It Was Never About Uncertainty
There is a sentence you will hear in almost every OCD treatment setting, said so often and so confidently that it has come to sound like a definition of the disorder itself: the problem with OCD is an intolerance of uncertainty, and the solution is to learn to tolerate it. It appears in self-help books, in clinical trainings, in conference talks, and in the encouraging messages people with OCD send one another. It feels humane, it feels wise, and it has [...]
Clarifying Measurement and Construct-Level Inference in Myers and Abramowitz’s Review of the Inference-Based Approach
Note to readers:A condensed, peer-reviewed version of this article has been published in the Journal of Obsessive-Compulsive and Related Disorders. That shorter version underwent independent peer review and is limited to 1,000 words in accordance with journal requirements. For those who prefer the concise, peer-reviewed version, a downloadable preprint is available here: [Link to published article page][Link to preprint PDF] The longer version below provides a fuller discussion of the issues addressed in the published article. Clarifying Measurement and Construct-Level [...]
OCD and Coconuts
How my brain turned a tropical snack into an existential threat My mind sometimes has trouble shutting down. So naturally, one afternoon, it latched onto coconuts. This happened in the Caribbean, where coconuts are everywhere, lounging under palm trees like they pay rent. Back home in Montreal, my usual habitat, coconuts are exotic celebrities you meet only in grocery aisles, wearing price stickers and an air of mystery. But here? They fall from the sky. Casually. Like it’s no big deal. [...]
Revisiting “Ten Commandments for the Scrupulous” through the Lens of Inference-Based Cognitive Behavioral Therapy
This post republishes a previously published article, “Revisiting Ten Commandments for the Scrupulous through the Lens of Inference-Based Cognitive Behavioral Therapy (I-CBT),” co-authored by Frederick Aardema, Ph.D., Constance Salhany, Ph.D., and Fr. Thomas M. Santa, C.Ss.R. Fr. Santa’s Ten Commandments for the Scrupulous has long offered practical pastoral guidance for people tormented by scrupulosity. In this updated commentary, we revisit those principles through an I-CBT lens, showing how obsessional doubt is constructed by reasoning and imagination, not by genuine moral evidence [...]
Dead Dodos and Better Outcomes: Why Different People Need Different Treatments
For decades, exposure and response prevention (ERP) has been described as the “gold standard” for OCD. Yet the field of psychotherapy has a long history of declaring winners too early. Budd and Hughes (2009) reminded the field that psychotherapy research faces an inherent difficulty: treatments are rarely isolated enough to determine whether one approach is universally superior. This problem became central to what is known as the Dodo Bird Verdict, a reference to the dodo character in Alice in Wonderland [...]
The Myth of Inner Parts in OCD
IFS’s Growing Popularity and Why It Falls Short for OCD Internal Family Systems (IFS) has swept through psychotherapy over the past decade. Its language of protectors, exiles, firefighters, and inner families gives people a cast of internal characters to identify with. It is imaginative. It is intuitive. It gives emotional life a narrative shape. And for many conditions, that narrative structure feels meaningful or even comforting. Because of this broad appeal, IFS is now being pulled into the treatment of OCD. [...]