This fully interactive official guide is the first to bring Inference-based Cognitive-Behavioral Therapy (I-CBT) directly to individuals struggling with OCD in a comprehensive, self-help format. I-CBT represents a fresh perspective in OCD treatment, departing from the traditional focus on behavioral techniques that, while effective, have largely remained rooted in their original framework over the past six decades. Unlike existing self-help resources, this manual offers a truly innovative approach, providing a new lens through which to understand and overcome OCD symptoms.

I-CBT has already made a far-reaching and powerful impact on OCD treatment, with a growing number of mental health professionals incorporating it into their practices. This widespread adoption is not the result of mere hype; rather, it stems from the resonance of I-CBT principles among individuals with OCD, including therapists with lived experience. Their testimonials have been instrumental in advancing and disseminating I-CBT, serving as powerful endorsements.

Furthermore, I-CBT stands as an evidence-based intervention rooted in scientific principles. Extensive research has bolstered its theoretical foundations and demonstrated its efficacy in multicenter randomized trials conducted by independent scientific laboratories. With such robust support, I have every confidence that the number of professionals offering I-CBT will continue to rise.

This first volume of the Resolving OCD Series endeavors to make I-CBT readily accessible to those dealing with OCD, with the sincere hope that it will serve as a valuable tool on your journey toward liberation from OCD. By the end of this volume, you will have a clear understanding of the many manifestations of OCD and your personal patterns, including your obsessional narrative. The focus of this volume is to help you build a foundational awareness of your own OCD, setting the stage for advanced techniques covered in Volume Two.

Who am I?

I am the co-creator of I-CBT, the psychological treatment framework underpinning this self-help guide. My journey with OCD began during my studies at the University of Groningen in the Netherlands in the mid-1990s, under the esteemed guidance of Professor Paul Emmelkamp. It was during this formative period that I delved into the intricacies of OCD and its treatment, particularly through exposure and response prevention (ERP), still widely viewed as a fundamental approach in OCD therapy. However, despite its reputation as an effective treatment modality, ERP doesn’t universally achieve success, often leaving lingering symptoms in its wake. Furthermore, the requirement to directly confront fears can pose a formidable challenge for many individuals.

In my quest for alternative approaches, I found myself drawn to cognitive models of OCD. These models focus on the impact of thoughts and beliefs on behavior, pinpointing specific cognitive patterns underlying OCD symptoms. However, cognitive interventions were typically only used to supplement ERP rather than standalone treatments, leaving a gap in addressing OCD comprehensively through cognitive means.

In 1996, while researching for my Master’s thesis, I stumbled upon a novel cognitive approach proposed by psychologists Kieron O’Connor and Sophie Robillard. This approach offered a fresh perspective on OCD, emphasizing unusual reasoning processes and suggesting a treatment avenue that bypassed the need for ERP. Intrigued, I embarked on validating this cognitive model empirically, confirming its efficacy in predicting OCD symptoms.

Driven by this discovery, I pursued a doctoral degree focused on further exploring reasoning processes in OCD, collaborating closely with Professors Paul Emmelkamp and Kieron O’Connor. Expanding the model to encompass all forms of OCD, not just contamination and checking, marked a significant milestone in my research journey. During this foundational period, I also developed the first treatment manual to support therapists and clients in our treatment trials, which was later published in Beyond Reasonable Doubt: Reasoning Processes in Obsessive Compulsive Disorder and Related Disorders. This work laid the groundwork for a new, reasoning-focused approach to OCD treatment.

In 2009, following my postdoctoral studies, I joined the University of Montreal as a professor and researcher at the Montreal Mental Health University Institute Research Center. Subsequent awards, including scholarships and research funding, have bolstered my commitment to advancing OCD research and treatment.

My dedication remains unwavering in providing effective treatment options for individuals suffering from OCD, particularly those unresponsive to standard interventions. I am indebted to the insights gathered from clients and collaborators, which have shaped my mission to alleviate the burden of OCD. This self-help book is a tangible manifestation of that mission, offering hope and guidance to those navigating the complexities of OCD.

 Who is This Book For?

This book is primarily intended for individuals with OCD. Regardless of the specific manifestation of your OCD, whether it’s contamination fears, unwanted thoughts, or compulsive behaviors, they all stem from the same core: unnecessary doubt. This doubt can permeate any aspect of life, regardless of its subject matter.

While this resource is designed for individual use, it’s important to emphasize that it’s not a substitute for professional treatment. If your symptoms are severe, or if you find yourself struggling with feelings of depression or suicidal thoughts, seeking the guidance of a qualified mental health professional is imperative.

Mental health professionals will also find this book an invaluable resource. Whether you’re a seasoned therapist or new to the field, this guide serves as a comprehensive companion for I-CBT. Packed with handouts, exercises, and diagrams, it is designed to complement therapy sessions with clients, making it a practical and interactive tool. Even therapists who are well-versed in I-CBT will benefit from the latest strategies, insights, and therapeutic frameworks presented in this manual. It can enhance your practice, offering a structured yet flexible approach to help clients break free from OCD through cognitive and inferential reasoning techniques.

Finally, if you’re someone who simply wants to deepen your understanding of OCD, perhaps because you have a loved one battling the condition, this book offers a comprehensive exploration. By gaining insight into the intricacies of OCD, you can offer meaningful support and compassion. However, it’s essential to respect individuals’ autonomy and readiness for help; forcing this resource upon someone who isn’t receptive may be counterproductive.

How Can This Book Help You?

Building on the principles of I-CBT, this book aims to address OCD at its core by targeting the unique reasoning styles that fuel obsessive-compulsive symptoms. I-CBT has proven its effectiveness in helping individuals with OCD, as evidenced by randomized controlled trials across multiple research centers. These studies consistently demonstrate that I-CBT achieves significant symptom improvement for most individuals, with a considerable number reaching full remission.

What sets I-CBT apart is its acceptability and tolerability. In contrast to treatments heavily reliant on exposure, I-CBT doesn’t demand confronting fears or enduring uncertainty. Instead, it targets the underlying dysfunctional reasoning to eradicate obsessional doubt without the need for ERP. At its core, I-CBT teaches that obsessions lack inherent validity, thus eliminating the need for direct confrontation of fears.

While proven to be effective, it’s important to acknowledge that I-CBT isn’t a one-size-fits-all solution. If previous treatments have been successful for you, that’s fantastic. This book doesn’t discredit your achievements. However, if you’re still struggling, it might be time to explore alternative approaches. Different treatments can yield different outcomes for different individuals, and failure to respond to one doesn’t equate to personal failure. This self-help manual aims to provide you with the support and tools you need for a different approach, recognizing that everyone’s journey to overcoming OCD is unique.

How do I Use this Book?

Try approaching this book with a relaxed mindset, allowing it to unfold naturally without jumping to conclusions or dismissing it prematurely. Maintaining an open and curious attitude will enable you to derive the most benefit from this self-help guide and workbook. I-CBT requires some work and persistence, but it is primarily a therapy of insight, rather than one of exhaustive effort. Its essence lies in understanding how obsessional doubts arise and recognizing their falsehood.

It’s also crucial to understand that the approach outlined in this manual isn’t purely intellectual, despite its focus on cognition and reasoning. I-CBT aims to reduce unnecessary thought and reasoning, a common feature in OCD, guiding you back to your true self and a life free from pointless obsessions.

In contrast to psychodynamic or psychoanalytical therapies, I-CBT doesn’t delve into the depths of the unconscious or trace symptoms back to childhood. Instead, it focuses on observable elements in the present, including the narrative and reasoning behind your obsessional doubts, which are often readily accessible with the right questions.

The book is structured logically to aid in overcoming OCD, with each chapter and exercise building upon the previous. Skipping ahead or rushing through may impede progress rather than accelerate it. Merely reading the exercises isn’t sufficient; active participation is essential, often over extended periods. Remember, resolving OCD requires more than just thinking about it — it involves thinking differently.

 What is Inside?

This first volume of the series, Resolving OCD: Understanding Your Obsessional Experience, is structured into three main parts, designed to provide a foundational understanding of OCD while building a deep awareness of how it manifests in your life. Through a comprehensive and practical approach, this book delves into the nature of OCD and helps you identify and understand your own obsessional patterns. It lays the groundwork for more advanced work in the next installment of the series, Resolving OCD: Advanced Strategies for Overcoming Obsessional Doubts, equipping you with the tools to take your journey toward freedom to the next level.

Part 1 focuses on the Fundamentals of OCD and its Treatment. It begins with an in-depth exploration of the different forms of OCD and the wide range of symptoms that accompany it. In Chapter 1, you’ll receive a broad overview of how OCD manifests in various forms and you’ll be encouraged to reflect on how these manifestations apply to your personal experience. By recognizing your own symptoms, you’ll begin the process of identifying the specific ways in which OCD influences your thinking and behavior.

Moving into Chapter 2, the focus shifts to understanding how different cognitive-behavioral theories have evolved in the treatment of OCD. This chapter delves into the key models to treating OCD, including the limitations and benefits of these models. You’ll explore why some traditional methods have been successful for some but challenging or incomplete for others. Crucially, this chapter introduces you to an inference-based approach to OCD, which offers a fresh and innovative lens through which to understand OCD. The groundwork laid here forms the foundation of the manual, helping you understand how I-CBT specifically targets the underlying reasoning that drives obsessional doubt.

Part 2 shifts the focus to what I-CBT describes as The Outer Wheel of OCD. This part explores the visible and most recognizable symptoms of OCD, such as compulsions, triggers, and emotional reactions to obsessional doubt. Chapter 3 introduces the concept of the obsessional sequence, helping you to trace how OCD operates in a step-by-step manner in your mind. By understanding how obsessional doubts emerge, escalate, and lead to compulsive actions, you’ll gain a clearer picture of how OCD takes hold of your thought processes. This chapter will guide you in mapping out your personal obsessional sequence—a critical exercise in identifying the patterns of thought and behavior that keep you trapped in the cycle of OCD.

In Chapter 4, we dive deeper into the nature of obsessional doubt, uncovering what sets it apart from the everyday doubts that everyone encounters. This chapter highlights the unique nature of obsessional doubt, which persists without resolution, thrives in the absence of concrete evidence, and leaves you trapped in a cycle of perpetual uncertainty—questioning your actions, thoughts, or intentions. By clearly distinguishing between everyday doubt and obsessional doubt, you will gain the insight needed to confront the reasoning driving obsessional doubt and take the first steps toward breaking its hold on your thinking.

The final section of Volume One, introduces Part 3: The Inner Wheel of OCD, which delves into the deeper cognitive processes that drive OCD from within. Chapter 5, which concludes this volume, focuses on one of the central elements of the Inner Wheel—the obsessional narrative. The obsessional narrative is the story that OCD creates around your doubts, making them feel more real and convincing. In this chapter, you’ll explore how OCD builds an elaborate story around your fears, often convincing you that your worst-case scenarios are plausible or even inevitable. By identifying this false narrative, you’ll learn to question its validity and begin crafting an alternative, non-obsessional narrative. Chapter 5 provides you with the tools to turn away from the stories that OCD tells you and start shifting your thinking toward a different, more balanced perspectives.

While Volume One introduces you to Part 3, which focuses on the obsessional narrative, the work in this section will continue in Volume Two of the series, Resolving OCD: Advanced Strategies for Overcoming and Breaking Free from OCD. In Volume Two, you’ll dive deeper into the remaining elements of the Inner Wheel of the OCD, starting with Chapter 1, which explores the confusion between imagination and reality in OCD during reasoning. This chapter explains how OCD blurs the line between what is real and what is imagined, leading you to distrust your senses and common sense. You’ll learn how to identify and dismantle the tricks of the OCD, allowing you to regain trust in your own reasoning and judgments.

Following this, Volume Two continues with Chapter 2, which examines the feared possible self—a distorted version of yourself that OCD convinces you is real or could become real. This chapter will guide you in disengaging from the obsessive fears that cause you to doubt your identity and capabilities, helping you realize that you are not, and will not become, the person you fear.

Finally, Volume Two transitions into Part 4: The Doing, where you’ll begin applying the knowledge you have gained in real-world cognitive and behavioral exercises. In Chapters 3 through 5, you will learn practical strategies to break free from OCD’s grasp, including exercises like reality sensing and techniques to stay out of the OCD bubble—a metaphor for the alternate reality OCD creates when you’re trapped in obsessive thinking. These exercises will guide you in re-engaging with the real world and building lasting change as you move forward in your recovery.

In summary, Volume One sets the stage for understanding the nature of OCD and its obsessional patterns, particularly through exploring the obsessional narrative. Volume Two will build on this foundation by guiding you through deeper cognitive work and practical exercises, equipping you with the tools to fully overcome OCD.

Downloadable Diagrams, Tables and Forms

To support your journey with this self-help guide, a selection of key materials—including highlights, diagrams, tables, and forms—are available for download and printing. These resources are thoughtfully designed to enhance your learning and can be accessed online in various formats. If you have purchased this book, you’re welcome to download these resources for personal use or, if you’re a practitioner, to utilize them in supporting your work with clients. You can find them here. Please note that reproducing these materials for anything other than personal or client use, whether for commercial or non-commercial purposes, is prohibited (refer to the copyright page for details). Additionally, please be aware that all other content in this book is protected by copyright, with all rights reserved.

How to Start?

Begin by avoiding the temptation to start randomly or rush through this book. Rushing can lead to setbacks or frequent backtracking, ultimately slowing your progress. Taking your time allows for deeper understanding, reflection, and integration. It gives your mind the chance to process new information, connect it to existing knowledge, and form meaningful insights, leading to more effective learning.

Starting at the beginning helps establish context, build a solid foundation of understanding, and progress systematically towards your goals. This approach provides clarity, structure, and often highlights key elements necessary for success. With that being said, the best way to get ahead is still to just get started. So, let’s get going.

Frederick Aardema, Ph.D., Clinical Psychologist.

Montreal, November, 2024