Inference-based Cognitive Behavioral Therapy (ICBT), Exposure & Response Prevention (ERP) and EMDR
What is Obsessive-Compulsive Disorder?
Obsessive compulsive disorder (OCD) is a neurological disorder that causes intense anxiety/distress. It affects your thinking and behavior and threatens things you value the most. When you feel anxious, it might feel like you are in danger. To rid yourself of the perceived threat, compulsions or rituals step-in. You might recognize that the fear is excessive or it does not align with who you are as a person, yet it still feels very real and scary. Your brain is telling you that you are in danger when you are not.
Treatment
Several key aspects of treatment are thorough assessment, goal-setting, and treatment planning which determines the path forward and may include, hierarchy planning, in vivo exposure, response (ritual) prevention and cognitive processing or a more narrative form. Exposure and response prevention (ERP), involves gradually exposing you to a feared obsession, and having you learn ways to resist the urge to do compulsions and/or rituals. ERP helps retrain the brain to have decreased anxiety and discomfort in the face of a perceived threat which has no basis in the current situation.
Additionally, research has indicated EMDR is efficacious for OCD treatment, specifically with use of the Distancing Technique. Before processing trauma, which may be (or may not be) behind some of the OCD obsessions and compulsions, the distressing encounters must first be addressed. Using the Distancing Technique prior to incorporating the Standard EMDR protocol is important. Depending on the client this can be a process which is slow and determined, or quickly incorporated. The client and client experience determines the path forward.
I-CBT or Inference Based Cognitive Behavioral therapy is a relatively new and evidence-based treatment which targets the obsessional doubt (versus reasonable doubts) from which the obsessional sequence follows. By asking the “why” questions traditional OCD treatment such as ERP does not, I-CBT addresses the narrative that propagates the loop in which one becomes stuck. I-CBT involves progressing through 12 modules over the course of 12-15 sessions to help decrease obsessional doubt which is the basis for anxiety.