Inference-Based CBT (I-CBT) for OCD in San Antonio and Across Texas

inference-based CBT

OCD Starts With a Doubt. I-CBT Works on That Doubt Directly.

OCD rarely starts with fear. It starts with a doubt: What if I didn't lock the door? What if I don't really love my partner? What if I offended God? Inference-Based Cognitive Behavioral Therapy (I-CBT) works on that doubt directly, before it ever becomes anxiety. At Integratus Counseling, I-CBT is one of our core specialties. We offer it in person at our San Antonio office and virtually anywhere in Texas.

I-CBT therapist at Integratus Counseling writing notes at a table beside a stack of books

I-CBT is an evidence-based treatment developed specifically for OCD.

It was developed by Dr. Frederick Aardema and Dr. Kieron O'Connor [1, 2], and it's built on one insight: OCD convinces you through a particular kind of reasoning, called inferential confusion. Inferential confusion happens when an imagined possibility starts to feel more real than what you can actually see, sense, and know [3]. OCD builds a persuasive story out of facts, rules, and "what ifs," and that story overrides your own senses and common sense. I-CBT helps you recognize how that story is built, step by step. As you learn to trust your senses and your real-life self again, the doubt loses its grip, and the compulsions lose their purpose.

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A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.

Luke Mayeux, LPC, I-CBT trained OCD therapist, reading a book outdoors
How I-CBT differs from ERP

A different route to the same freedom.

Exposure and Response Prevention (ERP) is the most established OCD treatment [4], and we use it every day. It teaches your brain to tolerate anxiety and uncertainty without doing compulsions. I-CBT takes a different route. Instead of facing the anxiety, it addresses the reasoning that creates the doubt in the first place. It doesn't require exposure exercises [5]. Neither approach is right for everyone. We'll recommend the one that fits your symptoms and history.

Is I-CBT evidence-based? Yes.

Randomized controlled trials found it as effective as established cognitive-behavioral therapy for OCD [5, 8]. A large open trial found it effective across all major OCD subtypes, including for people who hadn't responded well to standard CBT [7]. Studies also show it works for people who feel strongly convinced by their obsessions, and it may have an edge for those with the strongest conviction [5, 7, 8].

Schedule a free 15 minute consultation

A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.

why integratus counseling

I-CBT from clinicians who also know ERP.

Our I-CBT clinicians trained through the OCD Training School, and Luke is also a Certified Exposure and Response Prevention Therapist (C-EX/RP), so your care isn't limited to one approach. Alongside the official I-CBT materials, we use handouts we've created, including guides that help family members step back from reassurance and accommodation. If your history or symptoms suggest ERP would help too, we'll talk it through with you. We see clients in person at 16607 Blanco Rd, Ste 1308, San Antonio, and by telehealth anywhere in Texas.

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Open book with highlighted passages, representing the reasoning work of I-CBT

Who I-CBT can help

I-CBT may be a good fit if you:

  • Tried ERP and found it too distressing, or felt stuck partway through [7]
  • Feel strongly convinced your obsessions might be true
  • Have mostly mental OCD, often called "pure O." The compulsions are still there, just hidden in your head: reviewing, analyzing, mentally checking, or arguing with thoughts.
  • Get pulled into long mental reviewing, analyzing, or self-questioning
  • Fear something about who you are, such as being secretly dangerous, immoral, or unfaithful

What I-CBT sessions look like

I-CBT is structured and collaborative. Over a series of 50-minute sessions, we'll:

  1. Map how your OCD builds its doubts and what it's trying to convince you of
  2. Identify the reasoning tricks OCD uses, such as borrowing distant facts or treating possibility as probability
  3. Practice reconnecting with your senses, your common sense, and your real-life self
  4. Explore the "feared self" [6] OCD keeps warning you about, and why it doesn't fit who you actually are

Between sessions, you'll use short worksheets drawn from the official I-CBT materials. Many clients also read Dr. Aardema's Resolving OCD workbooks alongside therapy, listed on our Resources page. If you'd rather work with exposures, see our page on ERP therapy.

Frequently asked questions

Is I-CBT better than ERP?

Neither is better for everyone. Both are effective OCD treatments that work in different ways. ERP builds tolerance for anxiety and uncertainty; I-CBT targets the reasoning behind obsessional doubt. In your free consultation, we'll talk through which may suit you best.

Can I do I-CBT if ERP didn't work for me?

Yes. Many people come to I-CBT after ERP felt too overwhelming or stopped helping [7]. Because I-CBT works on a different part of the OCD cycle, it can open a new path forward.

Do I have to do exposures in I-CBT?

No. I-CBT doesn't use exposure exercises. Its work focuses on understanding and resolving the doubt that drives your compulsions.

How long does I-CBT take?

It varies with your symptoms and goals. I-CBT follows a structured sequence, and we'll review your progress together regularly.

Do you offer I-CBT virtually?

Yes. We offer I-CBT in person at our San Antonio office and by secure telehealth anywhere in Texas. You need to be physically located in Texas during each session.

How much does I-CBT cost?

Individual sessions are $150 for 50 minutes. We're a private-pay practice. Clients working with Luke Mayeux, LPC, can request a superbill for possible out-of-network reimbursement.

References

  1. O'Connor, K., & Robillard, S. (1995). Inference processes in obsessive-compulsive disorder: Some clinical observations. Behaviour Research and Therapy, 33(8), 887–896. https://doi.org/10.1016/0005-7967(95)00042-V
  2. O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Wiley-Blackwell. https://doi.org/10.1002/9781119960027
  3. Aardema, F., O'Connor, K. P., Emmelkamp, P. M. G., Marchand, A., & Todorov, C. (2005). Inferential confusion in obsessive–compulsive disorder: The Inferential Confusion Questionnaire. Behaviour Research and Therapy, 43(3), 293–308. https://doi.org/10.1016/j.brat.2004.02.003
  4. Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder: A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. https://doi.org/10.1016/j.cpr.2015.06.003
  5. Aardema, F., Bouchard, S., Koszycki, D., Lavoie, M. E., Audet, J.-S., & O'Connor, K. (2022). Evaluation of inference-based cognitive-behavioral therapy for obsessive-compulsive disorder: A multicenter randomized controlled trial with three treatment modalities. Psychotherapy and Psychosomatics, 91(5), 348–359. https://doi.org/10.1159/000524425
  6. Aardema, F., & O'Connor, K. (2007). The menace within: Obsessions and the self. Journal of Cognitive Psychotherapy, 21(3), 182–197. https://doi.org/10.1891/088983907781494573
  7. Aardema, F., O'Connor, K. P., Delorme, M.-E., & Audet, J.-S. (2017). The inference-based approach (IBA) to the treatment of obsessive–compulsive disorder: An open trial across symptom subtypes and treatment-resistant cases. Clinical Psychology & Psychotherapy, 24(2), 289–301. https://doi.org/10.1002/cpp.2024
  8. Visser, H. A., van Megen, H., van Oppen, P., Eikelenboom, M., Hoogendoorn, A. W., Kaarsemaker, M., & van Balkom, A. J. (2015). Inference-based approach versus cognitive behavioral therapy in the treatment of obsessive-compulsive disorder with poor insight: A 24-session randomized controlled trial. Psychotherapy and Psychosomatics, 84(5), 284–293. https://doi.org/10.1159/000382131

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