TMS Treatment for OCD: What It Is and How It Can Help

This blog is part of the Religious OCD Series.

For those struggling with Religious OCD, Transcranial Magnetic Stimulation (TMS) offers another promising tool. Understanding how it works can help believers make informed decisions about this treatment as part of God’s provisions for healing.

Introduction

For many Christians with Religious OCD, therapy and medication provide significant help. But for some, these treatments may not bring sufficient relief. When that happens, it’s natural to feel discouraged or even question God’s help.

Yet, God often provides multiple avenues for healing, and for some, TMS can be one of those avenues.
TMS is a safe, non-invasive, FDA-approved treatment that uses magnetic fields to stimulate specific areas of the brain involved in OCD.

It has become a valuable option for individuals whose symptoms have not adequately responded to traditional therapies and medications.

What Is TMS?

Transcranial Magnetic Stimulation is a gentle, non-invasive procedure that involves placing a magnetic coil near the scalp, delivering small, focused magnetic pulses to areas of the brain known to be involved in obsessive-compulsive symptoms.

The treatment is typically given in daily sessions over the course of several weeks and is designed to help the brain function in a more balanced way.

• Non-Invasive – There are no medications or sedation involved, and patients remain awake during treatment.
• FDA-Approved for OCD – TMS has been shown to reduce symptoms in patients who have not responded well to first-line treatments.
• Minimal Side Effects in most cases – The most common side effects are mild scalp discomfort or headaches during or shortly after treatment. The treatment itself is painless; patients simply sit comfortably during the sessions, often reading a book or watching TV during the treatment session.

How Does TMS Help with Religious OCD?

OCD, including scrupulosity, involves hyperactivity in certain brain circuits that process fear, doubt, and uncertainty. TMS targets these areas, helping to reset and calm overactive brain activity.
Improving Thought Regulation – TMS can help reduce the intrusive thoughts and mental noise that often plague those with OCD.

Reducing Compulsive Urges – By calming hyperactive areas, TMS can lessen the strong drive to perform compulsions.
Should Christians Consider TMS?

It’s understandable that some Christians may hesitate to consider brain-based treatments. However, it’s important to recognize that TMS does not alter who you are; rather, it helps restore balance to areas of the brain that are not functioning as they should.

God, in His grace, has allowed advancements in science and medicine. Treatments like TMS can be part of His provision for healing.

Questions to Pray Over and Discuss with Your Doctor

1. Am I experiencing severe, persistent symptoms that limit my daily life and walk with Christ?
2. Have I consulted with a qualified healthcare provider to understand the risks and benefits?

Encouragement from Scripture

Philippians 4:6-7

“Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.” 

This reminds us that in all decisions, especially regarding treatment, we can bring our concerns to God and trust Him to provide peace and guidance.

What’s Next?

In the next article, we will look at Exposure and Response Prevention (ERP) therapy—the gold standard for treating OCD—and how it can be thoughtfully adapted for believers with Religious OCD.

More on that next week…

For Kentucky Residents

If you live in Kentucky and are seeking support for religious OCD or scrupulosity, our team at Next Step 4 Mental Health in Louisville is here to help. We offer compassionate, evidence-based care—both in-person and through telehealth—for children, teens, and adults.

•  nextstep.doctor
•  502-339-2442
•  contactus@nextstep.doctor

For Those Outside Kentucky

If you’re not a Kentucky resident, we encourage you to seek care from a licensed mental health provider in your area. Professional support can be a vital step toward healing and peace.

Note: This article is for educational purposes only and is not intended as medical advice. Please consult a licensed mental health provider for appropriate care.

5 Myths That Keep Christians from Getting Help for Mental Health

By Brian Briscoe, M.D.

For many Christians, seeking help for mental health feels like walking a tightrope—trying to honor God, trust Scripture, and yet admit that something feels wrong deep inside. Sadly, far too many believers suffer silently because of well-meaning but misguided beliefs that block them from getting the help they need.

Here are five common myths that keep Christians from pursuing care—and the truth that can set us free.

Myth #1: “If I just had more faith, I wouldn’t be struggling.”

This is perhaps the most pervasive—and painful—myth. It equates emotional suffering with spiritual failure, as if anxiety, depression, or intrusive thoughts are signs that we are not “trusting God enough.”

But Scripture paints a different picture. Elijah, after witnessing God’s power on Mount Carmel, collapses under the weight of despair and asks God to take his life (1 Kings 19). David’s psalms are filled with cries of anguish, fear, and sorrow. Jesus Himself was “a man of sorrows” and “acquainted with grief” (Isaiah 53:3).

Faith is not the absence of suffering. Faith is the decision to cling to Christ in the midst of it.

Myth #2: “I should be able to handle this on my own.”

This quiet assumption often keeps believers isolated. Many Christians believe that if they were stronger, prayed more consistently, or simply pushed through, the distress would resolve on its own.

But Scripture doesn’t teach rugged individualism—it teaches interdependence. Paul reminds us that we are part of the body of Christ and are meant to “bear one another’s burdens” (Galatians 6:2). Seeking help—whether from pastors, mentors, medical professionals, or trusted counselors—is not a betrayal of faith. It’s an act of humility and wisdom.

God often provides healing through community and through others who are equipped to walk with us.

Myth #3: “Mental illness is just a result of unconfessed sin.”

There is no doubt that sin can affect our minds and relationships. But to assume that every case of mental illness is the result of moral failure is neither biblically sound nor clinically accurate.

Jesus rejected this kind of thinking when His disciples asked about the man born blind: “Who sinned, this man or his parents?” Jesus answered, “Neither… but that the works of God might be displayed in him” (John 9:2–3).

Mental health struggles can arise from a variety of influences—trauma, grief, spiritual stress, medical conditions, neurobiological vulnerabilities, or a complex mix of factors. The presence of suffering does not imply guilt. Sometimes, the most faithful thing a Christian can do is to humbly seek healing, even when the cause of suffering is unclear.

Myth #4: “Medication is a crutch—real Christians don’t need it.”

This myth often springs from a desire to rely on God alone. But we don’t take this approach with other medical issues. When someone has diabetes, we don’t shame them for taking insulin. When a child has asthma, we don’t ask them to throw away their inhaler and “just pray harder.”

Why, then, do we treat mental health differently?

Medication, when used appropriately and under the guidance of a physician, is not a sign of spiritual weakness. It is a tool—one that can help create the internal stability needed to engage meaningfully with therapy, community, and God’s Word.

Myth #5: “Getting help makes me a bad witness.”

Some fear that acknowledging anxiety, depression, or intrusive thoughts might “hurt their testimony.” But hiding pain behind a mask of perfection isn’t the witness Christ calls us to.

Paul boasted in his weakness so that “the power of Christ may rest upon me” (2 Corinthians 12:9). Our stories of struggle and redemption—the mess and the mercy—are exactly what the world needs to see. They point not to our strength, but to the sustaining grace of Christ.

A Better Way Forward

If you or someone you love is struggling, you are not alone—and you are not failing God. Mental health struggles are not a sign of spiritual collapse. They are a reminder that we live in a fallen world, and that healing often comes through both prayer and process, through both Scripture and support.

As Christians, we don’t have to choose between faith and mental health care. We can hold both. We can seek the help we need—while resting in the One who has already secured our ultimate healing.

About Dr. Briscoe

Dr. Brian Briscoe is a board-certified psychiatrist and the founder of Next Step 4 Mental Health, a private practice in Louisville, Kentucky.

He is passionate about integrating clinical excellence with a thoughtful, respectful approach to faith. Dr. Briscoe works with individuals across a wide range of concerns, including anxiety, OCD, and mood disorders, and has a special interest in helping Christians navigate mental health through a gospel-centered lens.

He previously served as Chair of the Psychiatry Section of the Christian Medical & Dental Associations.

ADHD or Anxiety? Untangling the Overlap for Women

Can’t remember why you walked into the room—again? Feel like your mind’s always in overdrive, yet somehow never quite lands on what it’s supposed to? If you’re a woman juggling work, family, and expectations, you may have started to wonder: Is this anxiety? ADHD? Both? And why does it feel like nobody else is struggling quite this much?

You’re not imagining things—and you’re not alone. Many women, especially in mid-life, begin to notice difficulties with focus, forgetfulness, restlessness, or an undercurrent of worry that just won’t quit. Often, these symptoms overlap between ADHD and anxiety, and it’s easy to feel unsure of what’s really going on.

In this article, we’ll explore how these two conditions can mimic, mask, or intensify each other—especially in women. More importantly, we’ll talk about how to find clarity, and why there’s every reason to be hopeful.

Why It’s So Hard to Tell the Difference

ADHD and anxiety are distinct, but they share a lot of surface symptoms: distractibility, racing thoughts, trouble finishing tasks, irritability, sleep issues. It’s not uncommon for someone to walk into a mental health evaluation, certain they have one, only to find they actually have both—or that their struggles were misattributed all along.

One key difference lies in what’s driving the distraction. Anxiety tends to fill your mind with worry: “What if I said the wrong thing? Did I forget to follow up? What if I fail?” With ADHD, your mind may drift because it’s simply hard to stay engaged or organized—even if nothing is stressing you out in the moment.

Both can be frustrating, exhausting, and isolating. And unfortunately, women are more likely to be misdiagnosed or overlooked altogether, especially if their symptoms don’t fit the “typical” (often male) presentation of ADHD.

What ADHD Often Looks Like in Women

Women with ADHD often fly under the radar. Instead of hyperactivity, they might experience:

• Mental clutter: A brain that never seems to slow down, bouncing from one thought to the next.
• Forgetfulness: Missed appointments, lost items, conversations that drift before they’re done.
• Time blindness: Struggling to estimate how long things will take—or remember how long you’ve already been doing something.
• Emotional intensity: Feeling things deeply, and sometimes reacting quickly, even when you wish you wouldn’t.
• Chronic self-doubt: The sense that you’re always a step behind, no matter how hard you try.

Many women with ADHD become experts at compensating. They build elaborate systems, checklists, or routines to hold it all together. From the outside, it might look like they have it all under control. On the inside, it feels like they’re barely holding on.

How Anxiety Shows Up Differently in Women

While anxiety is more widely recognized, it’s not always understood well—especially when it shows up in high-achieving women who appear “fine.” Anxiety might include:

• Constant worry and second-guessing.
• Tension and restlessness that you carry in your body, even when nothing seems “wrong.”
• Perfectionism that isn’t about excellence—it’s about trying to prevent anything bad from happening.
• Irritability, exhaustion, or guilt—often from juggling too many roles or trying to meet impossible expectations.

In many women, anxiety becomes a quiet, internal pressure—rarely visible to others, but always humming in the background.

When You Have Both

ADHD and anxiety often travel together. Sometimes, anxiety develops as a response to undiagnosed ADHD. For example, if you’ve spent years missing deadlines, forgetting things, or feeling scattered, it makes sense that you’d start to worry constantly. You may have learned to expect negative feedback or disappointment—and now live in fear of the next mistake.

On the other hand, chronic anxiety can make it hard to concentrate, leading to ADHD-like symptoms. You might re-read the same email several times because your mind keeps jumping to something else. Over time, it becomes hard to tell what’s driving what.

Understanding that these conditions can co-exist—and influence each other—is a crucial part of building a treatment plan that works.

How to Move Toward Clarity

Sorting this out isn’t something you need to do on your own. A thoughtful, comprehensive evaluation with a qualified mental health professional can help you understand what’s underneath the symptoms you’re experiencing. This isn’t about putting you in a box or assigning a label—it’s about gaining insight into the patterns that have shaped your day-to-day life, so that you can make decisions with more clarity and compassion.

A good evaluation includes more than just a questionnaire. It should consider your life story, your strengths, your challenges, and how your symptoms have changed over time. It’s a conversation—not a checklist—and one that can open the door to real relief.

Treatment Can Be Life-Changing

Whether you’re dealing with ADHD, anxiety, or both, treatment can make a meaningful difference. That might include:

• Therapy, which can help you learn skills to manage thoughts, reduce overwhelm, and respond differently to stress.
• Lifestyle changes like improving sleep, building structured routines, and using technology to stay organized.
• Medication in some cases, if appropriate, to support focus or reduce chronic anxiety.
• Education and support, so you can better understand how your brain works—and stop blaming yourself.

Treament isn’t about “fixing” you. It’s about giving you tools to work with your brain instead of fighting it. Many women report a profound sense of relief when they realize they’re not lazy, flaky, or “too sensitive”—they just have a brain that’s wired differently.

You’re Not Broken—and You’re Not Alone

If you’ve spent years trying to figure out why everything feels harder than it should, wondering why you can’t just “get it together” like everyone else seems to—please know this: it’s not a character flaw. And you’re not the only one.

There are real explanations. And more importantly, there is real help.

The path forward starts with understanding. From there, you can build a plan that supports you—your brain, your life, and your goals. Whether that means learning new skills, setting better boundaries, or simply being kinder to yourself on tough days, the result is the same: more calm, more clarity, more hope.

Whatever it is you’re facing, you don’t have to figure it all out on your own. There are people who understand—and there are steps you can take today.

We’re here when you need us. For questions, click here to get started.

Biological Treatments for Religious OCD: How Medication and Supplements Can Help

Introduction

The Role of Medication in Treating OCD

• What to Expect – Medications typically reduce symptoms by around 30-40%. Some individuals experience more improvement; others may need additional support through therapy.
• Patience Is Key – OCD medications often take 8-12 weeks to show full effects and may require adjustments in dosage.
• Common Medications – Examples include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and clomipramine (Anafranil).
• Medication Is Not a Lack of Faith – Taking medication is not about spiritual weakness; it’s using a tool that God has allowed us to discover for physical and mental health.

A Story to Remember

Supplements That May Help

• N-Acetylcysteine (NAC) – Some studies suggest that NAC, an antioxidant, may help reduce obsessive thoughts.
• Omega-3 Fatty Acids – These have been linked to improved mood and brain health.

Combining Biological Treatments with Faith and Therapy

• Prayerfully Consider Treatment – Seek wisdom, talk with trusted Christian counselors or medical professionals, and pray for discernment.
• Lean on Scripture – Remember passages like James 1:5: “If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him.”
• Trust God’s Provision – Whether it’s medication, therapy, or community support, all good things come from His hand.

What’s Next?

 The Impact of Religious OCD on a Believer’s Walk with Christ

This blog is part of the Religious OCD Series.

Religious OCD can turn faith into a source of anxiety rather than peace, leading to avoidance, isolation, and spiritual exhaustion. Understanding these effects can help believers reclaim a grace-filled relationship with God.

For Christians, faith is meant to be a source of comfort and strength. However, for those struggling with Religious OCD, faith can become a battleground of fear, doubt, and relentless self-examination. Instead of experiencing the joy of God’s presence, believers with Religious OCD may find themselves trapped in cycles of compulsive rituals, seeking reassurance, and fearing that they are failing in their faith. Over time, these struggles can lead to avoidance, isolation, and deep spiritual exhaustion.

Recognizing how Religious OCD affects a believer’s walk with Christ is an important step in learning to separate faith from fear and embracing the freedom found in God’s grace.

Avoidance: Fleeing from Triggers Instead of Facing Them

One of the major impacts of Religious OCD is avoidance—avoiding certain Bible passages, church services, conversations about theology, or even prayer itself out of fear that these will trigger intrusive thoughts and anxiety.

Common forms of avoidance include:

• Avoiding Scripture – Some believers may steer clear of certain Bible passages (such as those about blasphemy, judgment, or salvation) because reading them causes distress.
• Skipping Church or Worship Services – Fear of encountering triggering messages or being overwhelmed by doubts may lead some to withdraw from their church community.
• Avoiding Prayer – For some, prayer becomes so wrapped up in compulsive rituals that they stop praying altogether to avoid the stress of “doing it wrong.”
• Distancing from Christian Fellowship – Some believers may withdraw from conversations about faith, fearing that discussing theological topics will spiral into intrusive doubts or anxieties.

Avoidance can cause a believer to feel disconnected from God and their Christian community, reinforcing the idea that they are somehow failing in their faith or even losing it.

Isolation: The Silent Suffering of Scrupulosity

Religious OCD often creates a deep sense of isolation. Those struggling may feel that no one else understands their distress or that admitting their fears would make them seem spiritually weak or unfaithful.

Ways that isolation manifests include:

• Keeping Doubts and Fears Private – Many fear that sharing their intrusive thoughts or struggles will lead to judgment or misunderstanding. They may also feel embarrassed to admit the nature of their thoughts, worrying that others will not understand or may react negatively.
• Feeling Spiritually Alone – Despite being surrounded by fellow believers, someone with Religious OCD may feel utterly alone in their battle.
• Believing Their Faith Is Inadequate – The persistent anxiety and compulsions can make individuals feel like they are failing where others are thriving.

This isolation can intensify symptoms, making it even harder to break free from the OCD cycle.

Spiritual Exhaustion: When Faith Feels Like a Heavy Burden

The constant cycle of intrusive thoughts, compulsions, and reassurance-seeking can leave a believer feeling spiritually drained. Instead of experiencing peace in Christ, they may feel overwhelmed by the pressure to “get it right” in their faith.

Signs of spiritual exhaustion include:

• Feeling Overwhelmed by Religious Duties – Reading the Bible, praying, or attending church may feel like impossible tasks due to the fear and anxiety they provoke.
• Doubting One’s Relationship with God – Constantly questioning salvation or worrying about sin can leave a believer feeling distant from God.
• Loss of Joy in Worship – Worship and devotion, instead of being acts of love and connection with God, can become fear-driven obligations.

This exhaustion can lead to deep discouragement, making it difficult to engage in faith practices.

What Does the Bible Say About This Struggle?

Jesus Himself addressed the burden of legalism and fear-based faith, offering an invitation to rest in Him:

• Matthew 11:28-30 – “Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.” This passage reassures believers that faith is meant to be freeing, not an exhausting struggle. However, for those with Religious OCD, experiencing this ‘light burden’ can feel out of reach. It’s important to remember that struggling with fear and anxiety does not mean one is failing in their faith—God’s grace is sufficient even when peace feels distant. Christ is still with you even when peace feels distant.
• Romans 8:1 – “There is therefore now no condemnation for those who are in Christ Jesus.” A reminder that salvation is secured in Christ, not in perfect thoughts or rituals.

Reclaiming a Grace-Filled Walk with Christ

If you recognize these struggles in your own faith journey, know that there is hope. Here are some steps to begin breaking free:

1. Recognize That Feelings Do Not Define Faith – Salvation is not based on how you feel but on God’s promises.
2. Re-engage with Scripture and Prayer Slowly – Instead of avoiding these practices out of fear, take small steps to reconnect with God.
3. Lean on Trusted Christian Community – Surround yourself with believers who understand and can encourage you with truth and grace.
4. Seek Professional Help – Christian psychologists, therapists, and psychiatrists can provide evidence based treatments for OCD that can make a world of difference.  

What’s Next?

In the next article, we will explore the role of medication and biological treatments in managing Religious OCD.

More on that next week…

For Kentucky Residents

If you live in Kentucky and are seeking support for religious OCD or scrupulosity, our team at Next Step 4 Mental Health in Louisville is here to help. We offer compassionate, evidence-based care—both in-person and through telehealth—for children, teens, and adults.

 nextstep.doctor

 502-339-2442

 contactus@nextstep.doctor

For Those Outside Kentucky

If you’re not a Kentucky resident, we encourage you to seek care from a licensed mental health provider in your area. Professional support can be a vital step toward healing and peace.

Note: This article is for educational purposes only and is not intended as medical advice. Please consult a licensed mental health provider for appropriate care.

Understanding Compulsions in Religious OCD: Why They Form and How They Reinforce the OCD Cycle

Introduction

What Are Compulsions?

• Compulsive or ritualistic prayer – Feeling the need to pray repeatedly to ensure God has truly heard or accepted a prayer.
• Repeated confessions – Continually confessing the same sin out of fear that it wasn’t done “correctly” or sincerely enough.
• Scripture checking – Repeatedly looking up certain Bible verses to confirm one’s salvation or to counter intrusive thoughts.
• Seeking reassurance – Asking pastors, friends, or family members for constant confirmation that one is saved or has not committed an unforgivable sin.
• Avoidance behaviors – Steering clear of certain religious discussions, scriptures, or places out of fear that they will trigger anxiety.
• Mental review – Replaying past actions or thoughts over and over to ensure that no sin was committed.

Why Do Compulsions Form?

1. Intrusive Thought – A distressing thought enters the mind (e.g., “What if I didn’t pray sincerely enough?”).
2. Anxiety Increases – The thought triggers deep fear, leading to distress and uncertainty.
3. Compulsion Performed – The person engages in a ritual to ease the fear (e.g., repeating the prayer multiple times).
4. Temporary Relief – Anxiety subsides for a short while, reinforcing the belief that the compulsion “worked.”
5. Reinforcement of OCD Cycle – Over time, the brain learns that relief only comes from performing the compulsion, making the obsession stronger and more intrusive.

What Does the Bible Say About This Struggle?

Matthew 6:7

“And when you pray, do not heap up empty phrases as the Gentiles do, for they think that they will be heard for their many words.” 

Matthew 11:28-30

“Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.” 

Breaking Free from Compulsions

1. Identifying Compulsions – Pay attention to behaviors done out of fear rather than genuine devotion.
2. Reducing Rituals Gradually – If you feel the urge to pray multiple times for reassurance, try stopping at one and sitting with the discomfort.
3. Resisting Reassurance-Seeking – Instead of asking others for constant reassurance, remind yourself of God’s promises in Scripture.
4. Accepting Uncertainty – Recognizing that faith involves trusting in God’s grace, even when feelings of certainty are absent.
5. Seeking Professional Help – A Christian counselor or therapist trained in OCD treatment can help guide you through Exposure and Response Prevention (ERP), the gold-standard treatment for OCD.

What’s Next?

Understanding Intrusive Thoughts: Why They Occur and How They Take Root

How Medication in Marriage Counseling Can Strengthen Relationships

Guest post from Dr. Nick Bach 

How Medication in Marriage Counseling Can Strengthen Relationships

As a marriage counselor in Louisville, KY, I’ve spent years helping couples navigate the rocky terrain of their relationships. Some come to me with communication breakdowns, others with deeper struggles that words alone can’t fix.

One tool I’ve seen transform marriages when paired with therapy, is medication in marriage counseling. It’s not a cure-all, but for couples wrestling with mental health challenges like anxiety or depression, it can be a lifeline.

At my practice, rooted in a Christian perspective, I’ve witnessed how psychiatric help can align with faith to bring healing. And for those needing expert psychiatric support, I often point them to Next Step 4 Mental Health, a practice I trust to complement the work I do.

The Link Between Mental Health and Marital Harmony

Marriage is a sacred covenant, and as a Christian, I see it reflected in Ecclesiastes 4:12:

“A cord of three strands is not quickly broken.”

That third strand—God’s grace—sometimes weaves through practical solutions like medication to fortify a couple’s bond. Research supports this: untreated mental health issues, such as depression or anxiety, can fuel marital discord and lower satisfaction (Whisman, 2018). When one spouse’s mind is clouded by these struggles, it’s not just their personal peace that suffers—it’s the relationship itself.

I recall working with Sarah and James (names changed for privacy). Sarah felt James had become a stranger—distant and short-tempered. James admitted he felt “stuck,” unable to shake a heavy gloom. After a few sessions, it was clear James was grappling with depression. I encouraged him to seek psychiatric help for couples, and he started an antidepressant. Within a month, he was more present, and their conversations shifted from tense standoffs to tentative steps toward reconnection. Medication didn’t solve everything, but it cleared a path for the therapy to take root.

How Medication Bolsters Relationship Work

Medication for relationship issues can sound unconventional, but it’s grounded in evidence. When mental health conditions amplify everyday tensions—say, anxiety turning a quiet moment into a perceived slight, or depression draining a spouse’s energy to engage—it’s hard to make progress in counseling. Studies from the American Psychological Association show that treating these conditions with medication can lower emotional volatility and boost problem-solving skills, both essential for a thriving marriage (Snyder et al., 2016).

Another couple, Emily and Mark, showed me this in action. Emily’s anxiety had her second-guessing Mark’s every move, while Mark felt exhausted by her constant need for validation. Her anxiety wasn’t just stress—it was clinical. After I suggested a psychiatric consult, she began an SSRI prescribed by her psychiatrist at Next Step to Mental Health in Louisville. As her mind settled, she could listen to Mark without fear hijacking her thoughts. For them, medication in marriage counseling was a stepping stone to trust. Mark later said, “She’s still herself, just without the static.”

From a Christian lens, this resonates with Proverbs 17:22: “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” Sometimes, that “good medicine” comes in a pill bottle. God’s healing can flow through science, just as it did when Jesus used mud to restore sight (John 9:6-7).

What Research Says About Psychiatric Help for Couples

The data is compelling: mental health in marriage therapy can shift outcomes. A 2020 study in the Journal of Marital and Family Therapy found that couples where one spouse received psychiatric treatment for mood disorders reported better satisfaction after six months compared to those who didn’t (Johnson et al., 2020). Medication doesn’t sideline counseling—it amplifies it. By stabilizing moods or easing anxiety, it frees couples to tackle deeper relational wounds.

I’ve seen this play out in my office at Grace Psychological Services in Louisville. Antidepressants can lift a spouse out of despair, making them an active spouse again. Anti-anxiety meds can quiet the noise, opening space for vulnerability. The National Institute of Mental Health reports that 70-90% of people with depression improve with medication alongside therapy (NIMH, 2022). For marriages hanging by a thread, that’s a lifeline worth considering.

Overcoming Stigma with Faith

In my Christian-based practice, I often hear hesitation about medication—some worry it’s a lack of faith. I counter that God equips us with tools, from prayer to psychiatry. James resisted at first, fearing he wasn’t “trusting God enough.” We talked about how seeking help is an act of stewardship over the life—and marriage—God gave him. That perspective shift let him embrace treatment, and it paid off. Emily, too, found comfort in seeing medication as part of God’s provision, not a replacement for it.

When to Explore Medication in Marriage Counseling

Medication isn’t for every couple, but it’s worth considering if mental health symptoms—like persistent withdrawal, unexplained irritability, or overwhelming worry—derail your connection. At my practice, I assess whether these signs point to something deeper. If they do, I recommend a psychiatric evaluation. Look for:

• Emotional distance lasting weeks or months.
• Arguments sparked by mood swings with no clear cause.
• A nagging sense that “something’s wrong” despite your efforts.

If this hits home, don’t delay. Addressing mental health in marriage therapy can change your story.

Taking the Next Step

Start by talking with your spouse—honestly, without judgment. Then, seek professional input. A counselor can guide your relational work, while a psychiatrist can explore medication options. For couples in Louisville, I often recommend Next Step to Mental Health. Their Christian-based approach aligns with my values, seamlessly blending faith and evidence-based care.

Why Next Step 4 Mental Health Stands Out

If you’re ready to explore this path, Next Step 4 Mental Health can help. As a marriage counselor in Louisville, I’ve seen their team support couples with compassion and expertise. They offer psychiatric evaluations and personalized treatment plans—whether it’s medication in marriage counseling or standalone mental health care. For Sarah and James, or Emily and Mark, that extra layer of support made all the difference. Next Step 4 Mental Health doesn’t just treat symptoms; they help couples rebuild with faith at the core.

Ready for change? Visit nextstep.doctor to connect with their team. As someone who’s walked this road with couples, I can say this: a marriage strengthened by love, wisdom, and the right tools is a beautiful testament to God’s grace. Don’t wait to take that “next step.”

About the Author

Dr. Nick Bach is a licensed clinical psychologist and marriage counselor at Grace Psychological Services in Louisville, KY where he blends evidence-based therapy with a Christian perspective to help couples strengthen their relationships.

Understanding Religious OCD: What It Is and Why It Matters

This blog is part of the Religious OCD Series by Dr. Brian Briscoe. 

OCD tends to latch onto what a person holds most dear, turning their deepest values—such as faith—into sources of anxiety and distress.

Introduction

Imagine feeling an overwhelming fear that you’ve unknowingly committed a sin, even though you have done nothing wrong. Or obsessing that a past sin you have committed has not been forgiven, even though you have accepted Christ and know that in Him all sins are forgiven. You pray repeatedly, seeking reassurance from God, yet the fear does not go away. You confess the same sin over and over, but relief never lasts. Instead, doubt creeps back in, stronger than before. This is the reality for many individuals suffering from Religious OCD, also known as scrupulosity.

What Is OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions) performed to relieve distress. These compulsions offer temporary relief but ultimately reinforce the obsessive cycle, making the problem worse over time.

What Is Religious OCD (Scrupulosity)?

OCD obsessions and compulsions tend to center around the things that people care about the most. For some, OCD manifests as overwhelming fears about harm coming to their child. For others, it revolves around fears of contamination or illness. In many cases, OCD latches onto what a person holds most dear. Religious OCD occurs when these obsessive fears and compulsions creep into a person’s religious or spiritual life, distorting their faith experience and turning it into a source of distress rather than peace.

Religious OCD, or scrupulosity, is a subtype of OCD in which a person experiences excessive worry about religious or moral matters. Because faith is so central to a believer’s identity, OCD may distort genuine devotion into an exhausting cycle of fear, doubt, and compulsive reassurance-seeking. Common fears include:

• Doubting one’s salvation
• Fear of committing the unforgivable sin
• Worrying that thoughts themselves are sinful
• Repeatedly seeking reassurance from pastors or loved ones
• Feeling compelled to engage in excessive prayer, confession, or ritualistic behaviors

While it is natural for Christians to care about living righteously, scrupulosity takes these concerns to an extreme, leading to distress and interfering with one’s ability to experience God’s love and grace.

A Story of Religious OCD in Action

Let’s take a look at a hypothetical case:

Sarah is a devoted Christian who deeply desires to follow God. Her faith is one of the most important aspects of her life, making it a prime target for OCD-related fears. She begins experiencing persistent thoughts that she might have unknowingly blasphemed the Holy Spirit. These thoughts terrify her. She starts praying compulsively, asking God for forgiveness hundreds of times a day. She seeks reassurance from her pastor, who tells her she hasn’t committed the unforgivable sin, but the doubt returns almost immediately. Instead of feeling peace, Sarah feels trapped in an exhausting cycle of fear and rituals.

Sarah’s story reflects the struggle of many believers with Religious OCD. Instead of drawing closer to God, their faith becomes a battleground of relentless doubt and anxiety. What she values most—her faith—has become a source of distress rather than comfort.

Why This Matters

Scripture reminds us that God’s love is steadfast, and our salvation is secured through faith in Christ:

“For by grace you have been saved through faith, and this is not your own doing; it is the gift of God, not a result of works, so that no one may boast.” (Ephesians 2:8-9)

Recognizing that salvation is based on God’s grace—not our ability to achieve certainty—can help free those trapped in the cycle of Religious OCD.

Many people suffering from scrupulosity believe their distress is a sign of spiritual failure. However, Religious OCD is not a lack of faith—it is a mental health condition. Recognizing this distinction is crucial for those who struggle and for pastors, family members, and church communities who seek to support them. Understanding that OCD preys on what is most important to an individual can help sufferers, and those who support them, approach this struggle with compassion and clarity.

What’s Next?

In the next article, we will dive deeper into the nature of intrusive thoughts, why they occur, and how they take root in the mind.

More on that next week…

For Kentucky Residents

If you live in Kentucky and are seeking support for religious OCD or scrupulosity, our team at Next Step 4 Mental Health in Louisville is here to help. We offer compassionate, evidence-based care—both in-person and through telehealth—for children, teens, and adults.

📍 nextstep.doctor

📞 502-339-2442

📧 contactus@nextstep.doctor

For Those Outside Kentucky

If you’re not a Kentucky resident, we encourage you to seek care from a licensed mental health provider in your area. Professional support can be a vital step toward healing and peace.

Note: This article is for educational purposes only and is not intended as medical advice. Please consult a licensed mental health provider for appropriate care.

Introducing the Religious OCD Blog Series: A Message from Dr. Brian Briscoe

This article is part of the Religious OCD Series.

As a practicing psychiatrist who holds my Christian faith dear to my heart, I have had the privilege of walking alongside patients through some of their most challenging mental health struggles. In addition to my clinical work, I have served as Chair of the Psychiatry Section of the Christian Medical and Dental Association (CMDA), where I have had the opportunity to collaborate with colleagues who share both clinical expertise and a heart for ministry.

Why This Series?

• Support individuals who are personally struggling with Religious OCD — offering them hope, understanding, and practical tools.
• Equip pastors and church leaders — helping them recognize and respond wisely to congregants facing these struggles.
• Guide family members and loved ones — enabling them to support their spouses, children, or friends with compassion and understanding.

My Writing Process

Why Use Large Language Models?

A Final Word

Series Overview

This blog series is designed to be comprehensive and approachable, offering twelve articles that each address a different aspect of Religious OCD. The topics include:

1. What Religious OCD Is and Why It Happens
2. Understanding Intrusive Thoughts in a Christian Context
3. Compulsions in Religious OCD and How They Reinforce Anxiety
4. How Religious OCD Affects a Believer’s Walk with Christ
5. Biological Treatments: Medication and Supplements
6. TMS (Transcranial Magnetic Stimulation) as a Treatment Option
7. Exposure and Response Prevention (ERP) Therapy and How It Can Be Adapted for Christians
8. Supporting a Spouse Who Struggles with Religious OCD
9. How Parents Can Recognize and Support a Child with Religious OCD
10. Guidance for Pastors: Recognizing and Responding with Wisdom
11. How Small Groups Can Support Members Struggling with Religious OCD
12. Moving Forward in Hope: A Final Word

Each article has been crafted to offer clinical accuracy paired with compassionate, faith-sensitive guidance. My hope is that readers will find both clarity and encouragement, whether they are sufferers themselves, loved ones, or church leaders seeking to shepherd well.