Exposure with response prevention for Islamic religious OCD

Background

The standard treatment for obsessive-compulsive disorder (OCD) is exposure and response prevention (ERP) (see specific article). This behavioral therapy is primarily based on a functional analysis (see specific article) that identifies triggering stimuli, obsessive thoughts, and the function that behaviors (compulsions/rituals) serve within the context of the patient's fear. The patient is then gradually exposed, starting with a hierarchy of anxiety-provoking situations (see specific article).

Religious obsessions are common worldwide among those who suffer from OCD and for whom religion is a natural part of their lives. The challenges of religiously themed OCD (doubts, questions, blasphemous images or ideas, and in a Muslim context, the repetition of ablutions, prayer, fasting, etc.) stem from the fact that exposure can be delicate due to the sensitivity of the subject matter, which, for the believer, touches on the sacred. For example, directly exposing the patient to blasphemous or obscene thoughts or images involving figures considered sacred, or temporarily suspending certain acts of worship such as prayers and ablutions before gradually reintroducing them, can create reluctance in the patient, and even in the therapist if the latter is religious.

Furthermore, in a North African and Muslim context, the belief that OCD is the work of the devil, the evil eye, or a curse risks diminishing the patient's confidence in a therapy that may be perceived as "Western and secular." The risk is that the therapy will be perceived as not respecting, or even refuting, the patient's beliefs. The therapist, whether religious or not, is therefore faced with a challenge: How to apply the principles of EPR while taking into account the religious and contextual dimensions of OCD?