Inference-based Cognitive Behavioral Therapy (I-CBT)
by Frederick Aardema, PhD, Michael Heady, LCPC, Bronwyn Shroyer, LCSW, Stacy Sanders Shaup, PhD, Catherine Ouellet-Courtois, PhD, Kelvin Wong, PhD, Katie Marrotte, LCSW, & Henny Visser, PhD
Inference-based cognitive-behavioral therapy (I-CBT) is a psychological treatment designed specifically for OCD. It typically begins with 1–2 sessions focused on rapport building, psycho-education, and assessment of your symptoms. Your therapist will also assess for a particular type of reasoning called inferential confusion.
Once these initial sessions are completed, you and your therapist will go through a series of treatment modules in which your therapist will help you learn to identify the differences between normal reasoning and inferential confusion. You will be taught how your obsessional doubts come about and how to identify the reasoning tricks OCD uses to convince you to listen to your obsessional doubts.
The idea in I-CBT is that if you understand how obsessional doubts are created, you can resolve them. By helping you identify the specific reasoning errors involved in the creation of obsessional doubts, I-CBT helps you resolve obsessive thinking as well as any associated anxiety and compulsions, since they are dependent on these obsessional doubts.
A typical course of I-CBT spans anywhere from 18 to 24 one-hour sessions, but the number of sessions depends on each individual person’s needs. In between sessions, you will practice the skills you learn in therapy. I-CBT can be delivered in person or virtually. Although weekly individual sessions are most commonly used, I-CBT can be delivered in group and intensive formats as well. Self-help resources can also complement the therapy.
I-CBT is administered by mental health professionals such as psychologists, social workers, or counselors who have received proper training, incorporated I-CBT into their practice, and are licensed to provide psychotherapy. To find a qualified provider, consult the official I-CBT website.
WHY/HOW IT WORKS:
I-CBT works by helping you identify and resolve inferential confusion. Inferential confusion is a type of reasoning process that creates obsessional doubts. By identifying and purposefully slowing down that process, you will begin to recognize its components: distrusting your senses/self, over-relying on possibility, and using facts and information outside of their intended context. This will then enable you to correct your reasoning process and shift your attention toward observable reality when facing something that has previously triggered your OCD.
SUMMARY OF THE RESEARCH SUPPORT:
I-CBT is an evidence-based treatment for OCD with a growing number of clinical studies and randomized controlled trials. These studies have shown that most patients experience a significant reduction in symptoms and improved quality of life following I-CBT. There is also evidence from laboratory-based experimental studies to support the role of obsessional reasoning (inferential confusion) and feared possible selves in the development and maintenance of OCD symptoms.
AGE CONSIDERATIONS:
At this time, I-CBT has been primarily studied with adults. The treatment has been successfully adapted for use with children in case studies but there is a need for additional research in this population. Consequently, parents or guardians of children should be fully informed on the current state of research to be able to provide informed consent for I-CBT, including its limitations and potential benefits depending on the child’s condition and previous history.
An important consideration when working with children is whether or not a specific child has reached the developmental ability to know the difference between imagination and reality. For this reason, I-CBT may not be an effective treatment in younger children.
OTHER IMPORTANT CONSIDERATIONS:
Even though I-CBT is not effective for everyone, research has generally shown improvement across the major symptom dimensions of OCD (“pure” obsessions, contamination, checking, ordering, and arranging). There is also evidence that I-CBT may be effective for those with poor insight or those who have a strong conviction in their obsessional beliefs.
I-CBT can be effective for people with only OCD and with OCD and comorbid conditions. I-CBT was specifically developed for OCD, so it is important that you and your clinician gain a full picture of any co-occurring conditions and develop a treatment plan that addresses other co-occurring disorders you might have.
WHEN TO TRY THIS TREATMENT:
I-CBT is an option to consider if the first-line OCD treatments have not worked for you, or if you are hesitant to try first-line treatments (in other words, it is a second-line treatment).
I-CBT is suitable for most adults and can be considered for children and adolescents within certain parameters.
If you want to understand why you experience particular obsessional doubts, and how OCD tricks you into feeling like you need to listen to your obsessional doubts, then I-CBT might be a good fit for you.
You can continue to take medication for OCD while doing I-CBT.
As with any treatment modality, I-CBT is not for everyone. It can take time to learn since it involves gaining an understanding of a series of skills to help you identify and then break down obsessional reasoning (inferential confusion).
ADDITIONAL RESOURCES:
For more information on I-CBT, visit the official website.