Many individuals experience symptoms of Obsessive Compulsive Disorder (OCD) that impact their daily functioning, education, work life and relationships. Individuals are often wondering, what is the best treatment for OCD? Could it be I-CBT for OCD?
As 2024 comes to a close, we want to provide a guide for mental wellness if you are an individual experiencing symptoms of OCD. Read on as we discuss five strategies using inference-based CBT for OCD; a powerful, evidence-based OCD treatment.
What is Inference-Based CBT for OCD?
I-CBT for OCD is an OCD treatment approach for OCD that is based on years of research. A key tenant of this approach is that obsessions are experienced by an individual as excessive doubts about what “might happen” or “what could be”. These obsessions are doubts that arise due to faulty reasoning processes, experienced by an individual with OCD.
Within a more traditional approach for symptoms of OCD, we might understand these thoughts to be “intrusive” and while intrusive thoughts are “normal” and happen to everyone (with or without OCD), obsessions are not understood as necessarily developing from intrusive thoughts. Within the I-CBT for OCD model, obsessions are viewed as being inferences or doubts that can emerge because of these faulty reasoning processes.
For example, if someone locks their door and walks away and thinks “Maybe I didn’t lock the door?” they might go back and check. Upon checking the door again (perhaps giving it a jiggle or locking and unlocking the door) they walk away and think “Wait, maybe by locking the door again, I actually broke the lock. Maybe it is really unlocked now; I should check again”.
This could cause an ongoing loop of checking and doubting, with each check further propelling the individual into a doubting process. However, this doubting process is not based on anything that happened when the person locked the door and checked it (over and over again). Instead, these doubts, or inferences, arose through an obsessional reasoning process that took place during the lock-checking behaviour. Obsessional reasoning plays a pivotal role in the obsessional story that drives the symptoms experienced by someone with OCD.
Inference-based CBT for OCD can take place during online therapy. In doing so you are able to screen share with your therapist and work through the key cognitive exercises in order to learn the skills and strategies in a manner that allows you to then work on these tools in-between sessions. Individuals often find this to be a very useful way in which they can learn this therapeutic approach.
How is I-CBT for OCD Different from Traditional CBT for OCD?
Many people wonder about Inference-Based CBT vs ERP for OCD. I-CBT for OCD is an approach developed by Dr. Frederick Aardema and Dr. Kieron O’Connor. This therapy approach is different from CBT-Based ERP treatment for OCD. ERP treatment for OCD focuses on helping people to approach triggering events, words, individuals etc. that they would typically avoid and do so without engaging in their compulsions. Part of this approach also involves working with individuals to fully identify their appraisals and core fears related to these obsessions/intrusive thoughts. In other words, what is driving the avoidance of those triggers in their world?
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. Underlying this fear might be a fear of being vulnerable or missing out on life should they get sick. There can be many different appraisals and underlying fears that drive the intrusive thoughts. Working with an individual to understand that in the context of OCD treatment is an important and powerful part of the intervention.
Following this, your therapist will help you to create an ERP hierarchy or roadmap of things that you deem important to try out in order to push back against these core fears. This work can be difficult but it can allow you to live your life in a manner that is much more aligned with your values and things that are important to you.
During I-CBT for OCD, as described, obsessions are conceptualized as doubts that have emerged as a result of the obsessional reasoning that has taken place. Importantly, these doubts are extremely believable when they happen and often result in confusion for the individual between what is happening in reality (right in front of them) and what is happening in the context of the obsessional story that they are thinking about. In this manner, the OCD story is being fuelled by the power of our imagination.
This confusion between what is happening in reality and what is happening in our imagination is called inferential confusion. During the course of I-CBT, we will work with you to unwind this inferential confusion process and allow for the obsessional reasoning to not take place as readily.
You might wonder, how can these obsessional doubts be resolved. Part of the learning process in I-CBT for OCD is about understanding that obsessional doubts arise differently than “normal” or “reasonable” doubts. Doubts that we experience outside of our OCD themes often occur because of situations that are based on relevant doubts and are supported by evidence existing 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.
Five Key I-CBT for OCD Strategies
I-CBT for OCD is a cognitive processing-based approach. Although there are no specific strategies that you will learn, there are important ideas and skills you will learn that fit within the model of I-CBT for OCD. Below, we highlight 5 of those key strategies:
1. Unwinding the Inferential Confusion Process
We have talked a lot about the inferential confusion process. And how this inferential confusion is responsible for the obsessional reasoning and obsessional narrative that takes place and fuels symptoms of OCD. In order to begin to unwind this process, we want to raise our awareness as to when OCD is taking over. In order to do this, we want to become more aware of our OCD sequence.
It usually looks like this:
Trigger
Obsessional Doubt
Consequence of Doubt
Anxiety
Compulsion/Avoidance
One of the first strategies when working with a therapist during OCD treatment is to become more aware of these triggers and the rest of the sequence that follows. By mapping out the sequence with your therapist and on your own, in between sessions, you will raise your awareness of how the sequence is forming. This is one of the first steps in unwinding the inferential confusion process!
2. Begin to Trust in Your Senses
During inference-based CBT for OCD, you will speak with your therapist about the idea of trusting in your senses. Why might that be so important? Well, obsessional reasoning is driven by an over-reliance on possibility, irrelevant associations and distrust in our senses. Therefore, learning to trust in our senses is another strategy that we use within the model of I-CBT for OCD. With your therapist during OCD treatment, you will learn to:
- Practice trusting in your 5 senses within the domains of your OCD doubts – sight, sound, touch, taste and smell
- Learn about your sense data – which includes our 5 senses as well as our common sense
- Recognize that you trust in your senses during situations that do not involve your OCD
Through this process of trusting in your sense data, you will learn that decision-making under the story of OCD does not reflect what is actually happening in reality! It is based on reasoning processes that get their energy and power from your imagination.
3. Trust in Yourself
Within the context of ERP treatment for OCD, you might have heard your therapist speak about “leaning into uncertainty”. However, within inference-based CBT for OCD, you will actually start to learn to gain certainty within domains that your OCD tries to take over!
Gaining certainty is all about trusting in your senses, trusting in your common sense and trusting in YOU; not who OCD tries to convince you that you might be should you not engage in your compulsions! This might seem like a different process than what you have experienced during the course of OCD treatment in the past. And it might have felt like the most effective OCD treatment. However, it is not the only way to overcome your symptoms of OCD!
Inference-based CBT for OCD does approach the idea of certainty differently that you might have learned about. However, gaining certainty and trust in yourself is a significant way in which you can learn to overcome your symptoms of OCD.
4. Staying in Reality
You will learn different strategies for this within the I-CBT for OCD model. But the idea behind this is that you learn how to stay within reality and not veer off into OCD land. Once you move from reality into your imagination you have entered what is referred to as the OCD Bubble. Within the bubble, you are compelled to carry out your rituals. Instead, you will work with your therapist to trust in your senses, trust in your common sense, and rely on probability that is based on direct evidence as well as relevant association.
Although this might sound like there are a lot of things to learn, it is all very manageable when working with a therapist trained in inference-based CBT for OCD. Furthermore, these are actually reasoning processes that you use routinely within areas outside of your OCD! In that way, you are not being overwhelmed with new skills. You are actually being empowered to use the skills you have within your areas of OCD.
5. Getting to know the REAL YOU
Another key concept that you will discuss during Inference-based CBT for OCD is the idea that OCD compulsions happen in order to “protect” you from becoming your feared possible self. Your feared possible self is a version of yourself that doesn’t actually exist but OCD has created narratives that suggest you might become that person should you let your guard down and not enlist your rituals and compulsions.
Through the work of I-CBT for OCD with your therapist during OCD treatment you will begin to learn that who you really are is nothing like what OCD is suggesting! Although this will be a process it will be a helpful journey of beginning to explore the real you and find out who you are to others and, eventually, yourself. Changing the obsessional narrative will allow you to develop an alternate story that is eventually reflective of your Real Self and not your OCD Feared Possible Self!
Where Can I Find Inference-Based 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!
References
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.
https://criusmm.ciusss-estmtl.gouv.qc.ca/fr/chercheur/frederick-aardema
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