Inference-based CBT

Inference-based CBT (I-CBT) is an evidence-based treatment for OCD with over 25 years of research  supporting it. I-CBT is a modality designed by Frederick Aardema, PhD and the late Kieron O'Connor, PhD. It is used around the world and is becoming more popular in the United States in large part due to OCD specialists, who have lived experience of OCD themselves, finding merit in the treatment. 

I-CBT does not use exposures. It attempts to teach sufferers WHY they get the specific OCD doubts they get and HOW to resolve them. According to I-CBT, the problem within OCD is HOW the obsessions get created - this is called the Obsessional Reasoning Process (AKA Inferential Confusion). When we resolve the obsessional doubt aspect of OCD, then the anxiety and compulsion aspects don't happen. According to I-CBT, the "obsession" part of OCD is not random. These are not intrusive thoughts, but obsessional doubts that develop for specific reasons due to Inferential Confusion.

I-CBT sees OCD as a Disorder of Doubt, Imagination, and Trust in the Senses. When someone doubts that they have locked a door ("Maybe I didn't lock the door"), they have lost certainty in what their senses (including common sense) are telling them. They also have a narrative full of reasoning that is very convincing. When we zoom out, we can see that the reasons the person is using to support their obsessional doubt can be true, but within OCD, that reasoning isn't being applied correctly to the situation that is happening in that moment. For example, it is true that houses catch on fire. But is there smoke? Are there flames? Is there direct evidence in THIS moment that supports the obsessional doubt, "Maybe my house is on fire"? 

People with OCD have an over-reliance on their imaginations, use irrelevant associations, and have a propensity to dismiss actual evidence from their senses. Most people reason through perception, common sense, and who they know themselves to truly be. People with OCD do this in all aspects of their lives that don't involve OCD. But when OCD is triggered, they end up using their imaginations over their sense of self, common sense, internal sense data, and 5 senses. 

At the heart of OCD, sufferers are fearful that they will become someone they don't want to be: someone negligent, or immoral, or someone who hurts others, or someone who is inattentive, etc. What we find is that people with OCD are the opposite of this Feared Possible Self that they worry they will become if they do not do their compulsions. 

In I-CBT clients learn the following:
- OCD follows a sequence.
- People with OCD have reasons behind believing their obsessional doubts. The reasons aren't the problem. It is how they are applied to the present moment through the Obsessional Reasoning Process that  is causing the sufferer pain.
- How OCD constructs a convincing story.
- How to identify their Feared Possible Self, and why they get the specific obsessional doubts they get.
- How to identify reasonable vs obsessional doubts and the importance of direct evidence from the senses.
- How something being possible doesn't make it relevant without direct evidence from the senses to back it up.
- Why OCD narratives feel so real
- How to gain back trust in the senses
- How to tap into a narrative about Reality instead of OCD's story
- Specific ways that  OCD hijacks the reasoning process that makes OCD seem like  it has solid evidence
- Who they are in Reality compared to their false Feared Possible Self.
- Relapse Prevention

The OCD Sufferer and their therapist will do a series of lessons with the therapist teaching HOW the sufferer constructed the OCD narratives that are present and then teaching them how to take those narratives apart so that the doubt is resolved. Resolve the doubt, and the anxiety and compulsions no longer exist. 

I-CBT can be an incredibly powerful modality. Like all treatment modalities, it may not work for everyone. Please reach out to an I-CBT trained therapist for more information about I-CBT.

If you are clinician wishing to learn more about I-CBT through training or consultation, please visit the OCD Training School's training offerings HERE. 

Podcast Episodes Featuring I-CBT:

Medical Disclaimer
Although I am a therapist by profession, I am not YOUR therapist. All content and information on this website is for informational and educational purposes only, does not constitute medical advice, and does not establish any kind of patient-client relationship by your use of this website. A patient-client relationship with you is only formed after I have expressly entered into a written agreement with you, and you have signed all of my practice documents, including a consent for treatment. Although I strive to provice accureate general information, the information presented here is not a substitue for any kind of professional advice, and you should not rely solely on this information. Always consult a professional in the area of your particular needs and circumstances prior to making any medical or mental health related decisions.