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Inference Based CBT (I-CBT) an alternative treatment approach to ERP


Inference Based Cognitive Behavioral Therapy (I-CBT) is an evidence-based treatment for Obsessive Compulsive Disorder (OCD). It was created by Frederick Aardema, PhD and Kieron O’Connor, PhD. in the late 1990s. I-CBT is gaining popularity in the U.S. as an alternate treatment approach to Exposure with Response Prevention for OCD. It is a cognitive model (looking at how we think about things) but has distinct differences from traditional CBT. 


In I-CBT, our goal is to understand the reasoning process which gets us pulled into OCD’s bubble. This involves comparing the reasoning processes an OCD sufferer engages in day-to-day. Where they trust themselves and their senses (normal reasoning) and where they don't (obsessional reasoning). 


Showing the difference between normal and obsessional reasoning
Normal vs. Obsessional Reasoning

In normal reasoning, we use our perception, direct evidence from the senses, and other relevant data in the here-and-now to make decisions. In obsessional reasoning, there is an over-reliance on possibility, irrelevant associations, and a general distrust of the self. This faulty reasoning process generates obsessional doubts, which then prompt a sequence ending in a compulsion. 



Obsessional sequence examples for hit and run OCD and relationship OCD
Obsessional Sequence examples for OCD

In I-CBT, we aim to resolve the obsessional doubt at the start of the sequence. We do this by learning about the process and becoming skilled at watching our mind. The model is focused on trusting yourself and your senses to make appropriate conclusions. We do this by understanding your Vulnerable Self Theme, and other factors which make us more susceptible to OCD’s suggestions. 


This model differs from Exposure with Response Prevention in a few ways. I-CBT is a cognitive model rather than a behavioral one. Through a series of 12 modules, you will learn how OCD has pulled you into the “bubble” and become skilled at turning back from obsessional reasoning. I-CBT’s treatment target is the obsession rather than the anxiety and compulsion. Despite the treatment targets being different, I-CBT and ERP share the same goal: getting you freedom from your OCD! When done appropriately, both treatment approaches are evidence-based, compassionate, and goal focused. 


At Westside OCD & Anxiety Center, we offer both ERP and I-CBT to clients with Obsessive Compulsive Disorder (OCD). We encourage all clients to look into treatments and decide which one they'd like to pursue. More information about these treatments can be found on icbt.online and iocdf.org.


Madeline Moersch, LCSW is a psychotherapist in private practice in Los Angeles, CA specializing in the treatment of OCD and Anxiety Disorders. She is the owner of Westside OCD & Anxiety Center, seeing clients in California and New York.



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