ERP and ICBT for OCD: what’s the difference?

Exposure and Response Prevention (ERP or ExRP) has long been considered the ‘gold standard’ of treatment for obsessive-compulsive disorder (OCD). However, Inference-based Cognitive Behavioral Therapy (ICBT) has a growing amount of research supporting its effectiveness for treating OCD as well. But what’s the difference? Here’s a somewhat simplified explanation.

First, let’s clarify OCD. This is a disorder where your brain convinces you that a serious problem *might* exist, and it might mean something bad or dangerous about you or others- those are the obsessions. So OCD convinces you to do certain things to prevent the problem or consequence from happening- that’s the compulsion part. The compulsions relieve the anxiety caused by the intrusive thought- but that never lasts; the obsession comes back, and with it, the anxiety- sometimes even stronger than before.

ERP and ICBT are two major ways to work with OCD. What’s the difference?

Exposure and Response Prevention thinks of obsessions as random intrusive thoughts that may have nothing to do with your personality and what matters to you, but OCD convinces you that the thoughts might be valid, and might have disastrous outcomes (maybe you DID leave the stove on and your house will burn down; what if you’re attracted to children and might be dangerous to be around your nieces; you *might* be an evil person and just not realize it yet but one day you might snap). 

ERP in action is exactly what it sounds like: intentionally exposing yourself to your obsessions and fears, which raises your anxiety, *while* preventing yourself from responding to the obsession- by doing compulsions to relieve the anxiety caused by the obsessive thought. 

Your therapist helps you rank how upsetting your obsessions are, and starts exposures at the lower end of the list. Over time, your brain learns that it can experience anxiety about the obsession without the scary possible consequence happening- and you didn’t even have to do compulsions to make the anxiety go down. Anxiety eventually goes down on its own. You reclaim your power by showing yourself that you really don’t have to do compulsions, and you don’t have to know for certain that your obsessions are false. With practice, the obsessions can even come and go without bothering you.

Inference-based Cognitive Behavioral Therapy on the other hand, assumes that your obsessions aren’t random intrusive thoughts, but actually are based on “inferential doubt”- conclusions you come to based on things that you know, have experienced, or heard of, which OCD twists into a possible threat or danger. For example, if you experience contamination themes of OCD, you might know that it’s a rule to wash your hands after handling raw meat or using the bathroom. But perhaps you’ve also heard a story about someone who got sick because they didn’t wash their hands enough, and you know that germs are too small to see with your eyes– and OCD convinces you that this might be evidence that maybe YOU didn’t wash your hands enough, even if you did. So you wash them again (and maybe again, and again) because OCD says “but what if last time wasn’t enough, you missed something, and you spread illness to your whole family??” 

ICBT helps you learn this process of doubt applied to OCD themes you don’t have, so that you can learn about it without triggering your own personal anxiety. Then you begin to apply your knowledge of the predictable process to your own symptoms, begin to recognize the cycle in real time, and with practice you’re able to disrupt the process. You reclaim your power by noticing when OCD is trying to convince you that this imagined possible reality is a real threat — and you become able to stay grounded in trust of your own senses and knowledge. 

If you’d like to learn more about treating OCD and try one of these methods, click here to fill out the contact form and schedule a free consultation to see how I can help.