What is I-CBT? How will my therapist or dietitian be able to support me using I-CBT?

Understanding Inference-Based Cognitive Behavioral Therapy (I-CBT)

Inference-Based Cognitive Behavioral Therapy (I-CBT) is an innovative approach that focuses on the role of inferences in the development and maintenance of psychological disorders, including Obsessive-Compulsive Disorder (OCD). Unlike traditional CBT, which often emphasizes the modification of cognitive distortions and behavioral responses, inference-based CBT centers on how individuals interpret and make sense of their experiences, particularly in relation to intrusive thoughts and compulsions.

At Carmel Therapy Network we have several providers who are professionally trained in I-CBT including Katie Watson, LCSW; Brandy Kirk, LMHC-A; Madeline Williams, LSW; Kelsey Kintz, LSW; Justise Northrup, LMHC, Jasmin Carvajal, LCSW, Shannon Ellis, LCSW, Brenda Mendoza and one of our dietitians, Leianna Bussell, RDN.

The Role of Inferences in OCD

Individuals experiencing obsessions or compulsions, whether or not they meet full diagnostic criteria for OCD, often benefit from I-CBT. Those with OCD frequently experience intrusive thoughts that provoke significant anxiety, leading to compulsive behaviors aimed at reducing distress.

Over time, it can feel as though OCD is running you—rooted more in imagined inferences than in present-moment reality. You might find yourself worrying more about what could happen than what is happening.

Common inference patterns include:

• Overestimation of Threat: Inferring that an intrusive thought signals real danger, resulting in heightened anxiety.

• Catastrophizing: Believing a thought could cause catastrophic outcomes, prompting compulsive rituals.

• Self-Identity Inferences: Interpreting intrusive thoughts as reflections of your character, fueling shame and further entrenchment in OCD behaviors.

This is where I-CBT can help make the difference!

I-CBT posits that the way we interpret intrusive thoughts determines our emotional and behavioral responses. Traditional CBT and ERP target distress and behavior; I-CBT focuses on the origin of obsessional doubt itself.

For example, a person may move from reality-based perception (“The stove looks off”) to imaginative possibility (“But what if it isn’t, and I burn the house down?”). This mental leap is known as inferential confusion—confusing what is imagined with what is real or likely.

How Inference-Based CBT Supports Clients with OCD

Inference-based CBT offers several strategies specifically designed to support clients with OCD:

1. Identifying Maladaptive Inferences

Therapists work with clients to identify and challenge maladaptive inferences related to their intrusive thoughts (Inferential Confusion). This involves recognizing the cognitive distortions that contribute to OCD symptoms.

By identifying a maladaptive inference, you will be able to learn to recognize when you have left the realm of sensory reality and need to re-anchor yourself in present, verifiable information. This helps reduce obsessional doubt at its source rather than just managing the resulting anxiety.

2. Enhancing Cognitive Flexibility

By promoting cognitive flexibility, clients learn to consider alternative interpretations of their thoughts. This process helps reduce the perceived threat of intrusive thoughts and diminishes the need for compulsive behaviors.

3. Exposure and Response Prevention (ERP)

Although these are separate modalities, Inference-based CBT incorporates a few elements of Exposure and Response Prevention, a key component of traditional CBT for OCD. Clients are gradually exposed to their feared thoughts or situations while refraining from engaging in compulsive behaviors, allowing them to learn that their anxiety will decrease over time without resorting to rituals. Network interruption assists with stress and prevents compulsion completion.

4. Mindfulness and Acceptance Techniques

Incorporating mindfulness practices helps clients develop a non-judgmental awareness of their thoughts. This acceptance-oriented approach allows individuals to experience intrusive thoughts without feeling compelled to act on them.

5. Building a Supportive Therapeutic Relationship

A strong therapeutic alliance is crucial in inference-based CBT. Clients are encouraged to express their fears and concerns openly, fostering a safe environment where they can explore their thoughts and feelings without judgment.

Conclusion

Inference-Based Cognitive Behavioral Therapy offers a powerful framework for understanding and overcoming OCD.By addressing how you infer danger or meaning from intrusive thoughts, I-CBT helps you reconnect to reality, reduce anxiety, and regain a sense of control.

At Carmel Therapy Network, our I-CBT-trained clinicians are dedicated to helping clients untangle the reasoning traps of OCD and move toward grounded, confident living.