ICBT (or I-CBT) stands for Inference-based Cognitive Behavioral Therapy. ICBT sees obsessions as doubts rooted in inferential confusion. Inferences are conclusions we come to based on a set of information. In normal, everyday doubt, we might doubt whether we turned off the stove- so we check the stove, confirm that the knobs are indeed turned to ‘off,’ and go on about our day.
When you have OCD, your brain might see that the knobs are turned off, but when you walk away, OCD gets in your head with something like…
And it doesn’t stop there- behind the scenes, it adds to the mix, ‘if the stove is on, something might catch on fire and my house could burn down and destroy everything and everyone I care about and I might get taken to jail for being negligent and then my life will just be OVER.’ Anxiety skyrockets and you HAVE to go check the stove again, even though you know you just confirmed it is off.
OCD takes everything you know to be true and just ignores the shit out of it, insisting that there might be something wrong, which might lead to a preventable nightmare of a disaster that would prove you truly are a [negligent or irresponsible or horrible] person, and you need to do something about it now.
It sucks you into this bubble of imagined disaster that feels SO real and possible, it demands your immediate attention, and you feel that you have to do compulsions (washing your hands again even though you just washed them; going back home to make sure the house isn’t on fire; etc) to make the anxiety go away. It seems like maybe, if you do the compulsions enough or just the right way, you’ll be able to ensure that that nightmare doesn’t come true.
The problem is, that relief from doing compulsions doesn’t last. Something else happens to trigger those obsessive doubts and the whole cycle starts over again.
ICBT helps you identify this predictable process and develop the ability to notice when the ‘what if’s’ are gearing up again, taking you out of the present moment and what your senses tell you and into the OCD bubble, where all your worst irrational fears come true. When you see the bridge forming between what reality & your senses tell you (example: yes, my hands and eyes have confirmed the stove is turned off) and OCD’s obsessive ‘but what if???’ – you become able to choose whether to get sucked into the what-if bubble that drives the urge to do compulsions.
ICBT and ERP are different in how they think about obsessions and how they’re formed, and in which part of the OCD cycle they target.
OCD consists of a familiar cycle:
Trigger>Obsession>Anxiety!!!>Compulsion>Relief>>>>Rinse and repeat
| Obsessions | Compulsions | |
| ICBT | Obsessions are doubts rooted in inferential confusion, formed by an understandable process that can be learned.
Intervention occurs at this point: learn how the doubt is formed, the tricks OCD uses to reinforce it, and learn how to stay out of the OCD bubble. | The urge to engage in compulsions fades as you get better at recognizing OCD tricks in the moment, and keep yourself out of the OCD bubble. Obsessions may crop up, but they become less bothersome. |
| ERP | Obsessions are just intrusive thoughts.
We identify your obsessions so we can trigger them, but otherwise we leave them alone. | Intervention occurs here: we trigger the obsession and its anxiety on purpose, and actively spend time NOT engaging in compulsions. Eventually you learn that anxiety goes down on its own, and the thing you’re afraid will happen if you don’t compulse, doesn’t happen. Obsessions may pop up, but they don’t bother you as much. |
If you’d like to read a little more detail about the differences, click here to read a blog post I made about it!
ICBT sessions may consist of
We may apply these principles to off-themes that don’t bother you, so that it’s easier for you to learn the processes, and then apply them to your own OCD themes. If you’re more of a rip the bandaid off sort of person and you’d rather start directly with your own theme(s), that’s an option too!
I recommend going straight to the souce: Resolving OCD, Volumes 1 & 2, by Frederick Aardema. The entire ICBT process is broken up between the two volumes. Volume 1 contains detailed case examples of many of the most common themes of OCD, explanations of all the processes underlying and reinforcing the OCD cycle, exercises of how to apply those processes to the case examples and worksheets for you to practice with your own themes. Each volume has exercises relevant to that volume’s content, and extensive appendices that provide sample answers to the exercises as applied to the various themes, so you can ‘check your answers.’
The books are sold at ThriftBooks, other major online retailers like Amazon, and can be ordered by your favorite local retailer such as WordsWorth Books.