This annotated bibliography contains five articles focused on the treatment of scrupulosity as a feature of Obsessive-Compulsive Disorder using Cognitive Therapy. These sources discuss the cognitive processes underlying scrupulosity, assessment instruments to measure the severity of symptoms, and proposed cognitive therapeutic interventions. The sources highlight the need for further study to confirm the efficacy of CT for helping clients reduce the impact of scrupulosity symptoms by learning to distinguish scrupulosity from healthy religious practice.

In the current article, Abramowitz & Jacoby conduct a review of extant literature concerning scrupulosity. Combining this review with their own clinical observations, the authors conceptualize a cognitive-behavioral model for understanding the thought processes underpinning scrupulosity and propose a program of treatment using elements of psychoeducation and exposure and response prevention. 
There are several limitations to this article. Notably, the authors’ assertions are presented as facts, rather than hypotheses to be tested, with no specific recommendations for future research. The fact that Abramowitz is Editor-in-Chief of the journal in which this article was published could raise questions about the level of transparency and rigor employed in the peer review process. Also, while the authors’ proposed model for understanding and treating scrupulosity appears to be supported by the extant literature cited in the article, a clear limitation is that the model remains untested. This supports my research proposal that further quantitative research is needed to assess the efficacy of cognitive therapy models in treating scrupulosity. 


Dehlin, Morrison, & Twohig identified a research gap regarding the efficacy of Acceptance and Commitment Therapy, a form of CBT, as a treatment for OCD scrupulosity. The authors tested the efficacy of an ACT for OCD treatment protocol in treating a sample of five volunteer participants with OCD scrupulosity using a multiple baseline across participants design. The primary dependent variables tracked were the frequency of compulsions and avoidance of valued actions that might trigger obsessions or compulsions, measured by daily self-report via an Internet website. Secondary dependent variables were derived from multiple assessment instruments, including the Penn Inventory of Scrupulosity, which contains two subscales measuring the fear of committing sin and the fear of God’s punishment, respectively, using a 5-point Likert scale. The PIOS has demonstrated internal consistency, and both convergent and discriminant validity, in previous studies. After 8 weekly sessions, participants reported a dramatic reduction in compulsions and avoided valued behaviors, and scores on the PIOS decreased by 50%. These results were maintained 3 months posttreatment. The authors note that, to their knowledge, this is the first study of ACT conducted specifically for the treatment of scrupulosity. Limitations include the small sample size, and the heavy reliance on self-report measures, which can be biased in the direction of the desired treatment outcome. This supports my proposal that additional research is needed to assess the efficacy of cognitive therapy with a larger sample group of people experiencing scrupulosity.  
