What is I-CBT - Therapy for OCD?

In our last post, we talked about the OCD cycle and what Exposure and Response Prevention (ERP) therapy involves. If you haven’t read that one yet, you might want to start there — especially the section on how the OCD cycle works.

In this post, we’ll explore another approach to treating OCD: Inference-Based Cognitive Behavioral Therapy (I-CBT).

ERP vs. I-CBT

As a quick review:

ERP is primarily a behavioral approach. It helps people manage OCD by addressing the behaviors — the compulsions or rituals — that keep the OCD cycle going. While ERP does include exploring the “core fear” that drives obsessions, most of the therapy time is focused on doing exposures and processing them in session.

I-CBT, on the other hand, focuses on the why and how OCD develops and maintains itself. It targets the thinking patterns that feed obsessions and doubts, rather than focusing mainly on behavioral rituals.

Think of it this way:

If OCD is a magic trick, I-CBT teaches you how the trick works.

A Visual Comparison

For ease of understanding, here’s a visual that breaks down the main differences between ERP and I-CBT.

Curious if I-CBT for OCD could help you (and live on Wahpekute land, colonized as MN)?

Book a free 15-minute consultation to learn more

What to Expect in I-CBT

When engaging in I-CBT, you’ll explore how your mind constructs doubt and what makes OCD thoughts feel “real.” The goal is to separate imagination-based fears (“What if I lost control?”) from reality-based reasoning (“What is actually happening right now?”).

While I-CBT may include naturally occurring exposures, it doesn’t rely on structured exposure assignments between sessions like ERP often does.

Both therapies are structured and goal-oriented. Depending on your therapist’s approach, sessions may focus entirely on OCD work — because OCD thrives on avoidance, and it will try every trick in the book to steer you away from the discomfort of facing it.

Below is a general outline of what I-CBT might involve:

When Each Might Be a Better Fit

If you’re someone who:

• Learns best by doing

• Enjoys taking on challenges

• Is willing to face discomfort directly

Then ERP may be a great fit for you.

If you:

• Want to understand how and why OCD gets constructed

• Prefer exploring the thinking process behind obsessions

• Feel that traditional exposure work is too distressing

Then I-CBT may be a better match.

👉 Want to work with an OCD specialist in Minnesota who actually uses evidence-based therapy?

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Research on I-CBT

Study / Source	What They Did	What Was in It	What They Found	Why It Matters
O’Connor et al. (2005) – “Inference-based approach to treating OCD: A randomized controlled trial”	Compared I-CBT to standard CBT with ERP in adults with OCD.	I-CBT focused on recognizing “faulty inferences” — how doubt and imagined possibilities trigger obsessional thinking — rather than exposing people to feared situations.	Both treatments reduced OCD symptoms, but I-CBT showed similar or better results for those who found ERP intolerable.	Demonstrated that targeting the thinking process (not just behaviors) can be equally effective and often more tolerable.
Aardema et al. (2013) – “Inferential confusion in OCD and its treatment”	Tested how I-CBT helps people challenge the “what if” thinking that fuels obsessions.	Used guided reasoning exercises to separate imagination from reality-based doubt.	Participants had large reductions in OCD symptoms and improved insight into how obsessions start.	Shows that I-CBT helps people see their doubts as false alarms, reducing anxiety and compulsions.
O’Connor et al. (2016) – “One-year follow-up of the inference-based approach to OCD”	Followed individuals one year after completing I-CBT.	Continued to assess OCD symptoms and functioning.	Improvements were maintained at the 1-year follow-up — no symptom rebound.	Suggests I-CBT leads to long-term gains and lasting change in how people think.
Aardema & O’Connor (2017) – Book: “The Inference-Based Approach to OCD: Theory, Research, and Practice”	Summarized over a decade of research and treatment protocols.	Combined theory, therapy examples, and outcome data.	Evidence supports I-CBT as a valid alternative to ERP, especially for those stuck in overthinking or avoidance cycles.	Provided clinicians with structured guidance for using I-CBT in practice.
Lazarov et al. (2020) – “Mechanisms of change in I-CBT for OCD”	Examined how I-CBT works — what changes first and leads to relief.	Focused on reducing inferential confusion (mistaking imagination for probability).	Found that reducing inferential confusion mediates OCD symptom improvement.	Strengthened the scientific basis of I-CBT, showing how it changes underlying reasoning patterns rather than just behaviors.

Why Work With an OCD Specialist

Not every therapist is trained to treat OCD effectively. In fact, general talk therapy can sometimes make OCD worse if it unintentionally reinforces compulsions or reassurance-seeking.

An OCD-trained therapist will:

• Recognize even subtle obsessions and compulsions.

• Use evidence-based approaches like ERP and I-CBT appropriately and safely.

• Help you pace the work so exposures or cognitive exercises aren’t too overwhelming.

👋🏼 If you’re looking for OCD therapy in Minnesota (Wahpekute land) — I can help.

I’m trained in both ERP and Inference-Based CBT (I-CBT) for OCD, anxiety, and phobias, and I bring lived experience with OCD to my work.

🌱 Key Takeaways

• I-CBT focuses on reasoning, not exposure. It helps people recognize that OCD doubt comes from imagination, not real threat.

• Research shows equal or better outcomes than ERP for some clients, especially for those who find ERP too distressing.

• Long-term results are strong, with reduced relapse rates and increased insight.

• Best for: Overthinkers, people who find ERP intolerable, or those whose obsessions are mainly cognitive (less visible compulsions).

Interested in Support?

If you’re curious about whether I-CBT, ERP, or a blend of both might be the right fit for you, I’d be happy to help you explore your options.

At The Divergent Grove Therapy, I work with children, teens and adults living on Wahpekute land (colonized as MN) supporting them in navigating OCD, anxiety, and neurodivergence — offering care that’s evidence-based, affirming, and collaborative.

💬 You can reach out here to schedule a consultation or learn more about working together.