What is I-CBT for OCD? If you experience symptoms of Obsessive Compulsive Disorder, you might be very familiar with ERP treatment for OCD. You might be wondering what is the best treatment for OCD. Have you heard of Inference-Based CBT (I-CBT) for OCD? Read on to learn more about what I-CBT for OCD is and how it can help your symptoms of OCD. 

Obsessive Compulsive Disorder (OCD) is a serious mental health condition that impacts up to 1% of Canadians. Symptoms of OCD may interfere with your social functioning, education and/or work, daily activities and overall quality of life. In order to feel better, you may want to seek out treatment for OCD and anxiety. 

The Role of Inferential Confusion in OCD

During I-CBT treatment for OCD, your therapist works with you to help you unwind a process called inferential confusion

Inferential confusion is the process by which someone confuses what might be happening from within us (i.e., in our imagination) with what is actually happening in the present moment. Inferential confusion can be measured by a questionnaire, which allows us to understand how much inferential confusion is endorsed by an individual. Higher levels of inferential confusion have been found to be indicative of an individual experiencing symptoms of OCD. 

Understanding what inferential confusion means is essential when engaging in I-CBT for OCD. Treatment for OCD and anxiety with I-CBT focuses on understanding, recognizing and unwinding this inferential confusion process. Then can you begin to acknowledge that your experiences exist in the here and now, not within the OCD story, that has been developed without any direct evidence. Our OCD story is driven by processes of inferential confusion. 

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, you will learn how to slow down and unwind this seemingly automatic process. In order for this to be the most effective treatment for OCD, your OCD therapist will work with you in order to help you stay firmly planted in the reality of the here and now. 

Understanding I-CBT for OCD

What happens during treatment for OCD and anxiety with I-CBT? I-CBT for OCD is an evidence-based treatment approach and the main idea of this therapy is that obsessions are excessive doubts about what “could be” or “might be”. For example, if someone touches a doorknob they might then think” “I might be contaminated” or “I might have touched blood”. These doubts are not based on seeing anything on the doorknob. They are based on doubts that arise through the obsessional reasoning process.  

As described, this obsessional reasoning process is based on a narrative that is based on: (1) distrust of the senses; (2) over-reliance on possibility; and (3) irrelevant associations. This reasoning process fuels our obsessional doubts. Because these processes are not based on direct evidence from reality, you will learn that they are based on narrative from within our imaginations. 

This approach was developed by Dr. Frederick Aardema and Dr. Kieron O’Connor. This therapy approach is different from ERP treatment for OCD. ERP treatment for OCD focuses on supporting individuals to approach people or events they would typically avoid and do so without engaging in their compulsions. For example, one might fear touching a doorknob because they believe there are germs on it and they might get very ill. The appraisal of the doorknob is that it is now dangerous and should be avoided.

During ERP treatment for OCD, your therapist will work with you to tolerate the uncertainty of the possibility of germs being on the doorknob and touch it anyway without engaging in any ritualistic behaviour (i.e., excessive handwashing or opening the doorknob with gloves). During ERP treatment for OCD, individuals learn to tolerate uncertainty and not know the outcome of what might happen when one does not perform their rituals. Individuals also learn to navigate their feelings of anxiety and distress in order to be able to carry out actions and events that are meaningful and important. One learns that this can be accomplished despite experiencing anxiety. This can be very powerful and effective

During I-CBT for OCD, obsessions are understood to be doubts that emerge as a result of obsessional reasoning that has taken place. These doubts are extremely believable when experienced and often lead to confusion between what is happening in reality and what is happening within the context of the story presented to us by our OCD. In this way, the OCD story gains its power from our imagination. As described, this confusion between what is happening in reality and what is happening in our imagination is referred to as inferential confusion. How can these obsessional doubts be resolved?

Part of the learning process in I-CBT is about gaining an understanding that obsessional doubts arise differently than “normal” or “reasonable” doubts. Doubts that we experience outside of our OCD often arise as a result of situations that are based on relevant doubts and are supported by evidence in the here and now. By learning about these processes and how doubts develop during OCD treatment, you can start to shift the process of this way of thinking. 

Preparing for I-CBT: What to Expect

What will happen during my sessions? You might be someone who has undergone ERP treatment for OCD. During that type of OCD treatment, you will be learning to tolerate distress and uncertainty when encountering situations that your OCD often focuses on. 

During I-CBT for OCD, you will learn to:

  • Trust in your five senses
  • Trust in your “sense data”, which includes our common sense
  • Focus on evidence in the here and now
  • Focus on what is possible based on direct observation
  • Recognize when you are making irrelevant associations – driven by your OCD story

You might be thinking – how will I ever learn how to do that? The great news is – you already have these skills! You are able to engage in reasoning processes like everyone else in situations that are not connected to your OCD narratives. You actually don’t have to learn these skills during treatment for OCD treatment. You will learn ways to apply these skills and strategies during situations that usually trigger your OCD – and this will feel very new. However, by learning that your obsessional doubts are driven by your imagination and your OCD, you will be able to gain a sense of confidence and trust when you don’t engage in your rituals. Trust in who? Trust in yourself!! 

You might be wondering whether I-CBT can be used with both adults and teenagers. I-CBT can be an OCD treatment for teenagers and adults. The same key concepts will be taught to youth and materials can be adapted to ensure an understanding during a younger stage of development. 

I-CBT for OCD is definitely an OCD treatment that you will want to learn more about! It may turn out to be the best OCD treatment for you!

Effectiveness of I-CBT for OCD

Research has been accumulating to support the effectiveness of I-CBT for OCD. The body of scientific evidence is constantly growing and there are now over 100 research papers that support the positive impact this treatment can have on someone with OCD. A recent randomised control trial has been published showing the effectiveness of this treatment in a similar manner to ERP treatment for OCD. If you are someone who has already tried ERP treatment for OCD and you are still looking for help for your symptoms of OCD, I-CBT for OCD might be for you!

Where Can I Find I-CBT for OCD

Does FTPS offer Inference-Based CBT for OCD near me? We do! We offer this CBT treatment approach for youth, teens and adults. Our clinicians have completed training in I-CBT and continue to engage in professional development in order to provide you with the best treatment possible.  We deliver online OCD treatment across Canada, throughout  Ontario, Nova Scotia, British Columbia and New Brunswick. We look forward to hearing from you so we can tell you about our treatment approaches and services. 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

Law C, Boisseau CL. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag. 2019 Dec 24;12:1167-1174. doi: 10.2147/PRBM.S211117. PMID: 31920413; PMCID: PMC6935308.



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