Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a mental health condition that consists of time-consuming unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions) that cause significant distress & impairment.

Obsessions can take many forms & consist of recurrent & persistent intrusive, unwanted thoughts, images, urges, & sensations. Obsessions are thoughts that repeatedly enter your mind, occur against your wishes, & are ego-dystonic. "Ego-dystonic" means that the thoughts go against your values, morals, & ethics. Instead, they give you significant anxiety, disgust, shame, or other uncomfortable feelings. OCD goes after what you love most. 

Compulsions consist of repetitive mental or physical behaviors that you feel driven to perform in an attempt to reduce the distress associated with your obsessions. While compulsions can be observable, as with physical compulsions (e.g., checking, washing), they can also be entirely unobservable, as in the case of mental compulsions (e.g., ruminating, rehearsing, avoidance). You may recognize your compulsions as excessive or senseless & yet still feel an intense urge to complete them. With OCD, you often seek 100% certainty, or else you feel stuck, unable to move on.

Inference-Based Cognitive Behavioral Therapy (I-CBT) is an evidence-based modality designed specifically for OCD. As a cognitive modality, the target of I-CBT intervention is the obsessions, which occur earlier in the OCD cycle; in contrast, behavioral models of OCD focus on targeting the compulsions, which occur later in the OCD cycle. The aim of I-CBT is to help you resolve your obsessional doubts by learning to rely on & trust your senses, common sense, & real self. By returning to a more grounded self, focused on the here-and-now, you can learn to leave the obsessional doubt & story behind, because you realize that they don't matter. & when the doubt doesn't matter, there's no need to engage in your compulsions, or to resist them, because you see the obsession for what it is— an imaginary problem, an irrelevant possibility, not grounded in reality.

I-CBT views OCD as the result of faulty reasoning— also known as "inferential confusion"— in which you mistake an imagined possibility for a real probability, despite the direct evidence from your senses being contrary to your obsessional doubt. OCD is a liar, con artist, & trickster, convincing you that there's an urgent problem you need to address, by engaging in your compulsions. I-CBT then involves untangling these reasoning errors to help you understand that the problem is actually 100% imaginary & 100% irrelevant to the here-and-now.

Instead of getting sucked into your imagination & compulsing, I-CBT would encourage you to ground yourself in trusting your senses, perception, common sense, & your real self— that is, the real, authentic version of you. This is in contrast to what I-CBT calls the "feared possible self," which is a feared version of yourself that OCD has made you fear you may become if you do not engage in your compulsions. 

Compared to other modalities, which may encourage you to practice being uncertain about who you are, I-CBT instead focuses on the functional certainty that you already have— that is, coming from your senses, perception, common sense, & real self. 

"I-CBT holds out the possibility of restoring trust in one's perception, one's memory, & even one's self. Discovering or rediscovering trust in oneself offers a much higher goal for recovery than learning to tolerate being uncertain about who we are." —Carl Robbins, LCPC, Anxiety and Stress Disorders Institute of Maryland

I-CBT is effective for all sub-types of OCD. 

Below are some of the sub-types I have clinical and/or lived experience with:

Checking OCD

Ethics & Morality OCD

Gender Identity OCD

Harm & Aggression OCD

Health OCD

Negligence & Mistakes OCD

OCD About OCD (Meta-OCD)

Relationship OCD

Religious OCD

Sensorimotor OCD

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