OCD Therapy - Understanding Doubt Through i-CBT
- Siobhan Tyrrell
- Oct 9
- 4 min read
Updated: Oct 10
When Doubt Takes Over
When people think about OCD therapy, they often imagine it’s all about “fear” — fear of germs, fear of harming others, fear of losing control. But Inference-Based Cognitive Behavioural Therapy (i-CBT), developed by Kieron O’Connor and Frederick Aardema, offers a different perspective.
At the heart of OCD isn’t fear — it’s doubt.
Not everyday doubt like “Did I leave the kettle on?” but sticky, intrusive doubts that feel more real than direct evidence from your senses. This is called inferential doubt or inferential confusion (O’Connor & Aardema, 2012).
Inferential doubt happens when the mind mistakes a remote possibility for reality, and imagination overrides perception. Anxiety follows, and compulsions are used to try to resolve the doubt.
If you are looking to manage your OCD, understanding this cycle of doubt is the starting point for change. From clinical experience, clients understanding this in terms of their thinking process, has been a turning point.
What Is Inferential Doubt?
Imagine you’ve just locked your front door. You saw the key turn, heard the click, even tugged the handle. Yet as you walk away, the thought creeps in: “But what if it didn’t really lock?”
This tiny “what if” suddenly feels more persuasive than your senses. You picture being burgled or blamed. The anxiety rises, and you go back to check.
This is the obsessional sequence described in i-CBT:
Doubt comes first.
Fear follows from the doubt.
Compulsions are attempts to resolve the doubt.
Unlike traditional CBT, which often focuses on fear or distorted beliefs, i-CBT targets doubt at its source.
How OCD Doubt Is Maintained
Once inferential doubt takes hold, the OCD mind recruits familiar reasoning habits to keep it alive. These habits don’t cause OCD — but they make doubts sticky, believable, and difficult to dismiss with some examples of sub-categories.
Reliance on Indirect or Irrelevant Information
OCD often draws on stories, news, or abstract facts rather than current sensory reality.
SO-OCD: Reading an article about sexuality → “What if this applies to me?”
Contamination: Hearing about food poisoning → “What if my lunch was unsafe?”
Harm: Seeing a news report about accidents → “What if I caused one too?”
Sensory OCD: Reading that “people can forget how to swallow” → suddenly swallowing feels unsafe.
Discounting the Senses and Everyday Knowledge
Even when your senses give reassurance, OCD teaches you to mistrust them.
SO-OCD: Ignoring years of closeness with a partner because of one anxious thought.
Contamination: Dismissing clean hands because they don’t feel clean.
Harm: Remembering turning the stove off but thinking “Maybe I imagined it.”
Sensory OCD: Knowing breathing is automatic but worrying “What if I can’t let go and it never feels normal again?”
Catastrophic and Counterfactual Reasoning
The mind projects into worst-case futures or “if only” pasts.
SO-OCD: “If I looked too long at that person, my relationship is doomed.”
Contamination: “If I missed a germ, my family will get sick.”
Harm: “If I said something wrong, I’ll lose this friendship forever.”
Sensory OCD: “If I don’t blink evenly, I’ll never feel normal again.”
Rule-Based and Ritualistic Reasoning
Rigid rules develop to create certainty or safety, even if they have no logical basis.
SO-OCD: “I must never look at someone more than once, or it means something.”
Contamination: “I must wash three times, in the right order, or it doesn’t count.”
Harm: “I must replay the drive until I feel perfectly certain I didn’t hit someone.”
Sensory OCD: “I must blink evenly in both eyes or repeat until it feels balanced.”
Emotional Reasoning
Feelings themselves are mistaken for evidence.
SO-OCD: Feeling anxious near someone of the same sex → “That must mean I’m not straight.”
Contamination: Feeling disgust → “That must mean I’m contaminated.”
Harm: Feeling uneasy after driving → “That must mean I hit someone.”
Sensory OCD: Feeling “off” when swallowing → “That must mean I’ll choke.”
Why Consider a Cognitive Approach?
The most widely known OCD therapy is ERP (Exposure and Response Prevention). ERP is highly evidence-based and is often described as the “gold standard.” It works by facing feared situations and resisting compulsions.
But ERP is not always easy. Dropout rates can be high (Franklin & Foa, 2011), and for some types of OCD — such as obsessions with sexual, violent, or identity-related themes — ERP can feel too intense or difficult to apply.
This is where a cognitive approach like i-CBT can be valuable:
It goes upstream to the reasoning habits that generate doubt.
It suits presentations where exposures are hard to design (e.g. SO-OCD, somatic OCD).
It can complement ERP, giving people a fuller set of tools.
In practice, some clients use i-CBT alone, while others combine it with ERP for the best results.
A Practical Step You Can Try
Recall a recent OCD doubt.
Ask: Did I rely on indirect info? Discount my senses? Follow a rule? Treat my feelings as facts?
Write down how this reasoning style showed up.
Pause and reflect: “What do my senses tell me right now?”
Even the act of noticing creates distance from the doubt.
Ready to Take the Next Step?
If these patterns feel familiar and you’re seeking OCD therapy in Edinburgh or online, you don’t have to face them alone. i-CBT offers a structured way of understanding doubts and loosening their grip.
The first step is a brief pre-intake call where we can talk through your situation, answer questions, and see if therapy feels like the right fit.
References
O’Connor, K. & Aardema, F. (2012). Clinician’s Handbook for Obsessive-Compulsive Disorder: Inference-Based Therapy. Wiley.
Aardema, F. (2013). Inferential confusion, cognitive processes, and obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders.
Franklin, M. E. & Foa, E. B. (2011). Treatment of obsessive compulsive disorder. Annual Review of Clinical Psychology.
Anxiety & Depression Association of America (2022). Inferential Confusion: A New Treatment Target for OCD.
Comments