Mod 1 Client Version

Inference-based cognitive behavioral therapy

Module 1

Brittany Goff, LCSW-C

Differences from ERP

Differences

FROM ERP

I-CBT

ERP

Thoughts are Inferences

Thoughts are intrusions

Teaches the learner how to gain certainty

Teaches the learner how to accept uncertainty

Purposefully provokes anxiety through exposures

Does not purposely provoke anxiety

Content matters

Content doesn't matter

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

obsessional reasoning

Obsessional reasoning

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

Distrust of the senses

Irrelevant Associations

Over-reliance on Possibility

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

obsessional reasoning

Obsessional reasoning

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

Distrust of the senses

Irrelevant Associations

Over-reliance on Possibility

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

normal reasoning

normal reasoning

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

Trusting our senses

Relevant Associations

Direct evidence of possibility

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

WHat causes ocd?

Inferential Confusion

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.

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

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

Distrust in the Senses

Irrelevant Associations

Over-reliance on 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

Over-reliance on Possibility

Irrelevant Associations

Distrust in the Senses

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

The OCD Sequence

Anxiety

Compulsion

Consequence

Doubt

Trigger

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

The OCD Sequence

Anxiety

Compulsion

Consequence

Doubt

Trigger

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

Doubt

Consequence

Trigger

Anixety

Compulsion

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

What if I made a mistake on my email?

I wouldn't be able to live with the embarrassment

Re-reads 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

Doubt

Consequence

Trigger

Anixety

Compulsion

What if I made a mistake on my email?

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

I wouldn't be able to live with the embarrassment

Re-reads 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

Doubt

Consequence

Trigger

Anixety

Compulsion

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

Locks the door again

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

What if the door isn’t shut properly?

Locking the vehicle door

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

Doubt

Consequence

Trigger

Anixety

Compulsion

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

Locks the door again

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

What if the door isn’t shut properly?

Locking the vehicle door

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

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.

OBSESSIONAL DOUBTS

Obsessional Doubts

Where OCD Starts

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

Symptoms of OCD begin with the doubt

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

Same predictable sequence

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.

OBSESSIONAL DOUBTS

Obsessional Doubts

Where OCD Starts

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

Symptoms of OCD begin with the doubt

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

Same predictable sequence

What is the obsessional doubt?

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?

Shifting away from

UNCERTAINTY

shifting away from UNCERTAINTY

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

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

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

Next up,

The Logic of OCD

Doubt

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

Consequence

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

The Logic of OCD- Next Module

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

Personal Experience

Rules

Possibility

Facts

Hearsay

Anxiety

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

Consequence

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

Distrust of the Senses

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

Trigger

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?

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?

Doubt

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

Over-reliance on Possibility

Putting excessive reliance on potential possibilities without having direct evidence.

Trigger

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