Inference-Based CBT (I-CBT) in San Francisco and Throughout California

What can I expect when starting Inference-Based CBT?

I-CBT is a cognitive-based approach that involves a lot of education coupled with exercises and in-between session practice to help reinforce concepts. Throughout treatment, the client will go through a series of 12 modules. They are generally done in a particular order, but at times it may be essential to go back and reinforce learning that wasn’t quite grasped the first time. Treatment starts with education on the OCD sequence, the Obsessional Reasoning Process (Inferential Confusion), and how it compares to the Normal Reasoning Process.

Below is an outline of the modules covered in treatment with a brief description of each:

Module 1: The Obsessional Sequence

This module covers the different parts of the Obsessional Sequence (the OCD cycle) and provides examples of how it can be applied with various OCD doubts. Clients learn to identify where inferential confusion shows up for them and how their obsessional doubts fit into the sequence.

Module 2: The Logic Behind OCD

This module covers how OCD captures individuals in its stories using rules, facts, hearsay, personal experiences, and possibility. These stories come from somewhere, and they are believable because they are based on real information. However, the information is taken out of context and not based on what is happening here and now. Clients learn to identify why they believe in their obsessional doubts. 

Module 3: The Obsessional Story

This module covers the concept of storytelling and how life is all about our minds creating stories that shape our perceptions and affect our emotional state. Clients will learn how OCD has created a convincing story through the obsessional reasoning process AND that other non-OCD stories can exist.

Module 4: The Feared Possible Self

This module covers the underlying fear that connects all of a client’s obsessional doubts. It is who clients fear they are or will become if they don’t listen to their OCD. That could be fearing that one is a person who harms others, is irresponsible, is negligent, is bad, etc. Clients will identify their Feared Possible Self.

Module 5: Obsessional vs. Real Doubt

This module distinguishes obsessional from reasonable doubts. It covers reality-based reasoning (normal reasoning) and how it relies on sensory information and direct evidence in the moment. Through examples, clients learn how obsessional reasoning keeps them stuck in their imagination by dismissing sense information, over-relying on possibility, and making irrelevant associations.

Module 6: Possibility is Irrelevant

This module covers the concept of possibility and when it makes sense to attend to it. Possibility is relevant when backed by sensory information (which includes more than just the 5 senses) at that moment. Clients learn that possibility is never relevant with OCD due to a lack of sensory data.

Module 7: The OCD Bubble

This module covers “The Bubble” that OCD pulls you in, and how scary and threatening OCD’s stories can feel when you’re in it (even though they are not based on reality.) Clients learn to identify when they are in The OCD Bubble, how to refrain from entering it, and how to get out if they’ve gotten pulled in.

Module 8: Reality Sensing

This module covers the reliance on senses when confronted with OCD’s imaginal stories. Clients learn how to notice when they are on the bridge that connects “Reality” with “OCD/Imagination” and how to pause, realize that they are on it, and stop themselves from crossing it. The more clients practice accepting and relying on their sense data, the easier it becomes to dismiss the obsessional doubt, stay in reality, and put a stop to the rest of the obsessional sequence.

Module 9: The Alternative/Real Story

This module focuses on creating a new story based on reality and sense information to help one stay out of The Bubble and in reality. Clients work on making this the story they turn to rather than the false one created by OCD.

Module 10: Tricks and Cheats

This module covers various ways OCD tricks you into over-relying on possibility, dismissing actual evidence, and making irrelevant associations. These different tricks have names and clients can identify what relates to them.

Module 11: The Real Self

This module covers who the client really is based on what they know to be true. By comparing the Feared Possible Self to the Real Self, clients are able to observe the discrepancies between the two. Clients learn to identify who they truly are (which is generally the complete opposite of what OCD tries to convince them of.)

Module 12: Relapse Prevention

This module goes over what remission looks like and reducing the likelihood of relapse. Clients will learn to identify signs of a relapse and what to do when that occurs.