People with obsessive compulsive disorder can't just dismiss it, says Szymanski. Instead, they start what he calls the "thought-action fusion" process where the person believes that because he or she thought about letting the baby slip under the water, there's a chance he or she will lose control and do it.
After giving so much credence to a thought, a person with obsessive compulsive disorder tries to suppress it.
"When you try to push a thought away, they come back," said Szymanski. "But you tell someone 'don't think about pink elephants,' and the first thing you do is think about pink elephants."
In reaction, a person with scrupulosity or obsessive compulsive disorder will compulsively do something to temporarily counter this feeling like pray, bow or confess.
"But that little drop in anxiety in your compulsive behavior actually reinforces the anxiety the next time," said Szymanski.
To stop the obsessive compulsive spiral, therapists don't even try to stop the thoughts. They just try to sap the fear from the intrusive thought -- a difficult undertaking when the fear is of eternal damnation instead of germs or contamination.
"When you're talking about the possibility of someone going to hell, that is something that is just very difficult to challenge someone on," said Elyssa Kushner, a psychologist with the Center for the Treatment and Study of Anxiety at the University of Pennsylvania School of Medicine.
"That's where it becomes very tricky," Kushner said.
Obsessive compulsive disorder strikes less than 3 percent of the population, and only 10 percent of those with obsessive compulsive disorder also suffer from scrupulosity.
To use the standard exposure-response obsessive compulsive disorder treatment with someone who has scrupulosity, the therapy can sometimes appear blasphemous. For instance, some orthodox Jewish scrupulosity patients have been forced to sleep with a sandwich bag of bacon.
To treat Cole's scrupulosity, his therapist made him sit and write hundreds of sixes without writing a single seven. Then he took Cole on a field trip and forced him to litter.
"He took a piece of paper out of the trash and tore it in half and threw it on the ground, then gave the other half to me," Cole said. "I was really upset. I don't want to litter."
Cole's therapist even made him swear.
"He had me occasionally curse in these therapy sessions," Cole said. "I told him to screw himself, but it was actually a stronger word than that."
But for all the personal distress a person with scrupulosity faces in treatment, they have a fraction of a chance of adequately controlling their obsessive compulsive behavior.
"Two-thirds of people who go through treatment will see about 50 percent or more of reduction symptoms," Rego said.
Cole, who briefly studied scrupulosity in graduate school, knows this reality all too well.
Before his treatment he would occasionally have panic attacks when people around him used too many swear words. Once in college, he even broke down sobbing in a hallway.
"My sophomore year of college, it was just culture shock," Cole said. Once in a dance class, his classmates wanted to do a number to a song with very suggestive lyrics and sexually suggestive moves.