Inference-Based CBT (ICBT)

Have you been struggling with OCD? Have you tried ERP but it didn’t work for you? Are you feeling hopeless that you won’t be able to find help? While ERP has long been recognized as the “Gold Standard” treatment for OCD, it may not be effective for everyone. A newer approach called Inference-Based Cognitive Behavioral Therapy (ICBT) offers an alternative to ERP with similar effectiveness. ICBT may be a good choice for you if you have found exposure therapy to be too anxiety provoking or if you have had limited success with ERP.

The anxiety therapists at Anxiety Center of Tampa are pleased to be providing
Inference-Based Cognitive Therapy for OCD. If you are experiencing uncomfortable obsessions and find it difficult to stop obsessing, this may be a good treatment option for you. We offer both in-person and telehealth therapy for those seeking OCD treatment in the Tampa Bay area and telehealth for those seeking an OCD therapist in Florida.

Inference-Based Cognitive Behavioral Therapy helps clients recognize the reasoning errors fueling their obsessional doubt and learn to trust their senses in the “here and now”, instead of becoming absorbed in imagination. 

This approach also helps clients change negative beliefs about themselves that underlie the obsessional doubt. 

According to ICBT:

• Uncomfortable obsessions are internally generated doubts, rather than random intrusive thoughts.

• These obsessional doubts come from a person's faulty reasoning about what is possible (not probable), in the future. 

• These hypothetical possibilities are based solely in one’s imagination and are fueled by a frightening story (obsessional narrative) that is rehearsed each time a trigger is encountered.

• The obsessional narrative does not consider evidence from a person's current circumstances, senses, common sense, or intellect. 

• The OCD story takes the person away from reality. They lose touch with the here and now and enter an "OCD bubble". • The imagined story seems so real that the person experiences feelings of anxiety and discomfort.

• Compulsions are performed in a (misguided) attempt to reduce the anxiety and decrease the chance of the story coming true.

• The compulsions reinforce the belief in the obsessional narrative. 

• Obsessional themes are not random. Instead, their content reflects a “Feared Self or Vulnerable Self Theme”. For example, in Harm OCD, a person may have the underlying fear that “I might be the type of person who is neglectful”. This feared self is not based in reality but rather in a distorted self-perception.

What is ICBT?

An Alternative to ERP?

ERP has long been considered the first line treatment of choice for OCD, and it can be very effective for those who complete treatment. However, many people find it difficult to tolerate the anxiety involved in facing their fears and either refuse to participate in treatment or drop out due to the distress encountered during prolonged exposure. Often, even in those who complete ERP, residual symptoms may remain or recur after treatment ends.

ICBT does not use prolonged exposure, and instead focuses on strengthening reality-based reasoning. This approach may be especially helpful for those who have not had success with ERP, do not want to tolerate the anxiety involved in planned exposures or who firmly believe their obsessions are realistic and reasonable. 

Studies have found that ICBT is just as effective as ERP in reducing OCD symptoms and has a higher rate of remission. This means that people who were treated using ICBT were able to return to and maintain normal functioning in greater numbers than those who went through ERP.  

You can find more peer-reviewed studies related to ICBT at the following link: https://icbt.online/publications/

What to expect from ICBT

You may be wondering what to expect from ICBT and how it will be different from techniques used by other therapists for OCD. As noted above, ICBT is not focused on doing prolonged exposures to feared situations in order to habituate to the anxiety or learn that a situation is safe. Instead, you will work with your therapist to: 

  • Develop an understanding of the obsessional doubt that fuels your anxiety and compulsions.

  • Recognize the stories OCD tells you that make your doubt seem true. Doubting stories usually include “what if” and "maybe..." statements.  

  • Recognize the reasoning errors in the OCD story which lead you to believe your feared outcomes are possible. 

  • Compare the way you think in OCD situations to the way you think in other situations. For example, if you look both ways before crossing the street and see no cars, you most likely don’t doubt what you saw and then get lost in a story about “what if there was a car coming and I didn’t see it?” You trust your senses. 

  • Learn to recognize the doubt for what it is: a made-up story that doesn’t need to be taken seriously.

  • Develop a more reality-based “alternative story” that is grounded in facts, common sense, and trust in what your senses are telling you is happening in the present moment.

  • Recognize the obsessional doubt when it arises and become aware of when you cross over into your imagined story. When this happens, you will practice taking a moment to reflect on what is happening and to see that you have a choice to stay grounded in the alternative story or become absorbed in your imagination.

  • Identify and confront your “feared self/vulnerable self theme” and see that there is evidence that you are this person. 

  • Look at the facts about your “real self” and gain confidence in who you are. Gaining confidence is an important part of the program. 

  • Practice feeling confident in your senses and start to deal with OCD situations the same way you do in non-OCD situations.

Anxiety Center of Tampa’s Approach to OCD Treatment

At Anxiety Center of Tampa, you will have the opportunity to have the most individualized treatment options that are right for you. Our therapists understand that everyone is at a different place in treatment. Your treatment is tailored to meet your exact needs as our therapists can provide as little as a 30-minute maintenance check-in session, the standard 50-minute weekly session, or as much as a custom, 1 on 1, intensive outpatient option. Our therapists can also meet you in public locations if your treatment plan calls for it. Ultimately, you and your therapist will work together to identify the treatment frequency and location that is best for you and will continue to re-evaluate your needs throughout the duration of your treatment.