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KC 4: Traditional Islamically Integrated (TIIP) Treatment of Obsessive-Compulsive Disorder Scrupulosity (Waswasa) in Muslim Patients

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The expressions of the symptoms of Obsessive-Compulsive Disorder vary according to the socio- psychological context of patients. In religiously observant populations, OCD symptoms can interact with religious beliefs and practices, known as OCD scrupulosity. The literature is replete with discussions of OCD scrupulosity for Jews and Christian, but minimal discussions are available on its interaction with Islamic belief in Muslim populations. This presentation details some of the most common manifestations of OCD scrupulosity known as waswasa in Muslim populations and will be thematically presented based upon the attention afforded to its typical expressions in classical Islamic legal manuals. These broader thematic clusters of symptoms can be divided into four sections, (i) ritual purity and prayer, (ii) marriage and divorce, (iii) blasphemy and apostasy, and (iv) intrusive thoughts of sin. Additionally, assessment methods and identification of OCD symptomology as indicators of clinical psychopathology are discussed. Accompanying this, is an overview of the potential religious dispensations afforded to OCD patients in Islamic ritual law as disability accommodations. The role and conceptualization of waswasa according to normative Islamic belief is presented based upon the Qur’an, prophetic traditions and Islamic scholarly writings.

To follow, an Islamically integrated approach to cognitive psychotherapy and exposure response prevention therapy (ERP) is offered, drawing from traditional Islamic faith-based healing. Interventions are rooted in a published model of treatment known as Traditional Islamically Integrated Psychotherapy (TIIP). The model proposes a need to counterbalance the OCD patient’s negative attribution bias and accompanying compulsive behaviors that are indicators of excessive fear with a more self-compassionate cognitive orientation. Interventions include a cognitive restructuring component using cognitive techniques of: challenging the evidence, correction of faulty Islamic beliefs through psychoeducation, acceptance of intrusive thoughts and their inconsequentiality, ‘acting as if’ and Islamic positive cognitive reframing. Exposure response prevention is suggested to accompany cognitive interventions in order to extinguish the associated anxiety with intrusive thoughts that propels behavioral compulsions.

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