Why Consider Inference-Based Cognitive Behavioural (I-CBT) Therapy?

Many individuals experience symptoms of OCD throughout their lifetime. In fact, we know that approximately 1% of the global population experiences such symptoms, which translates into approximately 70 million folks throughout the world. There are likely even more people who experience such symptoms but have not yet received a formal diagnosis.  

It is imperative that individuals with OCD receive evidence-based, effective treatments. We know that traditional CBT has been very helpful for individuals with OCD. However, it is not a magic wand and does not help everyone with their symptoms. Therefore, it is important for OCD therapists to have more tools in our therapist toolbox.

I-CBT is a type of cognitive OCD therapy that has been shown to be an effective treatment for OCD. A recent multicenter randomized control trial found that I-CBT was associated with significant decreases in OCD symptoms following intervention. I-CBT also led to greater improvements in overvalued ideation (i.e., exaggerated beliefs within the context of OCD that are not necessarily delusional) and increased rates of remission compared to Mindfulness Based Stress Reduction intervention. 

Therefore, I-CBT for OCD provides us with another tool to provide obsessive compulsive disorder treatment. Read on to understand this type of OCD counselling and why it might be helpful for you!

Key Ideas Within I-CBT Treatment for OCD 

I-CBT treatment for OCD works with the individual to help them unwind a process called inferential confusion

Inferential confusion is the process in which we confuse what might be happening from within us (i.e., in our imagination) with what is actually happening in reality. Inferential confusion can be measured by a questionnaire, which allows one to see how much inferential confusion they are experiencing. Higher levels of inferential confusion have been found to be indicative of an individual experiencing symptoms of OCD.  Understanding the concept of inferential confusion is essential in I-CBT. Treatment for OCD with I-CBT focuses on unwinding this inferential confusion process and allowing clients to understand experiences as they exist in the here and now, not within the OCD story that has been developed without any direct evidence. 

The term obsessional reasoning, as compared to normal reasoning, is another essential term that is important in I-CBT. The obsessional reasoning process begins right after we have experienced a triggering event. When obsessional reasoning occurs, it pulls from an overreliance on possibility, not using direct evidence or trust in our senses and focusing on irrelevant associations. When obsessional reasoning occurs, an obsessional doubt is formed. Following that, the obsessional sequence occurs and individuals very quickly get pulled into inferential confusion. 

In I-CBT treatment for OCD, we learn how to slow down and unwind this seemingly automatic process. Your OCD therapist will work with you in order to help you stay firmly planted in the reality of the here and now. 

Read on for an overview of the I-CBT treatment for OCD program. We will provide an overview of all 12 modules! 

Overview of the I-CBT Treatment Program 

In order to fully understand the tenants of I-CBT, we will walk you through the modules that you will learn when learning this form of treatment for OCD. 

I-CBT for OCD therapy

Module 1: Your OCD therapist will help you to learn about what I-CBT is and how your obsessional sequence forms. In order to understand how this sequence is created, you will need to understand what an obsessional doubt is. Without an obsessional doubt, there would be no symptoms of OCD. It is also important to understand that our obsessional doubts do not come out of the blue. You will learn that these doubts are connected to important beliefs that we have about ourselves and who we want to be. 

Module 2: You will now begin to understand that there is a logic to the story created by your OCD. This is a very important part of the learning in I-CBT treatment for OCD. You will learn in this type of OCD therapy that there is justification behind the doubts which are often in the form of: abstract facts, rules, hearsay, personal experience and possibility). However, you will also learn in this type of OCD counselling that these doubts are not necessarily “correct”. 

Module 3: You will now learn about the entirety of your obsessional narrative. We will give OCD the microphone and allow it to tell its story in detail. We will then identify the areas of obsessional reasoning within our story. Through this process, it becomes clear that OCD is only one possible story. We will construct alternative stories so you can learn that the obsessional narrative is not the only story that is believable!

Module 4: We will now discuss what type of person you are afraid you might become if your OCD is “right”. Your OCD therapist will ask you questions such as, “what type of person would leave a door unlocked, not wash their hands properly or forget to re-read their homework?” You might reply “the type of person who is careless, negligent or selfish”.

Your OCD has convinced you that you can only not be this type of person by engaging in compulsions or rituals. However, there are actually many ways in which you are not that person, regardless of rituals and compulsions. Through this process, you will start to believe in your true self, not who OCD wants you to think you might become. 

Module 5: Your OCD therapist will help you learn that OCD uses information from within us; within our imagination. In this way, OCD is not using direct evidence in the here and now. It is using evidence that solely exists within our imagination and, in this way, the OCD story is not to be believed. You will start to notice when you are crossing the bridge from reality into the land of imagination; where OCD takes over. 

Module 6: OCD treatment now focuses on the idea that the doubt that OCD creates is 100% irrelevant. Given that there is no direct evidence for this doubt, there is an overreliance on possibility. Obsessional doubt does not stand up to evidence in the here and now. Therefore, we can learn to conclude that it is irrelevant. 

Module 7: You will now learn about the OCD bubble during this phase of OCD treatment. You will learn that when you enter the bubble, your OCD has taken over and you feel compelled to perform rituals and compulsions. Although the rituals and compulsions might feel helpful, they are not. When entering the bubble, one is often acting against their values and the person that they want to become. When you enter the OCD bubble you have left reality and are moving further and further into the obsessional doubt. 

Module 8: This module focuses on a very important concept in I-CBT for OCD treatment. It is called reality sensing. You will have already learned that OCD doubt is false and that OCD arises without direct evidence from the here and now. We also know that OCD occurs without any evidence in reality. But, most importantly, you will now learn that your OCD doubt actually goes against reality. You will learn how to actually use your sense data (5 senses, common sense data) in the here and now to dismiss your OCD. You will remain firmly planted in reality. This will allow you to not cross the bridge and not enter the OCD bubble. 

Module 9: You will learn how to construct a different story. This story is called the alternative story. This alternative story will be very rich in details and will slowly begin to allow you to understand how OCD is simply just a story. The alternative story is another way in which you are shifting the process of your thinking during this treatment for OCD.

Module 10: Here we will talk about the tricks and cheats of OCD! OCD has many tricks up its sleeve to convince you that your obsessional doubts are “true” and that you must follow through with the obsessional narrative. You will learn how to spot them!

Module 11: Finally, your OCD therapist will help you to develop and embrace the Real Self. This is the person that you really are, not the person that your OCD wants you to be. You will reconnect with your authentic self and trust in yourself to be the person you want to be. 

Module 12: In this module, you will review relapse prevention strategies and how you can continue to use everything you have learned to shift the process of your thinking away from the OCD story and the obsessional doubt. You will now be living in reality, in the here and now, and using processes of normal reasoning to guide all of your thinking. You will have gained trust in yourself and recognize who your authentic self truly is. 

I-CBT for OCD: How Can I Find an OCD Therapist?

You might be thinking, wow, this sounds fantastic! How can I find I-CBT for OCD? Does FTPS provide I-CBT for OCD near me? We certainly do! Our team has taken the time to engage in training, supervision and consultation for I-CBT for OCD. We look forward to working with you and teaching you all about OCD, obsessional doubt and how to value your authentic self and not your OCD! Contact us today!


Ardema F, Bouchard S, Koszycki D, Lavoie ME, Audet JS, O’Connor K. Evaluation of Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial with Three Treatment Modalities. Psychother Psychosom. 2022;91(5):348-359. doi: 10.1159/000524425. Epub 2022 May 18. PMID: 35584639.

Aardema, F., Wu, K.D., Careau, Y. et al. The Expanded Version of the Inferential Confusion Questionnaire: Further Development and Validation in Clinical and Non-Clinical Samples. J Psychopathol Behav Assess 32, 448–462 (2010). https://doi.org/10.1007/s10862-009-9157-x


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