What Is Inference-Based CBT (ICBT) — and Can It Help with OCD?

If you’re struggling with OCD, you may have heard of Exposure and Response Prevention (ERP)—a powerful, evidence-based treatment that helps people face fears and stop compulsions. But ERP isn’t the only approach that works.

There’s another therapy that many people find helpful, especially if they feel stuck or misunderstood in more traditional treatments. It’s called Inference-Based Cognitive Behavioral Therapy (ICBT).

So, What Is Inference-Based CBT?

ICBT is a form of cognitive therapy developed specifically for OCD. Instead of focusing just on compulsions or behaviors, it focuses on the doubt at the heart of OCD.

OCD isn’t just about being afraid of germs or checking the stove—it’s often about a story your brain creates about what could happen. These stories usually aren’t based on facts or direct experience, but on inferences—meaning guesses, assumptions, or imagined scenarios.

ICBT helps you recognize when your brain is pulling you into an OCD story and teaches you how to get grounded in reality again.

An Example:

Let’s say you have harm OCD and suddenly get the thought: “What if I snapped and hurt someone?” You might feel anxious and start analyzing your past behavior, avoiding sharp objects, or trying to get reassurance that you’re a good person.

ERP would focus on the behavior (such as avoidance or reassurance-seeking). ICBT goes deeper, asking: What makes you believe this thought in the first place? And more importantly: Is the story your OCD is telling actually based in reality—or just a scary what-if?

How Is ICBT Different from ERP?

ERP asks you to face your fears (like holding a knife) without doing compulsions, so your brain learns that you're actually safe.

ICBT helps you step back and question whether the fear even made sense to begin with.

Instead of assuming the thought might be true and learning to tolerate the anxiety, ICBT helps you realize the thought doesn’t deserve your attention in the first place. It’s like catching the OCD train before it leaves the station.

Can ICBT Be Used with ERP?

Yes! In fact, many people benefit from using both approaches together.

• ERP helps retrain your nervous system and reduce compulsions.

• ICBT helps you shift your relationship with doubt and recognize when your OCD is telling a false story.

Together, they can offer a powerful, well-rounded approach to OCD that addresses both the body and the mind.

Some people find that starting with ERP gives them symptom relief, and ICBT helps them go deeper and stay grounded. Others who struggle with ERP alone—especially if they feel flooded or resistant to exposures—find that ICBT offers a new way in.

Interested in Learning More?

If you're curious about ICBT and how it might fit into your healing process, I offer a weekly therapy group focused on supporting people with OCD. In the group, we explore ICBT concepts, strengthen your ability to recognize OCD thinking patterns, and share practical tools to help you feel more empowered and less stuck.

This group is a great option for:

• People who are already in therapy and want extra support

• Those new to OCD treatment who are curious about ICBT

• Anyone feeling stuck or looking for a fresh perspective

You don’t have to figure this out alone—and you don’t have to pick just one path to healing. Therapy is not one-size-fits-all, and your recovery can be as layered and individualized as you are.

If you’re interested in joining the group or have questions about how ICBT could help you, feel free to reach out. I’d love to help you take the next step.