Obsessive-Compulsive Disorder (OCD) is primarily comprised of chronic intrusive thoughts, accompanied by actions performed to suppress or neutralize those thoughts in order to relieve anxiety. 
The person overestimates the importance of intrusive thoughts, exhibiting moral thought-action fusion, the belief that merely thinking something immoral is the same as committing an immoral act.
Moral TAF becomes an even greater factor when the tenets of the person’s religion stipulate moral culpability for the content of one’s thoughts. The scrupulous person develops an obsessive fear of sin, God’s punishment, or both, then performs compulsive behaviors such as repetitive prayer, trying to perform religious rituals “perfectly”, repeatedly asking others for reassurance of salvation or of being a good person, or confessing sins repeatedly. 
The predominant treatment for OCD is Exposure and Response Prevention, a behavioral therapy method in which experiments are set up to incrementally expose a client to situations that provoke the obsessive-compulsive cycle. The client agrees not to perform the corresponding compulsion, with the purpose of eventual habituation to the exposure. For example, a client who has obsessive fears of germs and performs compulsive hand washing might be asked to participate in an experiment involving touching a doorknob in a public place without washing his or her hands afterward.
A potential problem with using ERP for clients with scrupulosity is in finding exposure situations that will not actually violate the tenets of the client’s religion. For example, it may be undesirable to require a client who experiences intrusive blasphemous thoughts to loudly curse God as an experiment in habituation if that client’s religion teaches that cursing God leads to certain eternal damnation. Similarly, assigning a pornographic video as an exposure for a client who experiences guilt over intrusive sexual thoughts may violate teachings against sexual sin in the client’s religion.

However, there have been no large-scale quantitative studies to date that measure the effectiveness of ACT for OCD in treating scrupulosity. My proposal is to conduct a quantitative study on the effectiveness of the ACT for OCD program for participants with scrupulosity. My hypothesis is that by the end of this program, participants will experience a significant reduction in scrupulosity symptoms, and in OCD symptom severity overall.

The population to be studied includes adults (age 18 and over) with moderate to severe OCD symptoms who experience clinically significant scrupulosity. Study participants will be recruited through Internet advertisements on social media pages and online support groups pertaining to OCD, and through flyers distributed to local clinicians and therapy centers that offer specialized OCD treatment. 

The analysis of all available data for this study failed to reject the null hypothesis that participants in the ACT for OCD program would experience either an increase in symptom severity or no change at all. Participants experienced statistically significant decreases in scrupulosity symptoms as measured by the PIOS-R, and in overall OCD severity. This has implications for future treatment options for clients who have moderate to severe OCD with clinically significant symptoms of scrupulosity. Some strengths of this study include a larger sample size than any previous study of ACT used alone specifically to treat scrupulosity; the inclusion of only participants with moderate to severe OCD who have clinically significant scrupulosity, to ensure that the correct population was being targeted; and the use of a single therapist in the treatment condition, to control for variations in content delivery of the ACT for OCD method that could occur with multiple therapists. Some limitations include a lack of control for confounding effects such as psychiatric medication (e.g. SSRI antidepressants), comorbid conditions (e.g. mood disorders, substance abuse), and prior or current therapy history. Future research is needed to further study the efficacy of ACT for OCD in treating OCD scrupulosity with a larger, well-controlled population.
