Inference-Based CBT (ICBT) for OCD: What You Need to Know
In my last post, I discussed Inference-Based Cognitive Behavioral Therapy (ICBT) for OCD. I reviewed how this approach does not require exposures, which I have found to be really helpful for more taboo OCD themes. For example, if you're obsessed with the idea that you could snap one day and hurt the people you care about, it can feel really challenging-or even wrong-to accept the uncertainty that this could happen. It can also feel equally difficult to disengage from these intrusive thoughts without first building self-trust. This is where I see ICBT being really helpful for my clients: it builds self-trust and works toward helping people look to evidence to realize that their obsessions are not true. You can read my last post here: What is ICBT for OCD?
I do want to give a trigger warning for this post, as I talk about suicide. Suicide OCD is a theme I often see in my office, so if this is a sensitive subject for you, please be aware that I discuss suicide here.
What Is Inferential Confusion in OCD?
ICBT also sheds light on the thinking patterns that contribute to OCD, often referred to as faulty reasoning or inferential confusion. In my last post, I discussed how mistrust of the self, senses (what you see, hear, smell, touch), common sense, desires, and intentions contribute to OCD. There are two other ways people with OCD experience inferential confusion that lead to the OCD cycle: irrelevant connections and over-reliance on possibility. In ICBT at Jen Lescher LCSW, I teach clients how to identify their inferential confusion so they don't get pulled into OCD.
How Irrelevant Connections Fuel OCD
One way we get confused with OCD is by making irrelevant connections. This is when we take something out of context and apply it to ourselves in the here and now, even though it doesn't actually relate, because context is everything. Let me use a hypothetical example to illustrate this.
A Hypothetical Example
Let's say Mary has an obsession that she could become very depressed and kill herself one day. Again, suicide OCD is a common theme I've seen, and one that is especially taboo and hard to describe because, of course, we want to prevent suicide. However, someone with this obsession doesn't actually want to kill themselves-they are afraid that they might. OCD is doubting what you already know, and suicide OCD is a great example of this. Oftentimes, therapists and loved ones assume the person is actually suicidal and focus on preventing suicide, when there wasn't an actual risk to begin with because it was OCD, not true suicidal intent. Instead the person is doubting what they are already know to be true- that they aren't suicidal.
How OCD Takes Things out of Context
So, let's say Mary has been feeling a little sad and down lately, and she recently watched a movie where a character was also depressed and then died by suicide. She starts thinking, "Wow, I'm feeling like that character-what if I kill myself? That would be so awful, oh my god..." and the spiral begins. Then Mary might think of a friend who has, sadly, experienced suicide in their family. Mary starts to think something like, "Wow, this really happens to people-this happened in my friend's family. What if I do it too?"
Slowing Down the OCD Pattern
But let's slow this down, which is something I help people do as a therapist to examine the OCD pattern, because it happens so quickly. Slowing down and zooming out allows us to see the steps involved in faulty reasoning, or the thinking that leads to OCD. Just because other people die by suicide, does that mean Mary is going to do the same? No because we have to look at context, which is exactly what OCD leaves out.
Looking at the Actual Evidence in ICBT
First, the character in the movie is fictional. The character was also abusing alcohol (a depressant), isolating from friends and family, and, most importantly, had the desire and intention to harm themselves. Mary doesn't share these factors. She drinks occasionally, and although she has been spending a bit less time with loved ones because she feels down, she is still regularly seeing her best friend and talking with her mom throughout the week. Most importantly, she does not want to kill herself. Yes, she's been feeling sad, but she has no desire or intention to harm herself-she is doubting and mistrusting herself. We can see here how OCD has taken the movie character out of context and applied it to Mary, which is irrelevant because they are very different.
Why Context Matters
Now, let's look at the other irrelevant connection: Mary's friend who had a family member die by suicide. This is all the information Mary has. She doesn't know what that person was going through, their trauma history, what their support system looked like, whether they were in therapy, taking medication, and so on. All Mary knows is that this tragic event occurred, and now OCD is telling her it could happen to her, too. But these details matter-context matters-and without that context, this story really has nothing to do with Mary. It's an irrelevant connection that is pulling her into the OCD narrative.
In my next post, I'll talk about how ICBT explains that over-reliance on possibility also leads to faulty reasoning and OCD. Stay tuned.
OCD Counseling in Boston, MA & San Diego, CA
If you find yourself constantly questioning your thoughts, intentions, or sense of self, OCD therapy can help you step out of the spiral of doubt and reconnect with what you actually know to be true about yourself.
Jen Lescher, LCSW, offers OCD counseling in San Diego, CA and Boston, MA for adults struggling with intrusive thoughts, taboo OCD themes, rumination, suicide OCD, and other anxiety-related challenges. In my work, I integrate Inference-Based CBT (ICBT) and ERP therapy to help clients better understand the thinking patterns that drive OCD.
Start Untangling the OCD Story
When OCD is loud, it can become hard to trust your own thoughts, intentions, or feelings. OCD Counseling can help you slow the process down, understand how OCD is pulling you into fear and faulty reasoning, and begin responding differently to intrusive thoughts instead of getting trapped in endless analysis.
Connect with Jen Lescher, LCSW to learn more about OCD therapy, ICBT, and ERP in Boston, MA and San Diego, CA.
Explore more blog posts to learn about intrusive thoughts, rumination, relationship OCD, taboo OCD themes, and anxiety recovery.
If this blog resonated with you, reaching out for support can be a meaningful next step.
Additional Services Offered in Boston, MA & San Diego, CA
Along with one-on-one OCD therapy, I also offer supportive resources that address challenges many clients face outside of sessions. On the Common OCD Themes page, you can explore detailed insights into recurring thoughts and behaviors. The OCD and Social Life page offers guidance for managing friendships, dating, and relationships while living with OCD and anxiety.
About OCD Therapist Jen:
Hi, I'm Jen.
I'm a therapist, coffee enthusiast (honestly, it's my favorite time of the day), and a big believer in finding small moments of presence-whether that's through mindfulness, photography, or a quiet walk with my camera in hand. Photography helps me stay grounded and see the world with a little more curiosity, and that same mindset shows up in my work with clients. I've been drawn to spirituality and healing work since I was a teenager, exploring everything from meditation to energy practices. But I'm also someone who loves blasting music in the car and getting lost in a true crime podcast. I think healing can include both stillness and movement, reflection and laughter. Therapy should have room for all of that. Since 2007, I've worked in a range of mental health settings, which taught me that healing isn't one-size-fits-all. It's personal, evolving, and sometimes messy-but always possible.
Training & Background:
Inference-Based CBT (ICBT) for OCD - The OCD Training School & The Cognitive Behavioral Institute
Certified in Exposure and Response Prevention (ERP) - The Cognitive Behavioral Institute
Gottman Method Couples Therapy - Level 1
Master's in Social Work - Portland State University, 2012
