Exposure (and response prevention) therapy is the most well established therapy for OCD, with those treated with it reporting around 75% reduction in their symptoms. One of the drawbacks of exposure therapy, however, is that the client may be required to tolerate high levels of anxiety in the process of getting better. Some studies have found that around 25% of patients may drop out of therapy because of this. This concern led two Canadian psychologists – Dr Kieron O’Connor and Dr Frederick Aardema to develop a new approach to treating OCD, called Inference Based Therapy (IBT). In a nutshell, this approach sees doubt as the basis of OCD and their treatment of OCD involves targeting the OCD doubts and OCD “stories” directly.
Obsessional doubts
Obsessional doubts lead people to doubt their own senses and perception of reality, and confuse them with what they imagine is possible. For example, take the case of a woman with obsessions about harming her children, or a man fearing he may be homosexual or a paedophile. Even though the reality is that these people have never exhibited any behaviour along these lines, they imagine it is possible and so doubt themselves.
They obsess about who they could become, rather than who they are in reality. Or in the case of people who wash or check repeatedly, they rely on what they imagine could happen (germs could be spreading; appliances could be left on and burn the house, doors could be unlocked and the house could be burgled) rather than their here and now senses that show them their hands have no visible dirt; they heard the lock click the first time they turned the key; there is no smell of burning.
Obsessional doubts
Obsessional doubts lead people to doubt their own senses and perception of reality, and confuse them with what they imagine is possible. For example, take the case of a woman with obsessions about harming her children, or a man fearing he may be homosexual or a paedophile. Even though the reality is that these people have never exhibited any behaviour along these lines, they imagine it is possible and so doubt themselves.
They obsess about who they could become, rather than who they are in reality. Or in the case of people who wash or check repeatedly, they rely on what they imagine could happen (germs could be spreading; appliances could be left on and burn the house, doors could be unlocked and the house could be burgled) rather than their here and now senses that show them their hands have no visible dirt; they heard the lock click the first time they turned the key; there is no smell of burning.
The opposite of what you fear
Those who are tricked by OCD have also lost touch with common sense about the likelihood of imagined catastrophes happening, particularly in view of the type of person they are, which is usually the opposite of what they fear. What I find time and time again with my OCD clients is that the OCD story about who they could become is actually the complete opposite of who they are in reality. For example, the clients I have seen who fear harming their children have been very caring parents.
Imagination confused with reality
Thus, people who have OCD are making inferences based on imagining what could happen, rather than what does happen in reality. Their doubts lead to rituals that make their doubts seem real and lead to more doubts. They are stuck in a viscous cycle. The core of the problem is that they have confused an imaginary possibility with a real probability. The inference based approach helps those with OCD to distinguish between normal doubt and obsessional doubt.
Normal, ‘authentic” doubt is based on new sense based information (I smell burning; did I leave the stove on?). Obsessional doubt is based on imagination, with no new sense based information in the present (e.g. I am leaving the house, the door looks locked, I heard it click, but I need to check it again and again because I am worried it may not really be locked, or it may have unlocked itself).
Logical and possible does not make it true
IBT accepts that people have logic and reasoning behind their doubts which make their doubts and OCD story seem credible. It is possible to leave doors unlocked and be burgled. They have heard stories about people “snapping” and attacking their children. Germs do exist and cause diseases, that is why there are rules about hand washing (e.g. after toileting). They may have experienced times when they did leave an iron turned on, or know of elderly relatives who forget to turn taps off. But this logic and reasoning does not make their obsessional doubts and OCD stories about themselves true.
Those who are tricked by OCD have also lost touch with common sense about the likelihood of imagined catastrophes happening, particularly in view of the type of person they are, which is usually the opposite of what they fear. What I find time and time again with my OCD clients is that the OCD story about who they could become is actually the complete opposite of who they are in reality. For example, the clients I have seen who fear harming their children have been very caring parents.
Imagination confused with reality
Thus, people who have OCD are making inferences based on imagining what could happen, rather than what does happen in reality. Their doubts lead to rituals that make their doubts seem real and lead to more doubts. They are stuck in a viscous cycle. The core of the problem is that they have confused an imaginary possibility with a real probability. The inference based approach helps those with OCD to distinguish between normal doubt and obsessional doubt.
Normal, ‘authentic” doubt is based on new sense based information (I smell burning; did I leave the stove on?). Obsessional doubt is based on imagination, with no new sense based information in the present (e.g. I am leaving the house, the door looks locked, I heard it click, but I need to check it again and again because I am worried it may not really be locked, or it may have unlocked itself).
Logical and possible does not make it true
IBT accepts that people have logic and reasoning behind their doubts which make their doubts and OCD story seem credible. It is possible to leave doors unlocked and be burgled. They have heard stories about people “snapping” and attacking their children. Germs do exist and cause diseases, that is why there are rules about hand washing (e.g. after toileting). They may have experienced times when they did leave an iron turned on, or know of elderly relatives who forget to turn taps off. But this logic and reasoning does not make their obsessional doubts and OCD stories about themselves true.
Rituals make the imagined feel true
OCD reasoning goes beyond common sense and what is likely to happen in the present situation. It turns a few possible ideas and doubts into a probable and imagined story which triggers anxiety and the need to undo the anxiety with some sort of ritual (either inside the head or an action). While the story is entirely made up, it starts to feel real because it is acted on with neutralising rituals and safety behaviours like avoidance. The OCD sufferer thinks that actions taken in reality can change imagined consequences.
Who you could be is not who you are in reality
The OCD sufferer relies on the imaginative story about who they could be (if they do not take OCD precautions, do rituals and other ways of neutralising their obsessions) instead of who they are in reality. So the problem is their central focus is on who they could be, not who they are in realty. And who you are in reality, is defined by your actions (did you actually harm your child), not your thoughts or feelings, because these are not under your control.
An alternative story helps you stop the rituals
Through a series of steps, IBT helps the OCD sufferer to become aware of the story they have bought into about themselves (and about what might happen) which is driving their OCD. It helps them consider a more reality based view of themselves and how the world operates. An alternative story about who they may become or what might happen is then developed. Once this alternative story is accepted, actions can be based on real here and now sense information instead of doubts about what could be. When this approach is followed, it is easier to stop doing the rituals which feed the OCD.
IBT is a new approach to OCD which has helped people free themselves from the tyranny of having OCD run (and ruin) their lives.
OCD reasoning goes beyond common sense and what is likely to happen in the present situation. It turns a few possible ideas and doubts into a probable and imagined story which triggers anxiety and the need to undo the anxiety with some sort of ritual (either inside the head or an action). While the story is entirely made up, it starts to feel real because it is acted on with neutralising rituals and safety behaviours like avoidance. The OCD sufferer thinks that actions taken in reality can change imagined consequences.
Who you could be is not who you are in reality
The OCD sufferer relies on the imaginative story about who they could be (if they do not take OCD precautions, do rituals and other ways of neutralising their obsessions) instead of who they are in reality. So the problem is their central focus is on who they could be, not who they are in realty. And who you are in reality, is defined by your actions (did you actually harm your child), not your thoughts or feelings, because these are not under your control.
An alternative story helps you stop the rituals
Through a series of steps, IBT helps the OCD sufferer to become aware of the story they have bought into about themselves (and about what might happen) which is driving their OCD. It helps them consider a more reality based view of themselves and how the world operates. An alternative story about who they may become or what might happen is then developed. Once this alternative story is accepted, actions can be based on real here and now sense information instead of doubts about what could be. When this approach is followed, it is easier to stop doing the rituals which feed the OCD.
IBT is a new approach to OCD which has helped people free themselves from the tyranny of having OCD run (and ruin) their lives.
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