Mod 1 Client Version

Module 1

Brittany Goff, LCSW-C

Inference-based cognitive behavioral therapy

Teaches the learner how to accept uncertainty

Differences from ERP

Thoughts are Inferences

Thoughts are intrusions

Teaches the learner how to gain certainty

ERP

I-CBT

Differences

FROM ERP

Content doesn't matter

Purposefully provokes anxiety through exposures

Content matters

Does not purposely provoke anxiety

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Irrelevant Associations

Distrust of the senses

For example: I dry my hands on a clean paper towel after washing them. But what if they are still dirty?

Obsessional doubts lack direct evidence from the senses in the present moment.

Obsessional reasoning

obsessional reasoning

Over-reliance on Possibility

Irrelevant Associations

Distrust of the senses

For example: I dry my hands on a clean paper towel after washing them. But what if they are still dirty?

Obsessional based doubts fail to have any direct evidence from the senses in the here and now.

Obsessional reasoning

obsessional reasoning

Over-reliance on Possibility

Relevant Associations

Trusting our senses

For example: I can visibly see poop on my hands and wonder if my hands are dirty.

Reality based conclusions established from having direct evidence from the senses in the here and now.

normal reasoning

normal reasoning

Direct evidence of possibility

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Inferential Confusion

In essence, inferential confusion represents a metacognitive dysfunction wherein the individual fails to accurately discriminate between an imagined probability and actual reality.

This concept refers to a cognitive distortion where individuals with OCD mistake their intrusive thoughts, doubts, or imaginative inferences for reality. This over-reliance on inferences often leads to the creation of distorted narratives and obsessive doubts, even when there is no concrete evidence to support these doubts.

WHat causes ocd?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Irrelevant Associations

Over-reliance on Possibility

Distrust in the Senses

inferential confusion

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Distrust in the Senses

Irrelevant Associations

Over-reliance on Possibility

inferential confusion

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Compulsion

Consequence

Trigger

Doubt

Anxiety

The OCD Sequence

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Compulsion

Consequence

Trigger

Doubt

Anxiety

The OCD Sequence

Re-reads email

I wouldn't be able to live with the embarrassment

If I make a mistake, all my colleagues will see and laugh

What if I made a mistake on my email?

Sends email

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Compulsion

Anixety

Trigger

Consequence

Doubt

Doubt sequence

Compulsion

Anixety

Trigger

Consequence

Doubt

Re-reads email

I wouldn't be able to live with the embarrassment

If I make a mistake, all my colleagues will see and laugh

What if I made a mistake on my email?

Sends email

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Doubt sequence

Compulsion

Anixety

Trigger

Consequence

Doubt

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Locks the door again

If it’s not shut, the car will be stolen

Locking the vehicle door

What if the door isn’t shut properly?

I’d be a negligent person if my car got stolen

Doubt sequence

Compulsion

Anixety

Trigger

Consequence

Doubt

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Locks the door again

If it’s not shut, the car will be stolen

Locking the vehicle door

What if the door isn’t shut properly?

I’d be a negligent person if my car got stolen

Doubt sequence

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Same predictable sequence

Where OCD Starts

Obsessional Doubts

OBSESSIONAL DOUBTS

Obsessional doubts are simply a possibility or a “what if” statement

A person starts with certainty, then it’s followed by doubt

Symptoms of OCD begin with the doubt

Symptoms of OCD begin with a doubtA per

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Same predictable sequence

Where OCD Starts

Obsessional Doubts

OBSESSIONAL DOUBTS

Obsessional doubts are simply a possibility or a “what if” statement

A person starts with certainty, then it’s followed by doubt

Symptoms of OCD begin with the doubt

Symptoms of OCD begin with a doubtA per

Allison is terrified of harming her husband. Anytime she watches true crime shows, Allison contemplates if she could be a killer as well. She has never felt any desire to harm him, but the thought keeps crossing her mind. She avoids sharp objects around the house in case she suddenly feels the urge to harm him. Even though she knows she loves her husband, anything is possible.

What if i harm my husband?

What is the obsessional doubt?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Shifting away from

Learning to sit with uncertainty is a helpful skill. However, it’s not necessary for this treatment.

UNCERTAINTY

We are teaching you how to GAIN certainty in yourself through your senses.

shifting away from UNCERTAINTY

The Logic of OCD

Next up,

What is the “what if” question you asked yourself? Where did your mind make a “could be” statement?

Doubt

If that doubt were to come true, what is the consequence to it? What is the scary story at the end?

Consequence

Hearsay

Taking logical reasonings and applying them out of context to the here and now.

Possibility

Personal Experience

Rules

Facts

The Logic of OCD- Next Module

Anxiety

And what would that mean to you? If your doubt were to come true, what would it say about your identity?

If that doubt were to come true, what is the consequence to it? What is the scary story at the end?

Consequence

Using hypothetical scenarios about reality in place of the present-moment sensory data

Distrust of the Senses

What happened to set this sequence in motion? What is the earliest thing they can remember happening before you did a compulsion?

Trigger

What happened to set this sequence in motion? What is the earliest thing you can remember happening before you did a compulsion?

Trigger

Compulsion

What behavior did you feel compelled to do as a result of that story?

Compulsion

What behavior did yo feel compelled to do as a result of that story?

Anxiety

And what would that mean to you? If your doubt were to come true, what would it say about your identity?

What is the “what if” question you asked yourself? Where did your mind make a “could be” statement?

Doubt

Putting excessive reliance on potential possibilities without having direct evidence.

Over-reliance on Possibility

What happened to set this sequence in motion? What is the earliest thing you can remember happening before you did a compulsion?

Trigger