“Worship is not merely about form”: Religiously integrated cognitive behavioral therapy in a case of scrupulosity

Abstract

Treating clients with scrupulosity (religious obsessive–compulsive disorder) requires clinicians to be prepared for various forms of resistance and ambivalence. These individuals may experience hesitation not only during therapy but also when initially seeking help. In particular, concerns about not being fully understood, being misinterpreted, or unintentionally misrepresenting their faith may contribute to hesitation in seeking professional support, especially among individuals with strong religious sensitivity. This case study presents the therapy process and outcomes of a client with scrupulosity, using a cognitive-behavioral therapy (CBT) approach integrated with religious interventions. In previous attempts to receive treatment, the client had avoided fully disclosing his symptoms due to feeling inadequately understood, perceiving that his concerns were normalized without sufficient exploration, and experiencing discomfort due to concerns about misrepresenting his religiosity. The client was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales before treatment, after treatment, and at follow-up stages. The results showed significant improvement: his obsessive–compulsive disorder symptoms remained below the clinical threshold at the 9-month follow-up, and his overall functioning increased considerably. To better understand which aspects of the treatment contributed to the observed outcomes, qualitative data were obtained from the client’s responses to an open-ended therapy evaluation form. These responses emphasized the importance of the therapist’s sensitivity to the client’s religious values and the effective use of religious references throughout the therapy process. The case illustrates how a therapeutic approach that respects the client’s faith-based concerns can foster trust, improve treatment engagement, and contribute to both clinical and spiritual well-being.