ICBT — The OCD Therapy You’ve Probably Never Heard Of
If you live with OCD, you might feel like your brain is a full-time detective — except it’s less Sherlock Holmes and more conspiracy theorist with a cork board full of red string. Many people have heard of ERP (exposure and response prevention, sometimes called exposure and ritual prevention). ERP is often called the gold standard for OCD treatment — and it is!
But what if there was another approach that focused on the thoughts themselves, not just the compulsions? Enter ICBT (Inference-Based Cognitive Behavioral Therapy) — an OCD-specific intervention with no exposures.
I know what you’re thinking: “How can this approach be effective if there are no exposures?” Honestly, I thought the same thing. As an OCD therapist, I pride myself on being evidence-based and making sure people with OCD are getting the right help. So I was skeptical when I first heard about ICBT — but intrigued.
After practicing ICBT with over 30 clients, I’m here to share what I learned and why I’m now obsessed (no pun intended) with this approach.
What OCD Does
OCD thrives on doubt and convinces people that intrusive thoughts =danger. OCD is sometimes even called the “doubt disorder.” Someone doubts what they know to be true, or doubts themselves, and a “what if” spiral commences.
Example: “What if I left the stove on?” → Cue hours of checking, spiraling, and Googling.
ERP helps by teaching you to face fears without rituals. It’s about building tolerance for uncertainty and showing your brain you’re safe without doing the compulsion, but what about the thoughts themselves? What about when you have certainty, but the doubt is still there?
That’s where ICBT comes in.
While ERP teaches you how to stop feeding OCD, ICBT looks at how OCD convinced you to open the fridge in the first place.
What is ICBT?
ICBT = Inference-Based Cognitive Therapy. This shift in focus — from compulsions to the way obsessions are formed — is what makes ICBT so powerful.
ERP focuses on not doing the compulsion (e.g., not checking the stove).
ICBT zooms in earlier in the OCD cycle — at the thought process that led your brain to decide the stove might be on in the first place.
If ERP helps you stop scratching the itch, ICBT helps you understand why the itch showed up in the first place.
The Logic of OCD vs. Real-Life Logic
OCD runs on imaginary reasoning (possibility-based) instead of real-world evidence.
Real-life logic: “I turned the stove off. I saw myself do it.”
OCD logic: “But what if you imagined that memory? What if you missed a burner? What if your house burns down?”
ICBT helps you recognize when your brain has jumped tracks into OCD’s “imagination land.” It builds back trust in yourself so your brain learns that the evidence you already had is enough. Here’s where choice comes in: you can learn to notice when OCD is inviting you into its logic — and decide not to buy the ticket.
Core Tools of ICBT
1. Reality Sensing
Training your brain to come back to what’s actually happening right now. Reality sensing is what tells me I’m wearing pants right now while typing this, without having to look down and check or it’s how I know my laundry is clean. Here’s how I know that the reality is my laundry is clean:
I can feel that it’s wet.
I can smell that it’s fresh.
I can see that the stains are gone.
I heard the washing machine running earlier.
I used my senses — and that’s enough certainty.
Reality sensing reinforces that you DO have control in the present moment. OCD wants you to live in the “what if.” ICBT teaches you that you get to choose to anchor yourself in the “what is.”
2. The OCD Bubble
Recognizing when you’re “inside” OCD logic and learning how to step back out.
Imagine being in a snow globe when OCD hits. Thoughts swirl everywhere, making it hard to see what’s right in front of you. The more you engage, the more shaken up the snow globe gets, and the harder it is to see clearly.
But here’s the part most people don’t realize: you don’t always have to step into the bubble in the first place. OCD tries to lure you in with “what ifs” — but there’s often a split second of choice before you get pulled in.
ICBT helps you spot that moment. It teaches you that you have agency — you can notice the invitation into the bubble, and choose not to accept it. Coupled with Reality Sensing, this means you’re not just waiting for the “snow” to settle. You’re learning how to stay grounded outside the bubble altogether.
3. Building the Alternative Story
Replacing obsessional reasoning with a narrative based on facts, not fears.
The Alternative Story isn’t about arguing with OCD or proving it wrong. It’s about offering your brain another option — one grounded in your senses and real evidence, not endless “what ifs.” This process gives you back the freedom to choose which story you want to stand in.
Why People Like ICBT
It’s gentle: less about “jumping into the scary thing,” more about understanding your thought process.
It’s empowering: gives you language to explain what’s happening in your brain.
It’s teaching-based: I often say ICBT is a teaching model. I’m not just giving you answers — I’m showing your brain how to fact-check its own stories.
Most importantly, ICBT helps people see that they’re not powerless in the face of OCD. There are moments of choice, and once you learn how to notice them, you can step out of the spiral earlier and earlier. In my practice, I usually start with ICBT for clients who are a good fit. If needed, we can add in natural exposures that align with your values.
A Real-Life Example
Take Sarah, who constantly checked the locks before bed. With ERP, she would practice walking away from the door without checking again. Helpful, yes — but the doubt remained.
With ICBT, she learned to notice when her brain had jumped from reality (“I turned the lock”) into OCD-land (“But what if you imagined turning it? What if the lock is broken?”).
That moment of recognition gave her agency. She could choose to stay anchored in her senses rather than step into the bubble. That shift helped her trust herself again.
What ICBT IS NOT
✗ It’s not reassurance
✗ It’s not debating with OCD
✗ It’s not just “positive thinking”
ICBT is retraining your brain to change the way you respond to obsessions. Think Wizard of Oz: we’re pulling the curtain back on OCD to see that the “all-powerful wizard” is just a guy with a microphone and a mask. In other words: ICBT doesn’t play OCD’s game. It changes the rules — and gives you the power to decide whether to play at all.
The Takeaway
There are multiple evidence-based approaches to OCD treatment, and you don’t have to do it alone. Whether you’ve tried ERP and want to add another tool to the mix, or you’re new to OCD treatment altogether, ICBT can shine a little light into the “what if” spiral.
The truth is, OCD doesn’t get the final say. You do. ICBT is one way to reclaim your choice, step out of the doubt spiral, and back into your life. If you’re curious about whether ICBT might be a fit for you, I’d love to connect.