Is I-CBT Right For Me?
While many people know about exposure and response prevention (ERP) as an effective treatment for obsessive-compulsive disorders, I-CBT is a less well known modality for the treatment of OCD and other related disorders that has been shown to be just as effective. Read more to find out about how it works, and who can benefit from this treatment. I-CBT is NOT the same as CBT-I, which is a treatment for insomnia.
What is I-CBT?
Inference-based cognitive behavioral therapy also known as I-CBT is an evidenced-based treatment model used for OCD as well as other inference-based disorders. Although exposure response prevention (ERP) is the current “gold standard” for OCD, I-CBT has shown to be just as effective as ERP. It was originally developed in Europe, and is quickly gaining popularity in the United States as an effective and innovative treatment model for OCD.
How Does I-CBT Differ From ERP?
I-CBT differs from ERP in that it does not conceptualize thoughts as intrusive or “coming out of nowhere” but rather coming from inferential confusion based on a narrative or theme of a vulnerable or “feared self”. These doubts rely on the person’s fears and imagination of possibilities instead of sensory evidence in the here and now.
I-CBT differs from ERP in that exposure is not a required part of treatment, which makes the treatment model an accessible option for those who did not respond well to ERP treatment. I-CBT can be used in tandem with ERP and ACT, as both modalities are also effective in treating OCD.
How Does I-CBT Work?
OCD thrives on doubt, “What if I’m actually a bad person? What if my partner doesn’t like me anymore? What if something terrible happens to my family and it’s my fault?”
I-CBT has 12 modules that help clients resolve their OCD and build self-trust. Treatment involves teaching clients first how to recognize an obsessional doubt, and then use inference-based tools to identify the doubt as irrelevant and imaginary. Clients then identify their obsessional story, and work to create an alternative story that is based in reality, not fear.
I-CBT works because if you address the doubt and are able to recognize it as irrelevant based on information in the here and now, you won’t feel the need to engage in the compulsion.
In summary, I-CBT conceptualizes OCD as based in logic, which then creates a narrative or “obsessional story”, resulting in compulsions. Change the story, and you change the doubt, thus relieving the need for the compulsion.
Who is I-CBT Right For?
I-CBT is a recommended treatment for those with OCD, body dysmorphic disorder, social anxiety disorder and other related disorders where inferential confusion is present.
It also may be a better fit for some clients based on personal preference for treatment model. I-CBT can be a strong fit for those who are curious about learning more about the obsessional thoughts, and where they may be coming from.
For example, someone who has relationship OCD (or R-OCD) who is curious about the why behind their obsessions. They may want to go more into the content of the obsessional doubt as it may tell a story (i.e. the feared self). I-CBT could then help them create an alternative story. I-CBT would help the client learn how to identify which thoughts are relevant relational concerns versus obsessional doubt by helping the client learn to trust their senses. I-CBT is a good fit for people with OCD and self-doubt, as it focuses on building self trust.
How Does I-CBT Differ From Traditional CBT?
Traditional CBT asks us to put anxious thoughts on trial, however if you’re prone to ruminating, or are prone to engage in mental compulsions (reviewing, preparing, planning, researching), this model is not ideal for OCD. While traditional CBT is proven to be effective for anxiety, this intervention may actually do more harm than good if not used with an OCD-informed approach. It is recommended that people with OCD work with a specialist trained in ERP or I-CBT.
I-CBT differs from traditional CBT in that it does not try to argue if the doubt is possible or likely, but rather asks us to live in reality instead of weighing different possibilities. I-CBT teaches skills like reality sensing - which help clients return to the here and now, trust their senses, and turn away from the obsessional doubts, thus relieving the need for compulsions.
OCD plays tricks on the mind that can be sneaky, convincing, and distressing. The good news is treatments are available and there is evidence that I-CBT and ERP are both very effective at treating OCD, and many people who receive appropriate treatment for OCD are able to successfully recover, and gain self-trust over the course of treatment.
Who Provides I-CBT?
Therapists who specialize in OCD and I-CBT are qualified to treat clients with I-CBT. I am a certified I-CBT provider. I work with clients with obsessional thinking, rumination and mental compulsions. If you are located in NY and NJ and think I-CBT could be right for you, click here to learn more about working together.
You can also check out the I-CBT website for more resources and clinicians who use I-CBT.
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