Our brains work daily to absorb and sort information, differentiating what is important from the clutter. On the daily, we are exposed to a plethora of both positive and negative input and media. For most people, the process of figuring out what is worth paying attention to is automatic and effortless. For others, however, and especially for those who have obsessive compulsive disorder, this process involves meticulously attaching meaning to thoughts. Some thoughts may be incongruent with their values, and they may start to question the implications of having these thoughts on their identity. These intrusive or obsessive thoughts are called egodystonic, because they are opposite to the person’s values. We think things that are disgusting, horrifying, and mean, and it can be scary, precisely because of how out of alignment these thoughts are to what we value and how we perceive ourselves.
Obsessive compulsive disorder is characterized by obsessions over thoughts and attacks on the values of the sufferer. The egodystonic, or values-opposing, nature of such thoughts is what makes the condition so debilitating. There are several different types of obsessive compulsive disorder, including sexual orientation OCD (a fixation on whether one is secretly a different sexual orientation than what they believed before), contamination OCD (a fixation on germs and fear of being contaminated), harm OCD (fear of harming others), and pedophilia OCD (fear of harming or abusing children). One particularly relevant form of OCD is called scrupulosity. Scrupulosity is characterized by religious-centered obsessions and compulsions, which may look like an intense fear of hell and of being unforgiven, or ritualistic prayer in hopes of getting it “just right.” It is incredibly painful for those who suffer from it, because the thoughts generated by OCD are inherently opposite to the values of the affected individual. 
OCD treatment to address egodystonic thoughts
The most effective treatment of obsessive compulsive disorder is called exposure response prevention.  These exposures involve individuals repeatedly encountering their fears and worries until they no longer display an anxious response. When exposed to the thoughts that scare them the most, individuals practice a different, neutral response, rather than the anxious response, in order to habituate to the stimulus. Although we may not all have OCD, we all experience egodystonic thoughts, and we can learn from the treatment and research surrounding obsessive compulsive disorder.
How do we know which thoughts to pay attention to? As Christians, how do we know which are from the Lord and which are just products of our living in this broken and fragile world? And how might knowing the Bible’s words that God sees and cares about our thoughts influence our thinking on this subject?
The practice of mindfulness
The Bible calls Christians to guard their hearts and teaches that our thoughts reflect the content of our hearts. Jesus said, “You have heard that it was said, ‘You shall not commit adultery.’ But I tell you that anyone who looks at a woman lustfully has already committed adultery with her in his heart.” 
What do we do with the seemingly contradictory information of obsessive compulsive disorder research and the claims of the Bible? How do individuals with obsessive compulsive disorder endure healing through treatment while also pursuing after the heart of the Lord?
First, there is a difference between dwelling on thoughts and accepting the presence of thoughts produced by our brains. Dr. Ted Witzig, a clinical psychologist and specialist in religious-focused scrupulosity, explains:
“There is a difference between the regular presence of thoughts and what Jesus talks about in this verse. We don’t view temptation as the same thing as sin. Martin Luther famously said, ‘You cannot keep birds from flying over your head but you can keep them from building a nest in your hair.’” 
Mindfulness is the non-judgmental acceptance of the presence of thoughts and a continuous practice of returning to the truth of who we are. The thoughts themselves are not in alignment with what God desires but are part of living in a broken, imperfect world. Nathalie Maragoni, a Christian associate marriage and family therapist who specializes in OCD, writes:
"...with OCD, we must remember that there is a physical problem happening in the brain (in the amygdala), which triggers our body's 'Fight, flight, and freeze' response when there really is no danger. Recognizing that OCD consists of egodystonic, unwanted and intrusive thoughts that are completely out of the person's control is the key here. People who have OCD aren't shooing to have these thoughts." 
The work, then, is to notice and recognize the egodystonic nature of these thoughts as something that is contrary to what God wants, and then to let them pass instead of giving them power by entertaining them. Then, Christians can focus on the work of healing our relationship with ourselves and with the Lord - reassuring ourselves of the truth of our identity in Christ - which will in turn help us change our relationship with our thoughts.
Looking at the heart
How does this align with the Biblical commandment to dwell on what is good and to not think lustfully, etc.? The same word for looking is used 1 Samuel 16:7 of the Bible, which says, “People look at the outward appearance, but the Lord looks at the heart.” I think this has both specific and general implications. Specifically, it seems here that God is saying that he examines not the outside, but the heart. However, in this verse, the idea of looking seems to imply an examination into the deeper motives and beliefs. 
Maragoni offers valuable insight, explaining, 'We can't control our thoughts, but simply having a thought that is a direct result of a malfunctioning brain is not a sin, but rather a result of... [living] in a broken world where any part of the body can get sick." Like mindfulness, we can practice a different response to these egodystonic thoughts, not giving them undue meaning and recognizing that they do not always tell us about who we actually are. Dr. Witzig says:
"If we tell ourselves not to think of something, our brain has to hold that thought in the front of our mind and then scans our thoughts to make sure we aren't thinking about what we aren't supposed to be thinking about. This is self-defeating. Alternatively, we can practice a model of 'shifting towards' thinking about what is pure, lovely, and good. The more we engross our minds on things that are in line with our values, the more the other things are going to dim in the background." 
Shifting our attention
For situations when it is difficult to figure out if a thought comes from the Lord or if it is a product of the world that we live in, I propose several guidelines. First, we must remember that mental illness can distort the thoughts to which we can give excessive meaning. Thus, it is important to work with a certified therapist. Secondly, anxiety feels urgent and demanding, while “the inner voice of love”  feels inviting and patient. Christians can look back to Biblical Scripture to affirm who we are and practice listening to the voice of the Holy Spirit.
Egodystonic thoughts are not God’s intention for people, and come from living in a broken world. However, we can experience healing when we change our relationship to our thoughts and resist the urge to let them tell us who we are. Dr. Witzig comments:
“OCD is an affliction, and we see time and time again in the Bible that Jesus deals with the afflicted through compassion and understanding. God’s grace is always given to us in the present. But our minds tend to go to either the future-tripping (anxiety), or the past where we dredge (discouragement and shame).” 
Working to fight the presence of egodystonic thoughts requires us to continually shift our attention back to the present where God's grace is, to turn our thoughts to what is "right, pure, lovely, and admirable." 
1. Kastens, Alegra. (July 2019). If the obsessions aligned with your values, they would not scare you as much. Instagram.
2. ERP Therapy. (n.d.). Intrusive Thoughts. Retrieved from https://www.intrusivethoughts.org/erp-therapy/.
3. Matthew 5:27-28, NIV
4. Witzig, Ted. (2019, Sep. 5). Personal interview.
5. Maragoni, Nathalie. (2019, Sep. 2). Personal interview.
6. Blue Letter Bible
7. Nouwen, H. J. M. (2014). The inner voice of love: A journey through anguish to freedom. London: Darton Longman & Todd.
8. Philippians 4:8
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