guys to feel comfortable, explore their life problems, and mental health symptoms.
As a guy, I have my own fair share of struggles. It’s good to normalize and destigmatize that and be a man who’s helping a man.
HEINZE: What’s a common fear among Christians you see? So, for example, what’s a fear that’s distinct to Christians from someone who doesn’t claim to be a Christian?
SCHIFERL: I specialize in treating anxiety, trauma, and obsessive-compulsive disorder (OCD).
There’s a certain type of OCD that’s called scrupulosity. Scrupulosity is OCD that’s focused on religious or moral obsessions.
For a lot of Christians, it’s constantly doubting their faith, wondering if they’re actually saved, questioning if they actually believe in God.
Some people have blasphemous thoughts or intrusive images that they can’t control. For people who genuinely love Christ and are trying to live for him, it’s very distressing for them to have these uncontrollable worries or anxieties that are focused on their faith.
HEINZE: And yet here’s something I hear a lot from people with scrupulosity.
They worry that these feelings of distress aren’t an anxiety issue, but instead the Holy Spirit trying to convict them of this problem.
SCHIFERL: I get that response a lot.
There are three things I ask people to do that helps distinguish the Spirit from scrupulosity.
First, look at the fruit of those thoughts. Are these thoughts bringing you closer to God? Are they helping you to live righteously? Are they helping you to live life to the fullest, like Jesus promised?
Or are they making you resentful of him? Are they making you depressed, anxious, and preventing you from being a good witness for God because you’re so distracted by them?
So that’s the first thing – look at the fruits.
Second, seek wise counsel.
It can be really helpful to have people in your life who are able to speak against these fears and to see the good fruit in your life that would suggest salvation.
Third, use common sense.
That’s not meant to sound rude. But I’ve heard of people who felt like the Holy Spirit was telling them to jump on the intercom at a grocery store and start saying the Lord’s prayer.
Now, true, God asks us to do crazy things and live radically for him sometimes, but in most of those moments where you feel convicted to do something crazy and worry that if you don’t, it means you’re a terrible Christian – that’s probably not the Holy Spirit, that’s probably your brain telling you to do something like that.
HEINZE: Do you think the origin of this scrupulosity is a clinical condition, and do you think it’s a nature or nurture or both thing?
SCHIFERL: I 100% think OCD is a brain condition.
We don’t know the exact parts of the brain that are responsible for OCD, but using fRMI (Functional MRI), we’ve been able to identify some of the parts that are more active in people with OCD than people without it.
One of those parts is called the orbitofrontal cortex.
It’s the part of your brain that creates thoughts. In someone with OCD, this part of the brain is more active. It’s creating more intense thoughts and a higher quantity of thoughts.
There’s another part of the brain called the anterior cingulate cortex, and I think of this as the brake that pumps when those thoughts are getting out of hand.
So if someone without OCD has a crazy thought, they’re just able to notice it, file it away, and not really even take thought of it.
But someone with OCD is producing more thoughts, more intense thoughts, and the brakes that would put a stop to those thoughts aren’t working well.
It’s this really difficult cycle of having these intense thoughts, you’re not able to stop them, and the more you notice them, the more intense they’re going to become.
As far as genetics, we do know that OCD can run in families. We can’t say it’s nature or nurture. I like to say it’s nature through nurture. That’s called epigenetics.
People may be predisposed to OCD, and then their environment might trigger their OCD.
HEINZE: Let’s say a Christian with OCD comes to you for help.
You present all those compelling facts in a way that helps them intellectually understand the condition.
But a lot of people with OCD, including myself, can intellectually understand grasp all that, but emotionally, it’s hard for it to sink in.
How do you help it sink in?
SCHIFERL: Yes, knowing what’s causing it doesn’t make it go away.
The gold standard for treating OCD is a cognitive behavioral therapy called Exposure and Response Prevention Therapy (ERP).
We take a list of exposures that are focused on a person’s obsessions, and these exposures gradually get more and more difficult.
In the case of scrupulosity, these exposures would be based on faith and morality.
We intentionally expose the person to the source of their fear and then help them not engage in compulsions that would alleviate their anxiety.
Now that kind of sounds like we’re being cruel and trying to torture them, but if a person is able to sit in their anxiety, if they’re able to sit in that emotional discomfort, then eventually it’s going to build, peak, then crash.
They’re going to start to feel less anxiety. That’s a process called habituation.
What they’re doing is 1) extinguishing the trigger from creating an obsession in their mind and 2) they’re learning that even if they’re feeling anxious, they can handle it and it’s not the end of the world.
Let me get you give you an example that is specific to scrupulosity.
Obviously, with scrupulosity, it can get tricky because, as Christians, I’m never going to ask you to do something that’s actually immoral or ask you to sin on purpose.
But what this might look like is this.
Let’s say you have scrupulosity and you’ve been texting your pastor every week, asking them for assurance of your salvation, whether or not you’re actually saved, asking if they see fruit in your life – I’d ask the person to go a week without sending that text.
Throughout the week, you’re going to feel more and more anxious, but eventually you’re going to notice that you’re not as anxious and that you can handle the anxiety.
We may also read Scripture together in a session. Maybe we’ll read the verse about the unforgivable sin. If you have scrupulosity, you might immediately pray, “God, please protect me from the unforgivable sin. Please make sure I haven’t done it.”
I’d ask them to sit there without saying that prayer and notice the anxiety build, peak, and then it’s going to eventually get better.
ERP is so cool because you can see people change in the moment, you can see that real-time relief when they’re starting to realize that they don’t have to engage in compulsions to make the anxiety go away.
I will say, too, that medication is helpful for some people struggling with OCD.
A typical SSRI can be really helpful. I know some men are hesitant to take that. But for some people with OCD, that can calm down that rumination to give you the ability to even be able engage in exposure therapy.
HEINZE: There was a controversial study, published last year, claiming that SSRI antidepressants were ineffective in treating depression compared to placebos.
A lot of Christians and anti-pharma folks jumped onto that and said it’s proof that medicine is a secular solution to what’s a spiritual problem.
So now there are a lot of Christians who are even more skeptical of taking medication.
SCHIFERL: Yes, I’ve heard people on Christian podcasts and even other Christian therapists say that the study proves depression is not a mental health disorder.
First, there’s an important point of clarity regarding what this study did and didn’t say.
This was an umbrella review, studying data from hundreds of different studies, and it was studying to see if low serotonin levels caused depression. They say their findings suggested that it doesn’t.
Some people have taken that and said that SSRIs or antidepressants don’t treat depression.
The way we [originally] thought SSRIs worked was by increasing the serotonin in your brain, and so the [authors’] logic was that if low serotonin doesn’t cause depression, then increasing serotonin won’t solve it.
But that’s not actually what the study was saying.
All it was saying was that low serotonin doesn’t cause depression.
The study didn’t address whether SSRI’s are effective.
There has been a lot of research on whether SSRIs treat depression, and based on the research I’ve done, the answer is “yes.”
We don’t know 100% why SSRIs work.
There are a lot of different theories.
Some people think they block some negative impacts of stress on the brain, some people think it works with different chemicals other than serotonin. There’s a chemical called BDNF which actually creates and supports brain cells. So they think that might help depression.
They think SSRI’s might reduce inflammation, which could help with depression.
Another important distinction to make is that SSRI’s aren’t meant to treat the root of depression.
Scientists and therapists know that it doesn’t treat the actual causes of depression, but SSRI’s treat the symptoms so you can find relief to actually treat the root.
It’s a little bit like how cold medicine doesn’t kill a virus in you. It treats your runny nose, your fever, your chills. It helps you feel better.
I should add that research shows that antidepressants don’t work with mild cases of depression. To me, that differentiates between someone with clinical depression and someone who’s going through normal life stress.
If you’re just going through a rough day at work, an antidepressant isn’t going to do anything for you.
But if you’re somebody with crippling depression who can’t get out of bed, who can’t remember the last time you felt joy, that’s when antidepressants are going to work.
HEINZE: Some Christians without anxiety bash other Christians over the head with Jesus’ famous saying to not worry about tomorrow, as well as Paul’s words to be “anxious for nothing.”
Then Christians with anxiety say, “Oh no, it’s a sin to be anxious, it’s a sin to worry.”
So they worry about their worry! It almost makes it worse for someone who’s a Christian than for someone who doesn’t claim to be a Christian because now they’re worried they’re sinning when they’re worried.
What’s your take on those two passages?
SCHIFERL: There’s a big difference between intentionally sitting in worry and the clinical anxiety that is a brain disorder
We know there are a lot of different causes for anxiety.
Someone who’s been through a lot of trauma is probably going to have more anxiety than the average person. Or you could have a hard time calming your nervous system. Or you could have OCD.
It’s normally those people who worry that their worry is wrong.
I have to reassure them that this is not the type of worry that Jesus was talking about.
He was saying, “Hey, don’t doubt that I’m going to take care of you. Don’t worry that your basic needs aren’t going to be met because I’m with you.”
I don’t think he was saying that they’re sinning because they have a mental health disorder that makes it very difficult, if not impossible, to control their worry.
HEINZE: What if someone counters, “How do I really know Jesus was differentiating between just intentionally sitting in worry and clinical worry?”
SCHIFERL: I don’t think Jesus would tell someone, “Hey, don’t have cancer.”
I think it’s similar to a mental health disorder. I don’t think it’s a sin to have something that’s malfunctioning in your brain.
I think we forget that our brains, in a lot of ways, control a lot of our emotions. Our brain is an organ like every other part of our body and because we live in a sinful, fallen world, that organ is going to malfunction sometimes and that’s only natural.
HEINZE: I’ve written an article on the worry thing, and it seems clear that Jesus is saying, “You don’t have to worry about tomorrow because I’ve got it under control.”
It’s an expression of care, not a moral imperative.
It’s the way we tell a friend at a restaurant, “Don’t worry about the check. I’ve got dinner covered.”
So it’s more about the care of the Father than a command.
I want to ask another question.
A lot of Christians are leery of psychology because of its roots in scientists who were fairly anti-religious.
What would you say to someone who would like to look for help, but are leery of looking into therapy if the source is secular?
Thus, they’ll only talking to a Christian therapist, if they’ll even talk to one at all.
SCHIFERL: If I woke up in the middle of the night and my heart was racing and my chest hurt and I thought I was having a heart attack, I would get to the nearest ER as fast as I could, and I wouldn’t care if it was a Christian or atheist.
I would ask the doctor to save my life.
And I think it’s the same for mental health disorders.
Sure, it’s nice to have someone who shares the same worldview, but if you’re struggling with a clinical mental health disorder, a therapist is going to be able to give you tools and skills to be able to help manage that — whether they’re a Christian or not.
I’ll also say, scientifically, there’s so much research that shows a lot of mental health disorders have biological causes.
For example, we don’t know the exact cause of schizophrenia, but we’ve been able to tell through MRI’s that changes in brain structure are associated with schizophrenia.
We also know that an overreactive nervous system is associated with a lot of the symptoms of PTSD.
So we’re able to tell that a lot of these symptoms are biological in origin which makes secular therapy a valid option.
HEINZE: There’s a great book on this by Dr. Matthew Stanford called Grace for the Afflicted, where he goes through the scientific basis of these mental health issues.
And, actually, there are more Christian therapists at this moment than there have ever been.
There’s more openness among Christians who talk with each other.
But if you hear pastors preach about depression or anxiety, I rarely hear them urge their congregants to look into medical advice if they’re experiencing symptoms.
They always just bring spirituality into it, and I don’t see many churches offering resources.
Why does church leadership seem so disconnected from all of this?
SCHIFERL: I think a lot of therapy is still misunderstood.
I think when you say the word “therapy” to someone, it conjures up images of someone like Freud who is sitting behind you on the couch, smoking a pipe, asking you inappropriate questions about your mother.
That’s not what therapy is.
Secular therapy is a lot about coping skills, looking at your family of origin, teaching you how your brain works, helping you process hard things you’ve been through.
HEINZE: I only know what pastors say publicly. But what attitude do Christians coming to you have about therapy? Are they leery?
SCHIFERL: I think my experience has been mixed.
I have a pastor who mentors me who’s very supportive about what I do. He’s very open to therapy, and even shares stories with me of times he’s referred people to therapists for help and medication.
But there are still pastors out there who have a hard time, and I think a lot of that is a misunderstanding of what therapy actually is.
I also encourage people to think of humans in three parts, a tripartite view.
If you look in Scripture, there are three different words to describe people – their spirit, soul and body.
There are different Greek words that all have different meanings.
When I think about mental health disorders, I think something can go wrong on all three of these levels.
Someone can have an issue with their body, which is causing their anxiety.
Someone can have an issue with their soul, which is their personality or emotions that can create depression.
And then there’s times when something is going on in someone’s spirit that might need more religious counseling or counseling with a pastor.
But a lot of times pastors ignore the soul or body of a person, which a therapist can help with.
HEINZE: Finally, what’s your favorite book on mental health?
SCHIFERL: I love The Body Keeps The Score.
I think it’s one of the most accessible books that talks about the impact of trauma. I think trauma is the thing that starts a lot of mental health disorders, and it’s so important for people to be aware of how they hold trauma in their body.
So that’s what I recommend to almost anyone.
There’s also a book I recently read called The Boy Who Was Raised as a Dog.
Each chapter is a story of the psychiatrists working with different patients and treating their trauma through different methods. It’s cool to see and hear stories of people who actually get better.
HEINZE: Okay, so for someone who’s reading this, at this very moment – someone really discouraged because nothing has helped them, so far – what message would you have for them?
SCHIFERL: I want them to hear as much compassion to this question in my voice as they could, but I would ask – “What’s your only option other than to keep trying? “
Your only other option is to give up.
And if you’re still trying, that’s better than giving up.
I’d also remind them that Christ is not unfamiliar with your suffering.
He experienced every emotion, every difficulty that humans do.
And if, at the end of the day, the only thing you can hang your hat on is that Christ is still with you in this, that is enough to wake up again tomorrow.
HEINZE: Thank you so much!
About Michael: Michael Schiferl is a licensed clinical marriage and family therapist and the owner of Trailhead Counseling Services in Overland Park, KS.
Michael specializes in working with men struggling with trauma, anxiety, and OCD, offering a mix of evidence-based treatments and Biblical truths.
He maintains an active blog, which you can access here. In his spare time, Michael enjoys rock climbing, playing pickleball, and spending time with his family.
