Hello, Our daughter L was transferred into a residential treatment program for mood and anxiety disorders on Thursday for what is intended to be a 30-45 day stay. It does not sound as if she will be getting a lot of ERP there, but at least she will be cut off from the opportunity to carry out some of her compulsions (e.g. going to the ER, checking her blood pressure repeatedly) and will be kept busier than she would be at home; they will also be able to monitor how she responds to her most recent medication switch (from Lexapro to Prozac.)
We expect that she will need further treatment when she leaves this program, and I am continuing to look into some of her possible treatment options. Do any of you have experience with or know something about “Inference-based Cognitive Behavior Therapy” (I-CBT)? I just became aware of it today. Apparently it is a less-stressful alternative to ERP, with some published scientific research supporting its effectiveness and several hundred therapists listed as offering it worldwide, including several in our immediate area. It also sounds like it might be a good fit for our daughter since it is more thought-oriented and less emotionally demanding than ERP, and she is a very clear thinker when not totally overwhelmed by her OCD. But I would hope to hear from people who have tried it, or at least are more familiar with it, before suggesting it as an option to L. Thanks for any responses. Wishing you all well.
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With ERP, you learn to tolerate the discomfort brought on by exposing yourself to triggers and not engaging in compulsions. You're relying mainly on habituation to free yourself from OCD.
On the other hand, I-CBT considers OCD more like a belief disorder. Like you said, it works more on a cognitive level. Far-fetched possibilities of harm are considered irrelevant, and you learn to rely on evidence through your senses and common sense to decide the best course of action. In other words, you learn to distinguish between imagined possibilities and real probabilities. If you confuse the two, you start on a path where turning back becomes increasingly difficult.
From my experience, I-CBT is helpful because it helps you redirect your focus from speculations to your present reality. What's important is what I can do so that my present actions would still make sense in my eyes after my OCD spike is over and the dust has settled. In the end, habituation to an OCD-free life, like with ERP, still plays a role in your recovery. I-CBT is not exempt from difficulties.
Mike Parker explains I-CBT in a very clear and accessible manner in his videos in OCD Space on YouTube .
Located the You Tube videos that you referenced, have not looked at them yet. One thing that is puzzling me--was there some sort of falling out between Mike Parker and the Institute for OCD and Anxiety in Pittsburgh? The labels of the videos appear to identify him as being the co-director of the Institute, but when I go to the Institute's own Web site, I see no reference to him, and also no reference to I-CBT. Any idea what that is about?
You're right. They offer treatments with CBT, ERP, and ACT. No mention of I-CBT. I've asked them on facebook if they offer therapy or live virtual trainings in I-CBT. I'll let you know if I receive an answer.
hello- I’ve had ocd for 19 years I would say and have done every therapy under the sun and taken many meds and I just started I-cbt in May and it makes so much more sense than anything else I have done. It’s module based and I would recommend you find someone who has a certificate of training because I’ve been to 2 therapists that said yeah I do that and then it was just regular cbt. I-cbt helps you learn to stay in the gear and now and rather than exposures you learn to use logic and your 5 senses touch taste smell see and hear as proof to what is really happening. It sounds simple but to a person with ocd it is life changing. I’m only about half way through and I am no where near perfect and I’ve lost my husband and one daughter and a sister that have sure out of their lives and not only do I want my life back I want to be able to not drive everyone nuts with my constant need for reassurance. Good luck. I could not recommend I-cbt more.
Thanks so much to both of you who have replied with your experiences with I-CBT! This sounds like it might very well be a possible therapeutic path for her after she gets out of her residential stay. I will post again if and when I have more questions or more news.
Oh, a couple of questions now:
Is there some way to find out if someone has a certificate of training before contacting them. It appears that the icbt.online resource list just lists anyone who says that they want to be listed.?
Scouns, you said that the program is module based and that you are currently half-way through it. I guess that implies that the standard course has a specific length? How many weeks, how many hours per week? Or do yoou stay with a module until you have masstered it.
I'm sorry for just now responding - I lost this site and forgot how to access it. It's 12 modules but that does not necessarily mean you do a new module each week. Just see where it goes. Some modules take several weeks to get the hang of or to work out .
No worries about your turn-around time--first of all it is actually very good, and secondly I will probably be doing this research for weeks while L is in residential. I did want to clarify--did you finally find a therapist who actually knew how to do I-CBT? or did you do a self-help version? Thanks.
Here is the website that I found. It gives all the information, modules, and worksheets. I tried to do it on my own but there was just too much that I was missing or needed help working out. On the site under Find Treatment you will have a pdf pop up. Scroll down to your country. If you are in the US the first ones that are listed are called PsyPact Reference List. The Psychology Interjurisdictional Compact (PSYPACT) is an interstate compact designed to facilitate the practice of telepsychology and the temporary in-person, face-to-face practice of psychology across state boundaries. These are the Psypact states for psychologists that indicate they participate; Alabama, Arizona, Arkansas , Colorado, Connecticut, Delaware, District of Columbia, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina (pending changes), Tennessee, Texas, Utah, Virginia,Washington, West Virginia, Wisconsin. Basically this mean they are jurisdiiction to practice therapy in any of these states.
OR (what I found eaiser becuase of insurance) was to scroll down to your actual state and it will list the therapists who have been trained in i-cbt through this particular organization. For my state there were not a ton of options and the ones that were listed were either not taking new clients or did not accept insurance. I called one of them anyway and she told me a few other therapists in my state who do telehealth i-cbt (which is 100% covered by BCBS insurance) and that she just wasn't listed on the cite because she was trained by an organization that was trained by the main organization and had branched off. She got me in within that week and my progress is going well.
Now let me tell you - I was absolutely debilitated by ocd. Some day were diffictult to brush my hair or take a shower - I know that sounds crazy. It sounds crazy saying it but it's true. I would wake up as late as possible that I would be able to mkae it to work on time (Im a school counselor) and then drag in to work hoping no one would want to talk to me until after I was past the depression ocd morning funk. I would call my mom and pastor 15-20 times a day for support and would find myself crying several times through out the day because the fear of nothing and everything would come over me relentlessly. This was what the 23-24 school year looked like for me. Almost every day.
But I started i-cbt at the end of May just as we went into summer break. I have done a session every week since and am able to emal my therapist when needed and this year, for the first time in 10 school years, I have started my first day of school by getting up an hour and a half early, reading my Bible, making my son breakfast, feeling light and smiling at people when I got to school. I did some creative things and had a great day and feel so much more motivated and no longer debilitated by ocd. It's still difficult at times to sit in the discomfort, but i-cbt doesn't focus on the nonsense of the fear or thought. It does not try to reassure you that the probability of that happening is slim. Because for me, if someone told me that they were 99.99999% sure my fear wouldn't happen, all I would be able to focus on was that there was still that .000001% chance. OCD likes to hav e100% certainty which is impossible. i-cbt brings your focus back to the here and now and uses evidence of things we can recognize with our 5 senses. It takes us from the imaginary story and the what ifs to what is actually happening in front of us that we have sensory proof of. Sorry for the novel. I just want to help other people. I'm no where near perfect! Dont think that. But I am so much better than I was this time last year, or last May for that matter.
Thank you so much for sharing your story. While I do not have OCD myself. I know pretty well how debilitating it can be. Our daughter’s OCD first manifested when she was 8 as a washing compulsion—she could spend nearly an hour “washing her hands” (actually her arms up to the shoulders) and sometimes stopped only when we told her that the alternative was that we would take her to the hospital. Over a couple of years of therapy and medication, we got her condition pretty much under control, but as she approached the end of college at the end of 2022, she began to have have attacks of illness anxiety which would periodically send her to the ER as a response to fearfulness about the possible meaning of relatively minor pains. These abated for a while, but returned after she graduated from college in January of this year, and became much more frequent in July. My wife also has OCD, and while it has been moderately well controlled since I have known her, she has told me some stories about how it affected her earlier in her life (in her 20s.)
One possible concern I have about the likely effectiveness of I-CBT for our daughter is that MOST of her anxiety spikes are triggered by more-or-less-specific pain sensations, with, as far as she is aware, no prior obsessive thoughts. She is doubtful that there is any interval between the sensations and the associated rise in anxiety during which she could apply I-CBT methods—I also wonder whether they would work as well since actual (albeit misinterpreted) sensory experiences are the actual triggers for her anxiety. Do you have any personal experience or knowledge that might illuminate to what extent these factors might interfere with the I-CBT approach?
YES! That's me too! When I found an ERP therapist-the ones that want to expose you to your fears and have you sit in the discomfort - I knew that would not do me any good because I didn't have habitual fears like germ contamination or worrying I would harm someone, or worrying I wasn't going to heaven or things like that. Mine were situational. I have found that my theme seems to be around safety or getting in trouble. But there isn't one specific "intrusive thought" that recurs. I worry a lot about my adult daughter who moved out at 16 because she couldn't stand my obsessional worrying. One day I would worry about her driving ok on the interstate. I would check on her incessantly until she arrived at her destination, and then I knew for certain that she was capable of driving on the interstate. So it would be impossible to "expose" me to that thought/worry. Or like another situation was being obsessed with not being taken off of my ex-husbands bank account that we shared when we were married. To him it was no big deal since we neither one used it, but to me it tied me to him legally and I didn't trust him any longer so wanted no association with him or I thought I would "get in trouble". It made me feel unsafe. So I texted his brother 50 times to ask him to ask his brother to remove me from the account. Then after he finally did, his brother told me I was off the account. But that didn't make me feel certain. They could be lying. So I called the bank. The bank teller told me that yes, I have been taken off the account. But that wasn't good enough because she was just a teller so I called the president of the bank and she confirmed yes, I was no longer on the account and even then I didn't feel like I have 100% certainty and honestly I think if God himself came down and said "You are not on the account anymore" I would say "Are you 100% sure God?" haha I hope this is making sense. So you see there is no way to expose that kind of ocd to a situation that causes fear and anxiety because once the "obsessional doubt" is solved or put to rest, exposing me to that situation again would no longer be distressing, which defeats the purpose of the exposure response therapy. So speaking of your daughter, I'm thinking that she isn't obsessively worried or scared about 1 specific illness like cancer or aids or something like that, but instead obsesses about whatever thought comes into her head based on what pain or ache or bump or symptom she is having at that moment that leads her to believe she has "x" disease or sickness. So her ocd theme is most likely Somatic or Health worries. Which can be all encompassing for any type of illness that her imagination tells her she has based on her physical sensations. So this is where i-cbt is so helpful. Because ocd right now is telling your daughter that her pains or aches are PROOF or CERTAINTY that something must be wrong and that she is going to get sick and die. But here is how i-cbt works - this is a very basic overview but I think it will really help you see how it can be of help to her even though she has actual sensory experiences. There are 5 areas to break down when you are experiencing an obsessional doubt (worry, fear, intrustive thought). Most therapies say that intrusive thoughts are random and just happen against our will or without any meaning and we are just supposed to ignore them and chalk it up to having a silly mind that works overtime. But i-cbt says that these thoughts are not just random and there is a reason we are distressed by them. So I'm going to list the 5 areas that break down an obsessional doubt:
1-Trigger or Prompt - I am having a pain in my lower side that comes and goes
2 - Obsessional doubt (fear/worry) - What if I have pancreatic cancer?
3-Consequence - If I have pancreatic cancer I will be very sick and could suffer and have to get tons of medical testing done and might die a slow and painful death
4-Anxiety - I won't be able to handle all the medical tests and invasive procedures and won't be able to work to provide for myself or my family and will be depressed and isolated
5-Compulsion (the worst part of ocd) I am going to go to the doctor or the ER or research on the internet until I am convinced I am dying which will lead me to more doctors and more ER visits until i either get 100% certainty or another health scare takes it's place
Am I close to how her mind works? So the way to combat this ocd spiral is a cognitive approach and is based on your 5 senses. And reality. And leaving imagination land. This is hard and this is where having a specialized therapist helps. So if this was me and I was working through this scenario I would say "OK is my obsessional story something that is happening in the here and now? Yes, I am having a pain, but do I have something within my 5 senses that proves it is cancer? I can't SEE any report or scan that shows cancer. I can't TOUCH anything that shows cancer. I haven't HEARD a dr tell me I have cancer. I have FELT a pain but that is not proof of cancer. So I can conclude that just because the sensation (pain) is REAL, that does not mean the obsessional story behind it that my imagination has created is real. It's recognizing that the story is built in the imagination. Sorry this is so long. I just so much want your daughter to get some relief. This therapy is a process but nothing I have ever done before this (and I have been in therapy for 21 years) has made an impact or makes sense like i-cbt.
Some people prefer to try I-CBT after ERP “failed” for them or they were scared to try it. ERP is not perfect but if ERP hasn’t worked for someone it’s important to look at why. It’s often because the provider wasn’t skilled enough in its use or the client has treatment interfering behaviors. (See Fred Penzel, OCD expert). The IOCDF isn’t recommending I-CBT as a treatment for OCD at this time. The reason for that is there isn’t enough evidence validated by researchers outside of Fred Aardema’s (founder of I-CBT) team yet. That doesn’t mean there won’t be down the road however. I personally am not a proponent of I-CBT because it relies on logic and logic has been shown not to work on OCD. Aardema talked about knowing for certain that X won’t happen when interviewed by Jon Abramowitz (OCD expert and researcher) but nothing is for certain. There will always be another “what if” no matter how much logic or grounding in the present moment is used. OCD thrives on possibilities and exploits them.
Evidenced-based is a term that gets thrown around lately and is misunderstood. There are different levels of evidence in research and they are not equal. Something can be considered evidenced-based but have little evidence supporting it or the research study methodology can be poorly designed or inappropriate for what is being studied. There can also be adequate evidence for something but the benefits don’t outweigh the risks. I’m thinking of a particular study on a medication that showed promise for its efficacy but the medication produced serious side effects in 48% of the study participants and was consequently not approved by the FDA.
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