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  • Writer's pictureTheresa Chiu, MSSW, LICSW

Inference-Based Cognitive-Behavioral Therapy

Obsessive compulsive disorder (OCD) is defined by the American Psychological Association as consisting of recurrent obsessions that prompt the performance of neutralizing compulsions.

Theresa Chiu, MSSW, LICSW, the founder of Olympic OCD Services in Washington state, has been providing consultation and helping other clinicians learn and discover effective treatments for OCD. She values an anti-oppression approach to healing and is neurodiversity and queer affirming.



Inference-based Cognitive-Behavior Therapy (I-CBT) is an evidence-based treatment option for obsessive-compulsive disorder (OCD) that emphasizes the role of reasoning in the development and maintenance of OCD. I-CBT has a large body of scientific literature supporting its effectiveness for helping adults with OCD. There are randomized controlled trials that have shown it to be effective for the majority of people suffering from OCD. It's also considered an alternative treatment option for people who haven't been able to benefit from other therapy.


This treatment targets what is called "Inferential Confusion." Inferential Confusion is the main reasoning process that's responsible for OCD, according to this theory.

Obsessional inferences of doubt are thought to be the result of the person getting tricked by reasoning distortions that are carried in an obsessional story. The person experiences confusion between what they know is real and what they imagine *might be* real. This whole process is characterized as over-relying on the imagination and distrusting the senses, sense of self and common sense. There's a lot of investment for the sufferer in what could be possible, instead of what is actually happening. This all falls under the "Inferential Confusion" umbrella.


As mentioned, inferential confusion leads to a special kind of doubt in OCD. OCD doubts are not like normal doubts - they are doubts that are obsessional because of the Inferential Confusion. These doubts are often “what ifs” “might be’s” or “could be’s.” These doubts can also be expressed visually as images for the sufferer.


Since Inferential Confusion is the main problem in OCD according to this model, the I-CBT treatment program aims to bring resolution of the obsessional doubts through a unique and stepped treatment program that helps show the sufferer the reasoning process, the role of the obsessional narrative, reasoning devices that contribute to the confusion, and how to integrate the different narrative. The reasoning that's based not on OCD, but on reality.

If you or someone you know is looking for OCD treatment in Washington state, please visit to book a free consultation.

This site does not provide medical or psychological advice. The content on all websites associated with Olympic OCD Services, including, but not limited to, the text, graphics, images, links, and other materials are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Olympic OCD Services does not recommend or endorse any products, procedures, opinions, or other information that may be mentioned on the website. Reliance on any information provided herein is solely at your own risk.


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