Debra Theobald McClendon: Scrupulosity—Obsessive-Compulsive Anxiety You May Mistake as Faith Crisis

Morgan Jones 0:00
Scrupulosity. It's a word I had never heard until last fall when I heard it described in a podcast by two people who had suffered from it. The podcast spoke to my soul. I felt that scrupulosity was something that I had maybe struggled with, and I also felt it had impacted the lives of people I love and care about. It is my hope that the information you're about to hear in the following conversation will help you or someone you love in the same way that it has helped me.
In the September 2019, digital-only version of the Ensign, Dr. Debra Theobald McClendon opened her article with the following questions: "Do you constantly obsess about Living the Gospel the "right way"? Do you feel an urgency to repent for the same mistake or sin over and over again because you doubt whether you have repented, "properly"? Do you feel perpetually guilty? If so, you might be struggling with a form of obsessive-compulsive disorder known as scrupulosity.
Dr. Debra Theobald McClendon is a licensed psychologist in the state of Utah. She is a clinical psychologist with training in marriage and family therapy. She focuses her practice on helping those with religious OCD, or scrupulosity. Dr. McClendon has published articles on anxiety and obsessive-compulsive disorder/scrupulosity in the Ensign. She has co-authored book chapters and articles on outcome assessment and group therapy in the academic community. She and her husband, Richard J. McClendon, have published the book Commitment to the Covenant: Strengthening the Me, We and Thee of Marriage. Dr. McClendon has previously taught as an adjunct faculty member at both Brigham Young University and Utah Valley University.
This is All In, an LDS Living podcast where we ask the question, "what does it really mean to be all in the gospel of Jesus Christ?" I'm Morgan Jones, and I am so thrilled to have Dr. Debra Theobald McClendon with me today. Debra, welcome.

Dr. Debra McClendon 2:23
Thank you so much, Morgan, for having me. I really appreciate it. And I'm excited to share what I can with your listeners today.

Morgan Jones  2:29
Well, I am thrilled because this is something that I have tried in the last few months to read up on. It's a subject we mentioned in an interview just a few weeks ago with John Hilton, and we got several comments back from people saying how much they appreciated our mentioning it, because they felt like raising awareness about this topic is so important for people. People don't realize that this is a thing. So very first and foremost, I realized I've been saying this word one way, and John Hilton said it a different way. So how do you say it, is it scrup-u-losity, or scrup-a-losity?

Dr. Debra McClendon 3:09
Scrup-u-losity.

Morgan Jones 3:11
Okay, perfect. Well, now that we've got that out of the way. Now that we know how to say it, let's talk about what it is about. Debra, tell us a little bit how you would explain to someone what scrupulosity is and how it affects people.

Dr. Debra McClendon  3:26
Scrupulosity is a form of obsessive-compulsive disorder. This is OCD. And people get very surprised when we talk about that. Researchers at BYU, including Dr. Judd, they did a study that John Hilton mentioned in his interview with you on grace, legalism, and mental health. There is a spectrum of scrupulous types of beliefs and attitudes, and not everyone who has a scrupulous thought or belief—and I'll identify that in a minute—not everybody who has one of those has OCD. But when we today are talking about scrupulosity, we are talking about a full-blown obsessive-compulsive disorder. So what is obsessive-compulsive disorder? It's a disorder that centers around thought control and toxic, very high, and poorly-regulated anxiety. So because anxiety is so high, when someone has a thought that they perceive for some reason is threatening in some way, that thought is so unacceptable that they do whatever they can to get rid of that thought. They end up attempting to ignore the thought, suppress it, or neutralize it, so they end up then, in order to do that, performing compulsions.
Most of us, when we think about OCD, we think about hand washing, right? Someone with a germ concern. And hand-washing is a very visual compulsion. In scrupulosity, the compulsions are often very mental. You can do repetitive mental actions or behaviors, and those are compulsions. The compulsions are done to reduce the anxiety caused by the unwanted thought. Some of the OCD compulsions are things like washing and cleaning, or "checking" behaviors—you know, they have to check that they've locked the door or turned off the stove many, many times before they can leave the house, things like that. A mental compulsion is repeating things, or, such as in scrupulosity, it's trying to confess, either through repetitive prayers or physical confessions to ecclesiastical leaders.
So how does scrupulosity vary from OCD germ-phobia? How is it different? Scrupulosity is where a person judges a personal behavior as immoral that the rest of their faith community would see as blameless—that's a quote from one author. So they will often be very concerned about a thought or behavior they've done, and then if you went and asked 1000 members of the Church of Jesus Christ of Latter-day Saints what they thought about this, they'd be like, "Oh, that's not an issue, it's no big deal," but this person judges it as immoral, and they are relentlessly plagued with pathological, toxic guilt. They have fears of offending God; fears of blasphemy; fears of doing immoral acts; fears of having actually immoral thoughts, even not doing the acts, but just the thoughts; fear of sinning. And it just overwhelms them with so much anxiety that they get into this OCD type of pattern.
We, as members of the Church of Jesus Christ of Latter-day Saints, are taught that the gospel is good news, and that religious rituals—such as attending church, participating in the community, attending the temple, partaking of the sacrament—these are things that are done to maintain religious tradition, to experience peace in the face of our trials, and to get social support from our community members. But in OCD/scrupulosity, it transforms someone's typical religious experience, and these kind of rituals become compulsive rituals that completely destroy their ability to gain any peace or contentment or even joy from the Gospel. It destroys faith, and it is so horribly painful for people that they just get into this hopelessness that often is hard to come out of if they don't seek professional help. I had one client who, on his mission, feared that he'd become a son of perdition because he was having some doubts about God. I had a client say that he felt like he was possessed by the devil. I had another client say that, through therapy, she had come to realize that she was worshipping the wrong God—that was her quote—because in her mind, He was a "scary dictator with a checklist" type of God. So, scrupulosity destroys any positive feeling, or much of the positive feeling people may have about their religious worship or their belief in God, and it wraps it up into this horrible anxiety that is just devastating.

Morgan Jones  8:34
This is so fascinating to me because we had Spencer Hyde on this podcast—and I don't know if you're familiar with Spencer, but he suffered from severe OCD—and with him, it was like these rituals of washing your hands, and so here we're talking about the ritual being confession, or something like that. So within our faith, I'm assuming, Dr. McClendon, that this manifests itself as often confessing to a bishop or priesthood leader, is that right?

Dr. Debra McClendon  9:12
Absolutely. That's one of the main confessions that I see. The content of OCD when you have a germ-phobia or checking issues, it's pretty clear to the individual that their fears are kind of irrational, or they don't make sense, but they're just stuck and they don't know how to get out of them. Scrupulosity really is a little bit of a different beast, because it gets confused. These anxiety symptoms get confused with promptings of the Spirit. So people think that they are listening to the Spirit, such as a prompting, or a thought that "Oh, I need to go confess this thing." They think it's the Spirit, when actually they've gotten in into a vicious cycle of anxiety.

Dr. Debra McClendon 10:03
It may be helpful for your readers to know that I have an article in the Ensign April 2019, and it is called "Discerning Your Feelings: Anxiety or the Spirit." This was really a precursor to the later article in the September 2019 Ensign on understanding scrupulosity. In this article, there's a really well-done chart—it's very colorful and very artistically well done—on the characteristics and feelings of anxiety compared to that of the Spirit. So for example, the Spirit, even if you might be guilty of a real sin that needs confession, the Spirit may give you a feeling of dissonance. You may know, "Okay, this is wrong. I need to take care of this." But you'll still feel calm. You may feel an urge to act, but you're going to have a sense of purpose and thoughtfulness about that, whereas anxiety gives you a sense of fear, panic, a huge one is a sense of crisis to the anxiety—everything is urgent. Someone feels like, "I have to repent right now, I gotta go see the bishop right now." Or basically they feel like, "I've got to do this now or I'm going to hell." So that could be a very helpful article for some of your listeners, either those struggling with this, or their family members, to kind of look at the difference between anxiety and the Spirit. So with scrupulosity, those lines have gotten so blurred that they believe they are acting on promptings of the Spirit as they get into these compulsive cycles. The problem is, when you obey the anxiety, it only relieves the anxiety temporarily, and then the anxiety comes back worse because you're actually reinforcing the anxiety cycle. And we'll talk more about that with treatment.

Morgan Jones  12:00
Well, I have to tell you, it's been so interesting, Debra, as I've tried to read up. And most of what I've read or listened to has come from you as it relates to our church, specifically. But as I've tried to read up on this subject, I've realized that this is something that I think I likely struggled with when I was younger, and up until a couple years ago when I literally left the temple and immediately called my bishop thinking, "I need to confess something." And I went into the bishop and he basically just said, "This is not something that you should be here for."

Dr. Debra McClendon 12:38
Exactly.

Morgan Jones 12:39
And it was so helpful to me. I think sometimes the reaction is like, "Oh, you're just such a good person. So it's so good of you that you would think that you would need to come and confess that." And for the first time, somebody said to me, "You really shouldn't be here for this," rather than applauding that. So I think it'll be so interesting as we talk today to hear more about the right way to approach this. Do you have any initial thoughts on that, though?

Dr. Debra McClendon 13:12
Yes. Well, just as you're talking about confession, the Ensign article I wrote that's in the digital content section for September of 2019 on understanding scrupulosity has a discussion about whether you should be going to your bishop or a therapist, and how to discern the difference. One of the things I clarify there is simply a quote from the LDS Bible Dictionary. We are taught doctrinally that we're only required to confess to an ecclesiastical leader for certain issues. So here's what the Bible Dictionary says, if I can share this with you: "Confession to a church official, in most cases the bishop, is necessary whenever one's transgression is of a nature for which the Church might impose loss of membership or other disciplinary action. The bishop cannot and does not forgive sin, but he may judge the matter and waive the penalty that the Church might otherwise impose against the person. The repentant sinner must still make confession and obtain forgiveness of the Lord."
That is such a critical piece that so many of my clients and so many people struggling with scrupulosity have lost. The bishop becomes an authority figure that gives them a false sense of security—"If I go to this authority and they tell me I'm okay, then my anxiety will go away." The problem is, it doesn't work that way. In fact, I have a story from an individual—his scrupulous concerns revolved around whether he'd broken the law. He went to the legal authorities at the police station and confessed, and he still struggled even though they said "you're fine." So then he went to his bishop and confessed and the bishop's like, "you're fine." And he says "I felt better for like a minute." So then he went to a stake president, and the stake president goes through, step-by-step, every reason logically why he's fine. Still, after all of those authority figures, he ended up in a suicidal crisis. It becomes very enticing to say, "If I go to this authority figure, they're going to tell me I'm okay." Because they're tricked by the anxiety, thinking it's a spiritual prompting. If it is a spiritual prompting, and you go through the things you need to repent, including a confession to an ecclesiastical leader if necessary, you will feel better. If it is driven by toxic anxiety, you will not feel better, because it's an anxiety issue. It's not a moral issue or a spiritual sensitivity issue. So that's a really important point that I'm glad you've asked me to talk about.

Morgan Jones  16:04
Yeah. I think one thing, too, in my experience, it's like sometimes there is a temporary feeling of feeling better, but then that comes right back, and like you said earlier, it comes back stronger.

Dr. Debra McClendon  16:18
Exactly. And as it comes back stronger, Morgan, it's important to note, because you've reinforced the anxiety, you will have not only those stronger, increased symptoms of anxiety, you're going to have more worry, and then you're going to lose confidence in your ability to cope with your own life. So OCD shuts people down because they've lost the confidence that they can cope. Treatment reverses that process by doing things to expose ourselves to those anxieties and, paradoxically, it actually increases our sense of empowerment. It increases our sense of confidence. That's a really important point. So when we talk about what kind of treatments are most effective, the answer is exposure therapy. I don't know if you're familiar with that, but I'd like to talk about that just for a second if that would be okay.

Morgan Jones  17:17
Please.

Dr. Debra McClendon  17:19
A lot of therapy today goes through cognitive work, where you look at identifying thought patterns that you have and finding where you have some thinking errors or some distortions, and you basically clean up your thoughts. You pull out the things that are distorted, and you're then able to look at the situation from a more reality-based perspective. I do some of that work with my clients with OCD, but the first and foremost treatment is exposure therapy. And literally, what does exposure mean? If you're out in the sun and you have too much exposure, you've gotten too much sun. Exposure therapy is when we take the very thing you fear the most and we give you—on purpose—experiences with that thing that you fear. The natural instinct is to avoid. It's to escape. It's to run away. So with scrupulosity, how do you escape, avoid, or run away? You go kneel down and repent for three hours to Heavenly Father, you go to your bishop every week for six months, you're trying to get away from the anxiety as much as you can. Instead, we bring the anxiety closer, we look at the fear, and we actually will repeat the fear again and again and again for 45 minutes, an hour, an hour and a half. Then we will do that on repeated experiences.
What we are basically doing is, we are giving your brain the opportunity to make sense of all this—that's in layman's terms. Another word you can use as habituate. We are habituating your mind. And if you hear in that word the word "habit," habituation means that it's becoming a habit for you to have that thought, and then it stops triggering anxiety as you do that. A thought such as, "I've offended God," may cause someone to be exceedingly anxious, but as they repeatedly expose themselves to that, "I may have offended God, I may have offended God," their brain it able to wrap around it and go, "Okay, I may have offended God, all right, I get it." And it just doesn't provoke or trigger the kind of anxiety that it was before so that they can now move on. Our brains are designed to think thoughts. That's what they do. It's estimated that we have 50,000 to 70,000 thoughts a day, and what happens in OCD, anxiety attacks the very thing you value the most. So if you think about having a thought on the freeway such as, "there's a blue truck," or, "that's a tacky billboard," or, "that's a noisy diesel truck"—you have the thought, and the moment you've had the thought, you've already let it go and you're on to something else. Because your brain knows, and you know, it's just not important.
But if all of a sudden you have a thought, as a highly religious person, that says, "I've offended God, I'm going to go to hell." All of a sudden, that thought feels more threatening. So instead of just letting it go, you start trying to wrap around that thought, things to insulate you, protect you, and bring the anxiety down from that thought. It's too threatening to say, "I may have offended God, because as a religious person, I love God, I want to please God, I value very much His influence in my life and His church in my life," right? So it becomes very threatening to have a miscellaneous thought that you may have offended God. Because we have 50,000 to 70,000 thoughts a day, we have a lot of thoughts that we particularly don't care for. They may be unpleasant or intrusive or unwanted, but they're naturally occurring. In OCD, we misinterpret the threat associated with these naturally-occurring, religious, intrusive thoughts. That's an important point.
Everybody has thoughts of doubt, or thoughts of committing a sin, like, "Oh, I could be snippy or rude to this person," or, "I could do this." These are naturally occurring, but the misinterpretation of threat causes the increase in distress, and then it creates these frantic futile efforts to remove the intrusion and reduce the obsessional distress and, paradoxically, it increases the frequency of the thoughts. Exposure therapy is hard, obviously, to face the thing you fear the most. It's probably best, especially with a severe case of scrupulosity, to try to do this with a mental health professional who can guide you through this, but this is the therapy that is most shown to be effective for OCD.
Now with scrupulosity, there's one other piece to the treatment, in addition to cognitive work and exposure, that I often do and other therapists have reported doing as well. We just talked about confession, right? We clarified the role of a bishop in confession, that not every thought we have, even a sinful thought, needs to be confessed to a bishop. Something I also do with my LDS clients at times is doctrinal clarification. That actually can be very helpful. Now most of my clients with scrupulosity, because they love God so much and they care so much about being good sons and daughters of God, if I asked them to give a Sacrament meeting talk, or a talk or even in a stake conference on any of these related issues, such as forgiveness or repentance or whatever, they could give me a perfect doctrinal talk. So doctrinal clarification can be helpful if someone is misinterpreting a doctrine, but just reading conference talks, listening to conference talks will not be enough if you're just clarifying doctrine, because, if you remember, the OCD, the central issue, is not a doctrinal misunderstanding—it's an anxiety issue. So these people know the doctrine about forgiveness, they know the doctrine about Atonement, they know the doctrine of repentance, and yet the anxiety is so painful. It still trips them up, and they get tricked.

Morgan Jones  23:41
I think that this is so interesting because I feel like I've observed this in myself and people that I know, so as I was preparing for this interview, I had a thought to ask a couple of people that I know have struggled with this, and they were kind enough to help me prepare a few questions. My hope is that, by sharing their questions, we're actually being more helpful to those who are grappling with scrupulosity. Here's the first one: "One of the most difficult aspects about scrupulosity is that we have all sinned and come short of the glory of God. Often, when one obsesses about a struggle, mistake, slip-up, it, in reality, is a sin that requires repentance. How can one go about correcting these sins while, at the same time, not giving in to obsessions, but striving to follow Christ?"

Dr. Debra McClendon  24:41
This speaks to what we talked about earlier, about understanding the difference between anxiety and the Spirit. It can be very tricky at times, because the content of what the anxiety is saying to you is of a religious nature. If you're getting a thought that says, "you need to go repent of this issue," it can be very tricky trying to figure out: is that the Spirit? Because the Spirit's job is to warn me when I've done something wrong. And the Spirit gives us guilt because it's a trigger to let me know I've done something wrong. So if I'm feeling guilty, and I'm feeling that I have this thought that I should repent and I'm feeling anxious, then it's tricky about getting it mixed up, thinking that it's the Spirit versus the anxiety. So again, the Spirit does not work through anxiety, even if you are guilty, even of a malignant, pretty serious sin. You will know you need to take care of it. You will maybe think about it repeatedly, because you know you need to take care of it, and you need to confess and repent, but you won't be wrapped up in anxiety over it. So that is the critical piece: OCD is an anxiety disorder. Guilt for true sin, you won't be wrapped up in anxiety. You might be a little bit nervous if you have to go confess to a bishop, and maybe you're embarrassed about that. But anxiety will not be driving the thoughts about confession.

Morgan Jones  26:18
That's super helpful. The next question, and this kind of ties into what you were just saying, that guilt is kind of a trigger for scrupulosity. "Are there other triggers, and does it tend to manifest itself in certain environments or conditions?"

Dr. Debra McClendon 26:34
Yeah, let's talk a little bit about what the research shows. Interestingly, age is mildly associated with scrupulosity, and it will make a little bit of sense to you when you think about it. This study looked at college students, and they found that scrupulosity was seen more often in the younger college students than the older college students. I think, as you get life experience, you are naturally getting exposure through the course of daily life. It might not be the targeted type of exposure that we do in therapy, but you're still being exposed throughout life. So someone with less life experience, you could understand, may struggle with this a little bit more. Interestingly, there's no significant gender differences found. You're not really going to see a difference between men and women here.
They have found in the research that individuals with scrupulosity who had a more negative concept of God tended to have more severe symptoms. So I find that one interesting because I've seen throughout my career that we often attribute to God characteristics that we've seen in our own parents. That kind of makes sense, if we're taught that God is our Heavenly Father, then how we experience our earthly father is going to influence how we view our Heavenly Father, right? If we have a negative view of our earthly parents, I could see that it would be easier to have a more negative view of God. And people with that negative view of God tend to have more severe symptoms.
Interestingly, being religious is not a trigger. Religious identity does not influence the overall severity of OCD, but it might inform the manifestation. So what it means is, the research has found that if you are religious, you are not more prone to get OCD/scrupulosity. However, if you have OCD, and you are a religious person, you're more likely to have it manifest in religious ways. We talked about that earlier and it kind of makes sense. If your religious belief is important to you, and then you have, in the course of daily living, an intrusive, negative thought about God that feels threatening to you, then you start trying that thought control process, and your brain structures kind of get locked up in that obsessive pattern. Being religious is not going to increase the likelihood of you getting scrupulosity.
The themes of scrupulosity are different based on different religions. For example, devout Christians, you're going to see themes such as displeasing God, going to hell, or devil worship. In my LDS clients, I see a lot of the displeasing God or doubting God fears, the fear of not being exalted, the confession compulsions, fears of immoral thoughts, or fears of being perfectly honest. Whereas a scrupulous person who's an ultra-Orthodox Jew, they more closely follow OCD behaviors like contamination and washing, because there is more ritual religion. Scrupulous themes in Muslims are often similar to those in Judaism, and they look at issues of purity, dietary laws, prayers, and other behaviors and such. With different religious traditions, you will see scrupulosity manifest in different ways.
But really, the main trigger is if you have propensity to have this OCD thought control issue, which is tied up in the structures of the brain, you will then struggle to control those thoughts. They see problems in the orbital cortex, in the thalamus, in the caudate nucleus. If you don't know what those terms are, that's okay. I'm not a neuropsychologist. I have to look them up every single time. But what it means is, this is not just a miscellaneous thing where you have a thought and it's like, "Oh, well, I should feel shame that I'm not controlling this thought and I'm having this thought." Your thoughts work according to the structures of your brain.
One author, in a book called "Brain Lock" by Dr. Jeffrey Schwartz, looks at OCD, and he uses the metaphor of a gate in the thalamus. A gate swings open, and a thought goes through. And the normal process is then for the gate to close, right? We talked about how we have 50,000 to 70,000 thoughts, and the moment we have a thought, it's kind of gone and we're on to the next one. Well, in OCD, that thought gate doesn't close. It stays open, so the thought keeps re-cycling through that gate again and again and again, and the person can't control it on their own. They don't know how. And that's why treatment is so critical because you have to basically train your brain structures to operate in a different way.

Morgan Jones  31:44
Okay, next question that came from a friend of mine says, "We have learned that godly sorrow is an important part of repentance. The scriptures and church leaders have recently taught that true godly sorrow is not of the world, but invites a change of heart and true repentance. However, certain church teachings and seminary videos have suggested that this can be a painful step and sometimes requires the passage of time. How would you counsel someone who is dealing with both scrupulosity and concern that they are properly implementing a healthy degree of godly sorrow in their life?"

Dr. Debra McClendon 32:23
The quick answer to that is that godly sorrow, true repentance, is not driven by anxiety. That's the bottom line. We are into anxiety disorder territory when we are looking at scrupulosity. So here's a quote from an individual that recovered from scrupulosity, and she said this: "I've come to feel the difference between the Spirit gently whispering to me when I have actually sinned and when a correction is needed, versus the relentless anxiety that led me to obsess about every tiny mistake and to try to be absolutely perfect in every detail. I've learned how to repent in a productive and cleansing way when I sin, instead of the compulsive, repetitive, futile "repentance" I was driven to in the past."
I just think that's a beautiful illustration to explain that. If we are feeling guilty because of true sin, if we are going through a repentance process, even that being led through an ecclesiastical leader, where maybe they're saying some time will need to pass, you can absolutely work through those thoughts, and even ponder repeatedly and think a lot about that repentance and that issue. You're not in "scrupulosity land" until it's this frantic sense of drive, because you're so anxious.

Morgan Jones  33:55
Interesting. Very, very interesting. I'm learning so much, so thank you, Debra.

Dr. Debra McClendon  34:01
You're welcome.

Morgan Jones 34:02
Another question that I got was, "How can we recognize scrupulosity in friends and loved ones? How can we encourage them to consider, while being sympathetic to their concerns, that it may not be the Spirit shaming them, but that they may actually be experiencing a clinical condition?" This is something that you mentioned in your initial email to me when I reached out to you. You said, "If I can help anyone realize that what they struggle with may be OCD that requires professional psychotherapeutic treatment rather than just more scripture study, prayer, confession, etc, then I feel my time is well spent." So how do we recognize this in other people or in ourselves, and how do we help people when we do recognize it, and how might we suggest that they seek professional help if that's something that we think that might benefit them?

Dr. Debra McClendon 35:01
I really appreciated what you said about your meeting with your bishop where he said, "You don't need to be here for this." Now, an initial time talking to someone, either with a bishop or with a friend, you might not pick up that their concern is driven by anxiety, and you might just have a regular conversation based on what comes up at that time. But for example, if they come back to you again, and you're kind of talking about the same issue, and you're like, "Huh, I'm a little curious about that. It sounds like you're kind of anxious." You start noticing what's driving this, and is it anxiety? Now this question asks about the Spirit shaming them. The Spirit will nudge us and, as we mentioned earlier, it will even cause feelings of dissonance if we're guilty of something, but the Spirit does not shame us.
The Spirit uplifts us and encourages us to have steady improvement—as Jeffrey R. Holland said in his talk, "Be Ye Therefore Perfect—Eventually" in October of 2017—and the Spirit encourages us to that. If they're feeling shame, if they're feeling anxiety, that's a clue to you as an ecclesiastical leader, as a family member, or as a friend, that they may be struggling with an anxiety disorder. Here's another statement from an individual. They said, "I didn't have the judgment at the time to know what was really happening. All I knew is I felt horrible and couldn't feel better. I didn't know what to do, and I was totally stuck. "Repenting" wasn't working." So if you're a bishop, and someone's coming to you repeatedly—"repenting is not working"—that's a clue that this is probably OCD, and it would be wonderful to suggest to the person that they look into that. And as a friend, that same type of thing.

Morgan Jones  36:55
It's important that we mention, I've had people reach out to me and they'll share experiences. Like I said, I think my initial reaction is always like, "Wow, you're such a good person that you feel like this was a bad thing or whatever, that you feel the need to confess whatever this thing is," and I wonder if that, even as a friend or a family member, is the wrong approach.

Dr. Debra McClendon 37:35
I would agree that it is. And yet, someone with scrupulosity draws that out of the friends, out of the family members, out of the ecclesiastical leaders because they are seeking for reassurance. OCD treatment, as we do the cognitive work and exposure work, it's about learning to come to tolerate a certain level of uncertainty. Well, maybe I did sin. And yeah, I understand the Atonement of Christ, and that He will cleanse me. But OCD wants a guarantee and wants to know that you've done everything perfectly. So one of the common compulsions that we did not mention is reassurance-seeking. For family members, for friends, for ecclesiastical leaders, we don't want to offer reassurance. So you might end up doing that the first time as you have a discussion, but if you've had, time and time again, these discussions, it's time to say, "I'm not going to answer that question, that sounds like an OCD question, or that sounds like a statement coming from scrupulosity. That would be good to seek out treatment for scrupulosity. It's not going to be helpful to you if I answer this question or give you reassurance."

Morgan Jones  38:48
Do you have any thoughts about whether, when it feels like maybe it's too late for people, is there like a timeframe in which you can help people see that it's scrupulosity? I just worry that sometimes people believe that they're having a faith crisis, when really what they're struggling with is scrupulosity.

Dr. Debra McClendon 39:11
Right. One of the things I discussed with clients quite a bit when they're looking at life-changing types of decisions—for example, when I work with parents, and they're concerned that their adult children have left the church, and that's very difficult for them—we discuss a lot the developmental approach to eternity. We are on a journey. All of us are at different places in the journey. But one decision in someone's life—such as at age 20, or 30, or whatever—that's not the end of their journey. They have the rest of their mortal life and the rest of eternity to continue to grow. It's never too late to come to realize what's happening and to try to make changes. If they can come to see that, by leaving the Church, they have actually not resolved their anxiety problems, they may be able to turn things around. However, that becomes tricky because, when they leave, they're not experiencing the high anxiety because they've separated themselves from the thing that is provoking that. The problem is, that's an escape or avoidance behavior, or a safety behavior, which will only bring the anxiety down temporarily, and then it will resurface.
The research has actually shown that religion is positively associated between religious commitment and overall well being. There are negative associations between religious commitment and psychopathology. What does that mean? If you're religiously committed, you are less likely to have mental health issues. Individuals using positive religious coping techniques report improved health and mental health outcomes, so by taking themselves away from the Church, they've actually abandoned a resource that can offer help and support to them to get through the crisis. As you said, they need to seek treatment in order to gain the full benefits of that church activity, so allowing them to recognize the nature of their anxiety is really the first step. And then to separate that and say, you know, this is not necessarily connected to the content of these religious doctrines or teachings.

Morgan Jones  41:35
Yeah. Debra, another question that came to me via a friend says, "As a church, how can we teach repentance in a way that doesn't encourage scrupulous thinking?" What are your thoughts on that?

Dr. Debra McClendon 41:54
We need to resist the urge to turn beautiful gospel principles into checklists. Elder Bednar just gave, on February 7, 2020, a training to seminary and institute teachers. It's called "An Evening with a General Authority," you can look it up online and watch the entire training. Throughout the meeting, they go back to this idea of avoiding checklists and formulas. We need to make the gospel principle based that we are always living in the Spirit, we're always accessing personal revelation—and he talks through how to do that very beautifully in there—and he says, "We've got to not turn things into checklists and formulas." Because someone with OCD is going to go through and they are going to make sure they have checked off every little thing on that checklist, and then they're going to wonder why they still feel so horrible.

Morgan Jones  42:58
Yeah. Well, and I think there's such danger anytime the gospel is viewed as a checklist, scrupulous thinking or not, because always, agency is going to factor into things and there's little guarantee based on a checklist. So I just think it's important for us to live the gospel for the principle and for the doctrine associated with it, rather than with a checklist, and then an expected result.

Dr. Debra McClendon 43:30
Exactly.

Morgan Jones 43:31
Debra, I have one last question before we get to our very last question for you. I just wondered, as you've worked with people who suffer from scrupulosity, how has it affected or strengthened your knowledge of the Atonement of Jesus Christ? What have you learned about the Atonement of Jesus Christ as you've worked with these patients and clients?

Dr. Debra McClendon 43:59
It's really reinforced to me that the Atonement of Jesus Christ is large enough to cover all of the yuckiness of life. These people struggle to feel like this concern that they have is so severe that they are condemned, or they're going to lose the exaltation. And the Atonement of Jesus Christ is large enough to cover everything, including OCD/scrupulosity. God knows that they are having this struggle. God knows the nature of scrupulosity, He knows that it's a mental illness, and He allows for the grace of the Atonement of Jesus Christ to cover them as well. It's not just for a blatant sin such as, "I told a lie." The Atonement covers doubts, it covers our fears, it covers are even the things that we think are so blasphemous, and we condemn ourselves for that. God does not condemn us for that. As we turn to Him through the Atonement of our Savior, He allows us, through the Savior, to become whole, and he welcomes us home.

Morgan Jones  45:16
Thank you so much. My last question for you, and this is the question that we asked at the end of every episode of this podcast, what does it mean to you to be all in the gospel of Jesus Christ?

Dr. Debra McClendon 45:31
As I thought through this, I thought back to a principle that has guided my whole life. And I'd like to share a little quote with you to explain this. When I was a teenager, I found one of those inspirational quotes that people put in businesses or whatever, with a beautiful poster, and it had this quote at the bottom of the poster. It says this: "Commitment is what transforms a promise into a reality. It is the words that speak boldly of your intentions, and the actions that speak louder than words. It is making time when there is none, coming through time after time after time, year after year after year. Commitment is the stuff character is made of, the power to change the face of things. It is the daily triumph of integrity over skepticism." This principle of commitment has guided my life, so when I thought about this, I thought, "Well, what does it mean for me, to be committed? To be all in to the gospel of Jesus Christ? And for me it is to look to my Savior, and see, what did He do? In all things, Jesus Christ submitted His will to the Father. He yielded, even when it was very painful to do, even when it was inconvenient, even when it was not politically popular. I have been working in my life on this principle of yielding, and if we will yield, to me, that's when I can say I am all in. Neal A. Maxwell, throughout his writings in his various books, he uses the terms "schooling" and "divine tutoring." As we submit to the Father, He will school us, He will provide us divine tutoring to allow us to become as He would have us, which is to become like our Savior, Jesus Christ. So to me, that commitment to be all in is about yielding and being submissive to my Father in Heaven in following the example of my Savior, Jesus Christ.

Morgan Jones 47:38
Thank you so much, Debra. You have been so helpful, and I am so excited. I hope that this helps a lot of people. So thank you so much.

Dr. Debra McClendon  47:47
You're welcome. I'm very grateful to have been able to share some things with you and your listeners today.

Morgan Jones  47:53
We are so grateful to Dr. Debra Theobald McLendon for joining us on today's episode. For links to additional anxiety and scrupulosity resources, please visit debramcclendon.com and click on the "About Dr. McLendon" and "Resources" tabs. You can also find the book Debra and her husband, Richard, wrote about marriage, Commitment to the Covenant: Strengthening the Me, We, and Thee of Marriage on deseretbook.com. A huge thank you to Derek Campbell of Mix at 6 Studios for his help, as always, with this episode, and thank you all so much for listening. We'll be with you again next week.