Treatment Appoach and Methods
My work is grounded in Cognitive and Behavioral Therapy (CBT), a practical, structured method that blends the theories and practices from two complementary approaches: Behavioral Therapy (BT) which focuses on how learned patterns of behavior can be changed through practice and new experiences and Cognitive Therapy (CT) which centers on how thoughts, beliefs, and interpretations strongly influence how we feel and act. By combining these perspectives, CBT helps individuals recognize and change unhelpful thinking patterns while also encouraging changes in behaviors
Behavioral Therapy
Behavioral Therapy (BT) has its roots in early 20th century psychology that studied learning and observable behavior. Behavioral psychologists viewed emotional difficulties and maladaptive behaviors as learned responses that could be modified or replaced with new learning experiences. For these earlier generations of behavioral psychologists, fear is a learned behavior shaped by experience. In controlled experiments they show that fear can be conditioned in neutral situations when paired with a threatening stimuli. Because fears could be learned, the argued, they could be replaced through new learning. In the 1950s Joseph Wolpe developed a treatment called Systematic Desensitization where patients were guided to gradually face feared situations using relaxation techniques, causing fear response to weaken or fade. In the 1960s other psychologists observed the role of avoidance in maintaining fear, developed Exposure Therapy where patients were guided to face avoided situations without experiencing harm. This allowed them to change the negative learned association by experiencing previously feared situations as safe. Subsequent researchers building on these foundations further refined exposure therapy for PTSD and phobias including Exposure and Response prevention (ERP) developed by Victor Meyer for the treatment of Obsessive Compulsive Disorder (OCD)
Cognitive Therapy
Cognitive Therapy (CT) was developed in the 1960s by psychologists Albert Ellis and Aaron Beck as part of the "cognitive revolution". Both Ellis and Beck argued that BT’s hard rejection of the "unscientific" theories and practices of psychoanalysis erred in overlooking the role of thoughts and beliefs in psychological distress. Independently they emphasized the role of cognition or thinking in the development of psychological conditions where underlying beliefs (schema) lead to biased, erroneous interpretations that in turn drive emotions such as depression, fear or anger. Treatment involves challenging and modifying maladaptive thoughts and behaviors to achieve psychological change] the use of socratic questioning to challenge and reframe such "cognitive distortions, which decreases emotional distress. leading to positive behavior changes.
The process of change in CT involves using structured dialogue called guided discovery the person learns to test their beliefs against the evidence and consider alternative perspectives, thus opening the door to more flexible and reality-based interpretations. Unlike "exposures" in Behavioral Therapy, CT uses Behavioral Experiments, which are planned activities designed to test the accuracy of negative predictions. Over time, this restructuring of thoughts together with corrective experiences changes maladaptive beliefs and leads to transformative behavioral changes
Inferential Based Cognitive and Behavioral Therapy (I-CBT)
Inferential Based Cognitive and Behavioral Therapy (I-CBT) for OCD was developed in the mid 1990s by Dr. Kieron O'Connor and colleague Dr Frederick Aardema, at the University of Montreal, as an alternative to the Exposure and Response prevention (ERP) and Cognitive Therapy models. O'Connor observed the short-falls of both Behavioral Therapy-Exposure and response Prevention (ERP) and Cognitive therapy. Rather than trying to map OCD onto theoretic models developed for other conditions, O' Connor decided to take a fresh bottom up approach: studying the the thinking and reasoning of people with OCD, he observed that rather than misinterpretations of intrusions that pop into the mind, as other models proposed, obsessions are created from a process of doubting direct evidence of what is perceived to be real, while giving preference to what is imagined, implausible or irrelevant. This "crossover" from reality to imagination and the hypothetical "what if" scenarios that follow represent the starting point of obsessions. Once in imagination, he observed, the mind begins building stories that flow naturally from the obsessional starting point: "if the light isn't turned off, there could be a fire"…"What if I thought I locked the door, but really didn't and someone comes in and robs my house".
Obsessions generate fear and "anxiety which, in turn, drives the person to do something to protect from or "neutralize" the doubt through a physical or mental action or compulsion, such as checking, washing, avoiding, mental reviewing or seeking reassurance to name a few. Because obsessions start from imagination and have no relevance to the present moment or context, Neutralizing, however, is futile as there is no resolution [in reality] to events that do not exist [reality]. Neutralizing is not just fruitless, it validates the obsession by behaving "as if" the doubt were real. That is, neutralization causes imagination to feel "lived in" which further reinforces the initial confusion between reality and invention: "if I 'needed' to check, maybe the 'threat' was real". This is a no change cycle that
I-CBT Treatment
I-CBT treatment begins with psychoeducation — a clear and supportive explanation of what OCD is and that it stems from reasoning errors rather than from dangerous thoughts. Treatment is organized into 12 modules. Each module addresses a specific aspect of how obsessional doubt develops and how it can be overcome. The sequence starts with how OCD begins, moves through correcting faulty reasoning, and ends with relapse prevention and reconnecting with personal values.”
Treatment Steps
OCD begins with a crossover which characterized by two key ways of reasoning: Inferential Confusion (when an imagined 'what if' feels more real than your senses or direct evidence) and Inverse Inference (reaching a conclusion based on imagination rather than what is known). By seeing OCD as a predictable reasoning sequence, you begin to take back perspective and control.
Identifies the reasoning style that powers doubt (e.g., overreliance on possibility, irrelevant associations, hearsay). Here, you’ll uncover how OCD creates its own “logic.” Instead of relying on real-world evidence, OCD uses rules like “if it’s possible, I must treat it as true,” or “if I can imagine it, it’s likely.” Understanding this faulty logic helps you see how doubt becomes convincing — and why it doesn’t actually reflect reality.
Shows how “reasons” are woven into a compelling narrative that sustains doubt; clients map triggers, themes, and story structure. Obsessiional doubts don’t appear in isolation — they get woven into a larger narrative, the obsessional story. In this phase, you’ll map out the stories OCD tells you and see how these “what if” scenarios gain power. Recognizing OCD as storytelling makes it easier to step back and see doubt for what it
OCD often ties doubt to a feared version of yourself — “What if I’m careless? What if I’m dangerous? What if I’m immoral?” In this phase, you’ll explore these feared selves and see how OCD uses them to fuel obsessional stories. By naming and externalizing the feared self, you weaken its hold.
Here, you’ll learn that OCD doubt is not based on your senses or present evidence — it’s 100% imaginary. Even when it feels vivid, it lives only in the mind. Seeing doubt as imagination, not fact, helps you step out of its grip.
Even if something is theoretically possible, that doesn’t make it relevant to your actual life. In this phase, you’ll practice separating possibility from reality: only what your senses show here and now is relevant. This helps you stop treating every “what if” as if it requires action.
When imagination takes over, it’s like being inside an OCD bubble — where the obsessional story feels more real than the world around you. This phase teaches you how to recognize when you’ve entered the bubble, and how compulsions keep you stuck inside. Naming the bubble makes it easier to pop it.
This is where you practice staying anchored in reality. Instead of checking or seeking reassurance, you learn to trust what your senses already show. “I see the door is locked. That’s reality. The thought ‘what if it isn’t’ is imagination.” Reality sensing is about grounding in the here-and-now world and refusing to follow OCD back into the bubble.
Once you see the obsessional story for what it is, you’ll learn to create an alternative, reality-based story. This new story is built on sensory evidence and logic, not imagination. Living by the alternative story helps you move forward in daily life without compulsions.
OCD is sneaky — it uses mental tricks to keep doubt alive, like “What if you missed something?” or “Better safe than sorry.” In this phase, you’ll learn to spot these tricks for what they are and refuse to be fooled.
Beyond the feared self lies your real self — the person defined by your values, choices, and lived experiences. In this phase, you reconnect with your authentic identity, separate from OCD’s distortions. This gives you a stronger foundation to make decisions with clarity and confidence.
The final phase brings everything together. You’ll review the skills you’ve learned — spotting crossover, reality sensing, building alternative stories — and develop a plan for the future. The focus is on maintaining progress, catching OCD’s tricks early, and living life guided by your values, not your doubts.
Blending of Appoaches
Although I-CBT was developed and validated for the treatment of OCD, I have also found it to be valuable in the treatment of other anxiety disorders, such as generalized worry as well as agoraphobia and panic. Even in the case of specific phobias, which respond well to traditional exposure and habituation, I-CBT can break a treatment impasse, when insidious, obsessional-type doubting is present. Additionally, I have found, at times, that an adaptive, flexible blending of models can be more effective. Thus, the choice of method(s) or strategies will, at times, depend on the conditions, specific symptoms, themes, and phase of treatment as well as the particular needs of the individual and at any given time.
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