ICBT for OCD in Boston, MA: Why Structured, Evidence-Based Care Makes a Difference
In OCD therapy, I primarily use Exposure and Response Prevention (ERP) and Inference-Based Cognitive Behavioral Therapy (ICBT). Both are offshoots of traditional Cognitive Behavioral Therapy (CBT).
If you’ve been to therapy or have read a bit about mental health treatments, you’ve probably come across CBT. While ICBT for OCD shares some similarities with traditional CBT—particularly in how it targets thoughts—there are important differences to understand.
What is ICBT?
First things first: ICBT is CBT specifically designed for OCD. (Yes, a lot of acronyms—I know!) While we're still learning how ICBT might help with other conditions, it was created solely to address the unique thinking patterns that drive OCD.
Unlike ERP, which focuses on compulsions and behavioral rituals, ICBT focuses on the obsessions—the thoughts at the start of the OCD cycle. That means no exposures. ICBT is a purely cognitive approach.
This can be especially helpful for people who’ve had tough experiences with ERP, or for those who simply aren’t comfortable with exposure-based work. I often find ICBT to be a powerful tool in those cases.
How Does ICBT Work?
At its core, ICBT looks at how obsessions are formed through faulty reasoning.
A common clue that OCD may be at play is when someone says something like:
“I know this is crazy, but I can’t help it.”
“I realize this isn’t true, but I still get pulled in.”
“It’s like my mind switched modes.”
That’s often a sign that the person is caught in what ICBT calls faulty reasoning or inferential confusion—a different kind of thinking that only shows up in situations where OCD is triggered. In all other areas of life, the person uses what ICBT calls “normal reasoning”: trusting their senses, common sense, and lived experience.
In other words, when OCD shows up, it can feel like your brain suddenly starts operating by different rules—and that can feel crazy, even though it isn’t.
An Example: Jon and OCD
Let’s say Jon has OCD centered around a fear of accidentally causing a house fire that harms his family. As a result, he:
Checks the stove multiple times to make sure it’s off.
Unplugs appliances.
Repeatedly checks that everything is unplugged.
Spends hours researching electrical fires.
You get the picture.
But here’s the interesting part: in most other areas of his life, Jon doesn’t struggle like this. He can drive a car, discuss complex matters with his boss, and manage his kids’ schedules—all without obsessively checking or second-guessing himself. That’s because he’s using normal reasoning in those areas.
However, when it comes to using the stove, his OCD gets triggered. Suddenly, he feels like he can’t trust himself. Anxiety kicks in, and he falls into compulsive checking. He might say something like, “I know it’s off, but I just can’t help it.”
What he’s really saying is: “I know this doesn’t make sense, but something still feels wrong.”
This is classic OCD reasoning. ICBT helps us target this exact shift in thinking—the moment a person moves from normal reasoning to OCD-driven reasoning—and teaches how to recognize it, challenge it, and ultimately change it.
So What’s the Faulty Reasoning Driving Jon’s OCD?
Let’s slow this down and look at what’s actually happening in Jon’s mind, from an ICBT perspective. What is the inferential confusion that’s keeping the obsession going?
1. Mistrust of the Senses and Memory
Jon can see that the stove is off. He might have heard the click when he turned the dial or even felt himself turn it off.
His senses are giving him clear, reliable information: the stove is off.
And in every other part of his life, Jon relies on these same senses and memory without a second thought. He trusts:
That it’s cold outside, so his kids need jackets.
That a red light means “stop.”
That he remembers when a project is due and can meet deadlines.
But in this area—when it comes to the stove and the fear of starting a fire—that trust disappears. He suddenly doubts what he sees, hears, and remembers. This mistrust of the senses is a hallmark of inferential confusion in OCD.
2. Over-reliance on Possibility
Here’s another piece: Jon is over-relying on what is possible.
Yes, technically it’s possible that he left the stove on. Almost anything is possible if we imagine hard enough. But in ICBT, we ask: Is that possibility relevant?
The evidence Jon has—his direct sensory experience—is that he turned the stove off. But instead of relying on that, he’s responding to an imagined scenario in which he didn’t turn it off.
He’s asking himself: “What if I didn’t? What if something went wrong?” And he’s acting as if that imagined possibility is as real and urgent as actual evidence.
This is a key piece of inferential confusion: responding to imagined threats as if they are real.
3. Irrelevant Associations
The third ICBT concept at play is something called irrelevant connections.
Jon might be thinking:
“My coworker had an electrical fire and lost everything… so it could happen to me.”
“One time, I actually did leave the stove on for 24 hours… so I could do it again.”
Here, Jon is pulling in unrelated information and applying it to the present moment, even when the actual context and evidence don’t support the fear.
ICBT helps us challenge this by asking:
Just because something happened to someone else, does that mean it is going to happen to me right now?
Just because I made a mistake once, does that mean I’ll make it again—right now—even with evidence from my senses that I did not make a mistake?
When we zoom out and look at the evidence, these connections don’t hold up. But in the OCD moment, they feel very convincing—and that’s what keeps the anxiety loop going.
This is Where ICBT Comes In
In ICBT, I help people identify and challenge these patterns of faulty reasoning.
We look at how OCD leads to:
Mistrusting your own senses and memory.
Over-relying on possibility over evidence.
Making irrelevant connections that fuel anxiety.
Once you learn to spot these mental habits, it gets easier to say: “Wait a second… this is OCD thinking.” And once you can see OCD for what it is, it’s much harder to fall for its tricks.
From there, we work on shifting back to normal reasoning—the same reasoning you use every day when OCD isn’t involved. We rebuild self-trust, use evidence over imagination, and learn to disengage from obsessions.
Click here to learn more about ICBT: https://icbt.online
Curious if ICBT might be a fit for you?
If this way of thinking about OCD resonates with you, ICBT could be a great next step. As an OCD therapist in Boston, MA, I’d love to help you explore it further.
Reach out to learn more or schedule a time to talk.
Virtual OCD Therapy in Massachusetts and California
You don’t need to be in Boston to start addressing OCD. I offer virtual counseling for adults throughout Massachusetts and California, making specialized care accessible no matter where you live, without the stress of commuting or added obstacles. All you need is a private space and an internet connection to begin receiving compassionate support.
In our OCD therapy work, the focus is on helping you step out of fear-driven cycles, learn to tolerate uncertainty, and rebuild confidence from the inside out. Whether this is your first time in therapy or you’re returning after some time away, you’ll receive the same evidence-based treatment and genuine care—all from the comfort of your own home.
Start ICBT for OCD in Boston, MA
Living with OCD can feel overwhelming, but you don’t have to face it alone. At my practice, I specialize in ICBT for OCD in Boston, MA, using evidence-based approaches like ICBT and ERP to help clients break free from cycles of fear, doubt, and compulsions. As an OCD therapist, I believe structured, practical care can make all the difference in building resilience and lasting change.
Here’s how to begin your journey:
Book a free 15-minute consultation to share your challenges and learn how ICBT for OCD can support you.
Begin virtual OCD therapy from anywhere in MA or CA, tailored to your unique experiences, goals, and pace.
Develop new strategies and confidence as you practice proven skills that create long-term relief and freedom from OCD.
You don’t need to let OCD control your life. Together, we can take steady, meaningful steps toward healing and balance.
Additional Resources to Support Your Healing Journey
Beyond one-on-one OCD therapy, I offer resources that can help you carry progress into your daily life. The Common OCD Themes page provides insight into the intrusive thoughts and behaviors many people face, helping you identify patterns and know you’re not alone. The OCD and Social Life page looks at how OCD influences friendships, dating, and relationships—sharing strategies to foster connection and build confidence while managing symptoms.
These resources are meant to complement your therapy, offering education, practical tools, and encouragement so you can continue moving forward between sessions.
