What is inference-based cognitive behavioral therapy or ICBT therapy?
Hmm ICBT therapy is a cognitive based therapy for OCD but it’s different from standard CBT and this is mainly because of its focus on obsessions and how it conceptualizes obsessions because an ICBT therapy team options:
- Primary viewed as doubts
- Inferences of that a conclusion about what you think might be true or not.
For example, the doubt that perhaps you did not lock the door correctly or the doubt that you might be contaminated or in the case of unacceptable thoughts. You may have to doubt that you could be a dangerous person that could do harmful things to others. All of these are obsessional doubts that set in motion all kinds of consequences.
Like if you forgot to lock the door then perhaps you worry about your house being robbed or that your family be unsafe. And if you feel anxious and start checking the door repeatedly. However all these consequences are distressing? They are not considered be the principle problem in OCD from an ICBT therapy perspective.
Why we need ICBT Therapy?
In OCD the problem is the inferences of doubts that precedes all consequence and sets the obsessional cycle in motion. On the other hand ICBT therapy goes back even further than that not only does ICBT therapy explicitly address these primary refers of doubts that set the cycle in motion.
It also looks explicitly what is behind them what’s behind these doubts. Because if obsessions are inferences. This implies that there are reason behind these doubts. These doubts don’t come from anywhere but there is a story behind all these. These stories come-out from OCD. Asking people about the doubts that they thought that, they tell you a reason and reason come-out form OCD and this is the real essence of ICBT therapy.
OCD Thought Patterns
Let assume an example of doubting that you didn’t lock the door correctly. Even though your senses (sight, hearing, touching) may registered that you have locked the door. OCD causes them to question or ignore the sensory information that your eyes, hands, hear have registered. You have the doubt even if you have just lock the door. So basically our brain overrides the act we just done with a doubt. There are various reasons give base to these doubts. Like “Key is not correctly turned”.
Normal vs Obsessional Doubts
- Normal doubts arise on the basis of our senses. For example, our ear listen the creak of the key, when you turned the key into the lock. These evidence provides you a reason to doubt.
- Obsessional doubts on the other hand lack basis to doubts. There is sensory information. No creaks of key. No visible issue. No feeling but the doubt still persist.
Obsessional Doubts Characteristics
Obsessional doubts are entirely base on imagination. These doubts has no relationship with reality. There is not role of senses in these doubts. These doubts are purely irrelevant to reality. These doubts often arises due to the fear of losing something like if the door is still opened then maybe there are chances of robbery. Or if she left her children at home alone. This is crucial to understand that the people with OCT doesn’t have a global problem with any logic or perception. These people decide on their own with undue doubts that “What if don’t look properly?”
Focus of OCD Therapy
Focus of OCD therapy is mainly on educating the patient to differentiate between the normal and obsessional doubts. OCD help people to separate both of these doubts. OCD also help people to recognize imagery construction without evidences. Give the understanding of obsessions. Faulty conclusions are the labels like the sentence “What if don’t look properly?” in these sentences, person is challenging the validity, not just the probability.
Therapeutic Approaches
In this treatment, the approach of the therapeutics is to compare the obsessional situations with the situations of self-trust. Assuming that you are crossing the road with no doubts. Since the OCD depends on the base of imagination-based stories. For overriding these stories, try to think about the resistance of the lock. The click of the key and many more which will dissolve the doubt.
ICBT (Inference-Based Cognitive-Behavioral Therapy) recognizes that some obsessions are driven by dreaded possible selves -the murderer, etc. By directly addressing the fear, therapy can reduce the power of obsessions they fuel. Reducing anxiety is another approach of therapeutic. This technique ties everything together. Ultimate goal of OCD is to trigger the thing opposite to that one which is triggering the problem or doubt. But anxiety makes it difficult. This is very difficult for highly anxious people and they more struggle to process information correctly.
ICBT Therapy Philosophy
The philosophy of ICBT therapy is “Doing Follows Knowing”. This phrase tells the secret that if you know something then you definitely do it. In OCD treatment, many approaches like exposure and response prevention, start with the doing. While in ICBT therapy, it doesn’t involve exposures. OCD steals this certainty, replacing it with ever-present doubt. ICBT therapy aims to restore it. This is powerful because it moves beyond symptom management to quality of life. The end game isn’t just fewer OCD behaviors but the ability to move through the world with the same ease as anyone else.
ICBT game changer for my OCD
Review of a client of ICBT therapy
“I’m posting simply to encourage others to find a therapist trained in ICBT if they haven’t been responsive to ERP.
This is an approach that is not gold standard like ERP, but my therapist has said she has multiple clients who have had success with it who did not respond to ERP. And it does not involve exposures!
I’ve struggled with OCD for years, really realizing I had it in 2019, but then doubting it at times. I’ve been to five different therapists before finding my current one. She introduced me to inference-based CBT for OCD, and it took a couple months before things clicked for me.
My primary compulsion is rumination, usually in the form of trying to figure out and resolve discomfort/anxiety by being careful (checking to make sure things are done “right”). My OCD is also fused with perfectionism which has made things hard because I’m constantly doubting if I’m doing things right. But once I realized I’ve been inferentially confused, and that I didn’t have to be so careful all the time, things really changed. I’ve just finished tapering off Zoloft after taking it for 6 months.
“Clinician’s Handbook for Obsessive Compulsive Disorder: Inference-Based Therapy” by Kieron O’Connor and Frederick Aardema has been a great resource. This is the book my therapist uses.
Good luck!”
Conclusion
ICBT stands for Inference-based Cognitive-Behavioral Therapy. The philosophy of ICBT therapy is “Doing Follows Knowing.” ICBT therapy is game changer for OCD. It has worked for all types of OCD. There might be some differences in how a therapist approaches it depending on the type of theme, and also what part of ICBT therapy clicks for you.
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