And yet it locates the problem in the wrong place, and not by a small margin. The error is fundamental, structural. This essay makes the case that obsessional doubt is not a form of uncertainty at all, that treating it as one quietly concedes the very thing the doubt is trying to establish, and that the alternative, a position rooted in the foundations of Inference-Based Cognitive Behavioral Therapy (I-CBT), leads somewhere different. I want to argue the point on the merits, take the strongest objections seriously, and show why the conclusion holds across every form of OCD, not only the doubts that look easy to dismiss from the outside.

Where this idea comes from

This is not a recent reframing. The distinction between doubt and uncertainty sits at the foundation of I-CBT, and it was drawn in plain terms in the model’s earliest clinical writing. The starting point is a definition. The OCD Clinician’s Manual by O’Connor and Aardema (2012) reserves the word uncertainty for one thing: not knowing because the full facts are not available to you. It applies to what has not yet happened, or to what cannot be checked, and it is resolved either by finding the missing information or by accepting that it cannot be found. In its own words:

“Uncertainty is used in the sense of being unsure as to the full facts.”

Obsessional doubt is not that. It does not arise from missing facts. It questions what the person already knows through their senses and common sense, in a setting where the information is fully available. That is why the same manual states the separation directly:

“Doubt then is not to be confused with ‘uncertainty’ or with ‘lack of confidence’”

It also addressed the specific clinical construct by name, distinguishing the trait psychologists call “intolerance of uncertainty”, the inability to tolerate not knowing all the information, from the cognitive state that I-CBT places at the center of OCD:

“There is a cognitive trait termed ‘intolerance of uncertainty’ where some people who suffer anxiety are unable to tolerate not knowing all the information. However, this trait is distinct from the cognitive state of doubt as we use it in IBT.”

This was not a late refinement. The earliest published statements of the model already placed intolerance of uncertainty downstream of the reasoning, not at its source. Writing in 1995, O’Connor and Robillard argued that “the key symptom of pathological doubt and intolerance of uncertainty would follow from illogical inference, rather than be stand alone symptoms,” and that a person who treats imagination as reality “will forever be uncertain”. The uncertainty is the product, not the cause. Later work made the same point about the felt sense of not-knowing: it is manufactured by the inferential process, which sets the person an impossible task, “looking for something without knowing when they are certain of finding it,” so that “inevitably this discrepancy creates perpetual doubt.”

A more recent theoretical chapter draws the line in a single sentence, and adds the observation that makes the whole distinction concrete: “doubt is conceptually distinct from uncertainty since … people with OCD are often certain before they doubt” (O’Connor, Ouellet-Courtois, & Aardema, 2019).

Obsessional doubt is not a gap in knowledge waiting to be filled; it is a movement away from knowledge the person already had. The same chapter notes that intolerance of uncertainty is “found in many disorders … and not specifically in OCD,” and so fails to “properly capture the phenomenology of OCD” at all.

And the early work specified the order of events, which comes first, the doubt or the uncertainty, because the order is the whole argument:

“Certainly someone who doubts their senses may subsequently engender feelings of uncertainty and lack of confidence in action. But these are subsequent to the doubt.”

That last sentence is the seed of everything that follows. Uncertainty, in OCD, is downstream. It is produced by the doubt, not the reverse. The newer self-help materials state it more plainly still: “OCD does not arise from real uncertainty; it starts with doubting, which creates unnecessary uncertainty,” and “treating obsessional distress as a problem of ‘intolerance of uncertainty’ therefore mislocates the core mechanism, but they are saying what the model has said from the beginning. With that lineage in view, the rest of this essay makes the case on its own terms.

There is also an empirical edge to this that is worth stating plainly. For all its intuitive appeal, intolerance of uncertainty has struggled to show that it is specific to OCD or that targeting it adds anything to treatment. It appears across the anxiety disorders and in healthy people, it is not what patients spontaneously report, and the appraisal framework built around it has produced mixed findings on whether those beliefs even distinguish people with OCD from other groups.

Inferential confusion, by contrast, has shown both specificity to OCD and a relationship with treatment outcome: it is elevated in OCD and related disorders, it tracks symptom severity, and reductions in it uniquely correspond to clinical improvement across multiple studies (e.g. Aardema, Wu, Careau O’Connor, Julien & Dennie, 2010; Ouellet-Courtois, Bouchard, Giguère, Koszycki, Lavoie, & Aardema, 2026)

Given that balance of evidence, it is genuinely surprising that the uncertainty framing continues to be repeated as settled fact, including by researchers and clinicians who otherwise hold themselves to the empirical literature, in the podcasts and public discussions where the disorder is now most often explained to the people who have it.

It has even become the rallying cry of the field’s advocacy: the International OCD Foundation’s flagship fundraising event, the One Million Steps for OCD Walk, marches under the well-meaning banner “embracing uncertainty, one step at a time.” The sentiment is kind, and the cause is good. But it quietly installs as the movement’s motto the very premise this essay is questioning, that what the person must learn to do is embrace an uncertainty which, on the inference-based account, was never the problem.

The intuition that needs unwinding

Let’s start with why the uncertainty story is so persuasive, because any honest argument has to account for that. The person with OCD genuinely feels uncertain. They say “I can’t be sure,” and they mean it. They check, they seek reassurance, they replay events: all the behaviors of someone trying to close a gap in knowledge. From the outside, and from the inside, it looks exactly like a person who cannot bear not knowing. So the inference seems natural: the discomfort is the intolerance of uncertainty, and if we could raise the person’s tolerance, the discomfort would ease.

But watch what happens when you look at where that feeling of uncertainty actually comes from. We all live inside genuine uncertainty constantly, about next week’s weather, the commute, our health a year from now, whether the people we love will still be here. Genuine uncertainty is the ordinary condition of being alive, and for the most part we move through it without agony. The person with OCD does too, in almost every domain of their life. So the relevant question is not “why can’t this person tolerate uncertainty?” It is the much sharper question I-CBT insists on:

Why did this one possibility, out of the ocean of things no one can be certain about, suddenly become urgent, personal, and impossible to set down? That question is the hinge of the whole essay, so the next sections answer it from several angles.

Two things that wear the same word

The trouble is that one word, “uncertainty,” is being made to carry two completely different things. The first is real uncertainty: it comes from an actual gap in information. You don’t know the biopsy result because the result is not yet available to you. You don’t know whether it will rain because the future has not happened. The not-knowing is real, and it is located in the world.

The second is obsessional doubt, and it runs in the opposite direction. It arises against the available information, in spite of the senses, usually in exactly the setting that gives the person every reason to be confident. You watched yourself lock the door. You feel nothing but love for your child. You saw the stove knob in the off position. There is no missing information here. The doubt did not come from a gap. It was manufactured, and then dressed up to look like a real question.

Inference-based CBT draws the line exactly here. Real uncertainty is not knowing because the information isn’t available to you. Obsessional doubt is doubting what you already know to be true, based on reality and the here-and-now context. That is the entire difference, and once you see it you cannot unsee it. The OCD sufferer is not failing to tolerate an unknown. They are being made to distrust something they already know.

This is why the standard advice produces such a strange result in practice. Telling someone to “tolerate the uncertainty” about whether they are a danger to their child treats the question as a legitimate open one, as if there really were an unknown there that a brave person would simply learn to sit beside. But there is no unknown there. The person knows their devotion to their child the way they know the door is locked. Asking them to tolerate uncertainty about it does not resolve the doubt; it ratifies it. It hands the obsession the one thing it was reaching for: the status of a real question with real stakes.

The tell: the “intolerance” is suspiciously selective

Here is the single most revealing fact about obsessional doubt, and the one an uncertainty model cannot explain. The person with OCD does not struggle with all unanswerable questions equally. They are not paralyzed by the thousand genuine uncertainties they pass through every day. The contamination sufferer who cannot touch a doorknob will happily eat food prepared by hands they never watched, breathe air they never tested, cross streets trusting drivers they never met. The person tormented by a harm obsession tolerates the very real, statistically nonzero possibility of a car accident every time they drive, without a flicker.

If the mechanism were a general intolerance of uncertainty, the intolerance would be general. It is not. It lands, with uncanny precision, on one question. And which question it lands on is never random. It is always the question that hooks the self: the one that threatens something the person cares about most, their goodness, their safety, their faith, their love, their very identity. A person who values kindness gets “what if you’re cruel.” A person who values honesty gets “what if you’re a liar.”

That selectivity is exactly what an uncertainty model cannot predict and an inference-based model expects. A general trait cannot account for a target this specific. The doubt is selective because it was built, assembled around the precise spot where it could do the most personal damage, then disguised as a neutral question about odds. The location gives the game away. This is not a gap in someone’s tolerance. It is a production aimed at the self.

Nobody else is “tolerating” the question either

There is a tempting rescue for the uncertainty model at this point, and it deserves a direct answer because it sounds airtight. The defender says: “Fine, low tolerance in that one spot. So we train tolerance there.” But this concedes too much, because it assumes the person without OCD is succeeding at something the sufferer is failing at, bravely enduring the same uncertainty with greater skill.

They are not. The person without OCD is not tolerating the question of whether they secretly harmed someone, or whether reality is real, or whether they are fundamentally corrupt. They are not heroically enduring that uncertainty. There is nothing to endure, because the question was never granted personal relevance in the first place. It simply sits where possibilities sit: unremarkable, unaddressed, inert. You are not, right now, bravely tolerating uncertainty about whether your roof will hold. You are not tolerating anything. The thought was never admitted as a relevant problem.

This is the asymmetry that matters, and it is not an asymmetry of tolerance. It is an asymmetry of inference. Tolerance only becomes necessary after a doubt has already been accepted as real, urgent, and personally meaningful. And that acceptance, that prior step of granting the possibility the status of a problem, is the disorder itself. Everything downstream, including the felt uncertainty and the urge to resolve it, follows from that step. Which gives a clean way to state the difference between the two approaches:

Exposure-based work intervenes after the doubt has been accepted as real, and trains the person to live with it. I-CBT intervenes on the acceptance itself, the move that made an inert possibility into a personal emergency.

You cannot resolve a manufactured doubt by enduring it. Enduring it only confirms, performatively, that there was something real there to endure. The resolution is to see that the doubt was built, and that seeing dissolves it in a way that no amount of tolerance can.

What the I-CBT materials actually say

The I-CBT position is stated plainly across the materials. Several passages make the central point clear.

The Doubt Illusion by Aardema (2025) raises the question in its introduction and answers it throughout:

“Traditional approaches to managing these doubts often advise us to ‘accept uncertainty’ or simply ‘sit with distressing thoughts.’ Yet what if uncertainty itself isn’t the issue?”

“This is what this book is about — not fighting your thoughts, not tolerating endless uncertainty, but recognizing the performance for what it is.”

Its fourth chapter addresses the construct head-on, drawing the distinction between a real unknown and a fabricated one:

“The issue isn’t learning to stomach endless unknowns. The issue is recognizing when the unknown itself is fake.”

It is equally direct about why the felt sense of uncertainty is not evidence of an uncertainty problem, but a by-product of the doubt:

“Yes, OCD always comes with a feeling of uncertainty — but that’s part of the trick. The doubt manufactures that feeling first, then points to it as proof that something must be resolved. The sensation of ‘I can’t be sure’ isn’t a sign of low tolerance for uncertainty — it’s the by-product of a false alarm.”

And it states the practical consequence, that there is nothing left to tolerate once the doubt is seen for what it is:

“You don’t need to practice ‘living with the doubt’ that maybe you touched your baby inappropriately while changing a diaper. You need to recognize that this doubt was never a question to begin with — it’s an imagined accusation, irrelevant and without basis. Once you see that, there’s nothing left to tolerate.”

The self-help volumes of the Resolving OCD Series, (Aardema, 2024, 2025) draw the same separation in the language of treatment mechanism:

“At its core, the bridge exercise is about not being carried into the bubble at all. It is not about tolerating obsessional doubt or learning to endure its effects, nor is it about accepting its supposed relevance.”

“While ERP focuses on habituating to anxiety and building tolerance for obsessional doubt, the bridge exercise focuses on clarity — on recognizing that the doubt itself is a trick, an illusion, and something fundamentally irrelevant to reality.”

And one statement of the model’s endpoint contrasts the resolution it rejects with the one it offers:

The resolution is not framed as coping with uncertainty, learning to live with doubt, or tolerating incomplete knowledge. Instead, it rests on the recognition that doubt was never required by reality, that uncertainty was inferred rather than encountered, and that perception was sufficient all along.

Read those phrases slowly, because they carry the whole position in miniature: uncertainty was inferred rather than encountered, and perception was sufficient all along. The doubt was never a report about the world. It was a conclusion the reasoning produced and then attributed to the world.

This holds for every form of OCD, not only the easy cases

It would be a serious misreading to think this argument works only for the doubts that look obviously groundless from the outside: the checked-and-rechecked lock, the harm thought with no act behind it. The principle is not a trick that depends on the doubt being easy to dismiss. It is inherent to what obsessional doubt is, whatever the doubt happens to be about. The mechanism is the same whether the content is contamination, morality, relationships, health, blasphemy, sexuality, or the metaphysical question of whether anything is real at all.

Take the hardest case for the model, the one critics reach for first: contamination, where the feared agent really is invisible. The objection runs like this. Germs cannot be seen, so you genuinely cannot confirm the subway pole is clean, so isn’t that a real unknown you simply have to tolerate? It sounds airtight. What makes it sound airtight is a quiet slide from a bare possibility to a specific, live, personal problem.

It is abstractly true that germs could be on the pole. It is equally true that the food at lunch could be contaminated, that the tap water could carry something, that a handshake could pass an infection. None of these can be ruled out with certainty, and we act anyway, every minute of every day, without tolerating anything, because bare possibility was never the standard for action. The senses and the actual context are. The commuter standing beside the person with OCD also cannot be certain about the pole, and feels no doubt at all. Not because they tolerate the uncertainty better, but because they never crossed into it.

So the word “uncertainty” is doing double duty again. There is the neutral, shared fact that germs exist and can’t be seen, which every person carries and no one acts on. And then there is the obsessional conclusion stacked on top of it: this pole, right now, has put me in danger, and I have to do something about it. The first is true and inert. The second is the manufactured part, reached by inference rather than by anything actually in front of the person. The invisibility of the germs gets recruited afterward, to give the conclusion a respectable cover. Strip the conclusion away and the germ-fact just sits there, as harmless as it is for everyone else on the train.

This also shows why “can you verify it?” is the wrong test. Plenty of ordinary situations cannot be verified and trouble no one. There are settings where caution about germs is entirely warranted, scrubbing before surgery, washing after the bathroom, handling raw meat, and those are not OCD, because the context itself calls for the care. The subway pole, for an ordinary commuter, is not one of them. The test was never whether certainty is available. It is whether the actual situation, read on its own terms, justifies the concern. Obsessional doubt fails that test characteristically, because it arrives from outside the context rather than from within it.

The hardest version of the objection: but there usually is a trigger

A sharper form of the objection now arrives, and it deserves the most careful answer of all, because the clean picture of “evidence versus no evidence” is too clean, and a thoughtful critic will say so. In real life, obsessional doubt rarely descends out of a clear blue sky. There is usually something: a passing feeling, a flicker of an image, a moment that didn’t sit right. Take someone with relationship obsessions, doubting whether they really love their partner. They will often point to a real moment: a flash of irritation at dinner, an absence of the warmth they expected, a stray thought about someone else. The trigger is not invented. So it is simply not true, in these cases, that “nothing happened” to start the doubt. Reality is more ambiguous than the tidy version admits, and any honest account has to say so.

It also has to say two things the objection leaves out, and together they are where the whole argument turns. The first: these small, ambiguous experiences are universal. Everyone feels a flicker of irritation at someone they love, an evening where the warmth isn’t there, a passing thought about a stranger. The person without OCD has the identical moment, and it stays a moment. It does not become maybe I don’t love them, maybe I never did, maybe I’m living a lie. The raw material was the same. What differs is not the presence of a trigger, but what gets constructed on top of it.

That construction is the obsessional engine, and it is what an inference-based account has been pointing at all along: a distrust of one’s own direct experience, an over-reliance on imagination, and a pull toward the self. The flicker of irritation is real and, on its own, inert. What inflates it into a verdict is the reasoning sequence that distrusts what the person actually feels day to day, treats an imagined possibility (“what if this means I don’t really love them”) as though it were evidence, and routes the whole thing through what it would say about me: my honesty, my capacity to love, who I really am. The same engine runs in every theme. The stray feeling, the intrusive image, the half-remembered action, the ambiguous glance: each is a real-enough scrap, and each gets fed into the same machine that manufactures a personal emergency from it. The person without OCD has the scrap and not the machine.

And here is the part the objection misses entirely, because it assumes the trigger always comes first. Very often it doesn’t. The doubt comes first, and then produces the very sensation or experience that seems to have caused it. The person doubting their love starts scanning for the feeling, and the scanning itself flattens it, because no feeling survives being anxiously monitored. The flatness is then read as proof: see, it isn’t there. The doubt manufactured its own evidence. The same thing happens across themes: search your mind for an unwanted thought and it arrives on cue; check whether a feeling is present and the checking deadens it; replay a memory enough times and it warps into something that looks incriminating. These are phantom experiences: sensations, feelings, images, and even “memories” generated by the doubt and then mistaken for its source. The arrow points backward. What looks like the triggering evidence is frequently the doubt’s own exhaust, read as if it had arrived from outside.

This is also why obsessional doubt is so often indistinguishable, on the surface, from a reasonable concern, and why that is not a weakness in the argument but the heart of it. Obsessional doubt is built to be convincing. It borrows a genuine moment and wears it as cover; it speaks in the language of honesty and care; it can be extraordinarily hard to tell apart from a concern that genuinely deserves attention. I-CBT does not pretend this distinction is easy. It can be genuinely difficult, and saying otherwise would be dishonest. But difficulty in telling two things apart on the surface does not make them the same thing underneath. A real concern and an obsessional doubt are generated in entirely different ways. A real concern arises from the situation and stays proportionate to it: a person who is genuinely unhappy in a relationship notices a steady, coherent pattern that the context itself supports, and can think about it and set it down. An obsessional doubt arrives the other way around: the conclusion comes first, urgency already attached, and then recruits whatever scrap is available, real or manufactured, to justify itself. The difference is not in how plausible the doubt looks from the outside. It is in how it was built.

So the test can never be “was there a trigger?” or “can you be sure?” There is usually a trigger of some kind, and you can rarely be wholly sure of anything, and that is true for everyone, all the time, and it troubles almost no one. A person can have the stray feeling, be unable to prove with certainty what it does or doesn’t mean, and still not be carried into obsessional doubt, because the trigger and the uncertainty were never what generated the doubt. The obsessional engine is. Where that engine is running, an ambiguous moment becomes a verdict and the search for evidence keeps producing more of it; where the engine is not running, the same moment stays exactly what it was. The conclusion stacked on top of the experience was reached by inference, not established by the experience, and once that is seen, the experience settles back into the unremarkable thing it always was.

The metaphysical case makes the same point from the opposite extreme, where the question really is unanswerable. “Is reality real?” may well have no answer. So does “why is there something rather than nothing?”, and nobody loses sleep over it. Philosophers have asked whether reality is real for millennia, for a living, without distress, without urgency, and without needing it solved by Friday. Same question, no OCD. If the content of the question caused the suffering, every philosophy department would be a treatment population. Unanswerability was never the active ingredient. The difference is not the question. It is the relationship to it: one person entertains a possibility, the other is being personally summoned by it.

Notice how the doubt arrives, and the signature is identical across all content. Genuine inquiry, philosophical, scientific, practical, follows from curiosity, stays open, and can be set down. Obsessional doubt arrives the other way around: the question shows up first, with urgency already attached, and then goes looking for relevance: what this means about you, what might happen to you, who you might really be. The doubt was not derived from anything in reality. It was manufactured, and then dressed up as inquiry. That is the through-line that unites the locked door and the unanswerable cosmic question. The content varies infinitely; the structure does not.

The strongest objection: “but the senses aren’t reliable, and nothing is certain”

The most substantive challenge to I-CBT does not come from the acceptance camp at all. It comes from clinicians steeped in a probabilistic worldview, and it is worth stating in its strongest form before answering it, because answering a weak version would be dishonest.

The objection runs roughly like this. I-CBT tells people to “trust their senses” so that much uncertainty becomes unnecessary. But this is naive. Eyewitness studies show that people who witness the same event perceive it differently; perception is not infallible. Our senses are probability statements, not guarantees. And nothing in life is truly certain: low probability is not no probability. Improbable things happen: a small plane really did once collide with a helicopter over a schoolyard at recess; a healthy person really did collapse at dinner with no explanation the tests could find. Given all that, the only honest stance is to accept that life is a series of probability judgments and learn to live with the risk. “Trusting your senses” and “resolving doubt” sound like a promise of certainty that no honest account of perception can deliver.

This is a serious argument, and parts of it are simply correct. Perception is fallible. Nothing is certain. Low probability is not no probability. Improbable events do occur. I-CBT does not dispute any of this. The argument fails anyway, because it attacks a claim the model never makes.

First, “trusting the senses” in I-CBT has never meant sensory infallibility. It does not claim perception is flawless or that two witnesses will agree. It means re-establishing contact with the direct evidence of reality, the concrete information actually available in the moment, rather than reasoning from imagined alternatives. The person who has just watched themselves lock the door and then doubts it has not suffered a perceptual error. Their vision worked fine. They are overriding adequate perception with an imagined “maybe it wasn’t locked.” The eyewitness research is about the limits of perception under difficult conditions. Obsessional doubt is not a hard perceptual discrimination at the edge of human ability. It is the abandonment of perfectly good information in favor of a hypothetical. Those are different problems, and the fallibility of the first does nothing to license the second.

Second, and more fundamentally, the objection treats obsessional doubt as though it were a probability problem, a matter of correctly weighting low-likelihood risks. But obsessional reasoning is not probabilistic; it is counterfactual. It does not say “this is unlikely but possible, so I will weight it accordingly.” It treats an imagined possibility as though it were present evidence, despite the absence of any sensory support for it right now. The stove is off, you can see it, but imagination says “what if it isn’t,” and that what-if is granted the standing of a fact. That is not a miscalculation of odds. It is a loss of contact with the information in front of you. Probability logic does not apply, because the doubt was never generated by a probability judgment in the first place.

This is why these examples, powerful as they are, point away from the conclusion they are meant to support rather than toward it. Consider the worry about airplane parts falling out of the sky, or a frightening medical episode — collapsing at dinner and later being diagnosed with syncop, a fainting spell of uncertain cause. Both are real. Both are genuine uncertainties about genuine events, exactly the kind of real-world unpredictability I-CBT affirms and never tries to argue away. A person reckoning with a real medical emergency and asking a doctor for an honest probability is doing sound inference: the conclusion follows from what the situation actually presents, calibrated to it, and the residual risk is lived with. That is not OCD. It is the opposite of OCD. What makes OCD different is not the absence of a trigger; there is often a trigger, sometimes an ambiguous bodily sensation, sometimes nothing more than a passing thought. What makes it OCD is that the conclusion does not follow from that trigger. The verdict arrives first, with its urgency already attached, and only then recruits whatever is at hand, a real sensation, a vague memory, or an experience the doubt itself produced, to make the conclusion look earned. The doctor’s patient reasons forward, from the situation to a measured judgment. The obsession reasons backward, from a fixed conclusion to whatever can be made to support it. The objection describes, without intending to, the very distinction the model draws. It assumes I-CBT denies that rare and serious things happen, when in fact the model grants every one of them. It simply asks a different question: not whether bad things can happen, which they plainly can, but whether this particular doubt, right now, was reasoned to from what is actually there, or was reached first and then dressed up as a real question afterward.

The endpoint of I-CBT, then, is not blind faith in the senses. It is trust in a specific and defensible sense: a return to the direct evidence of reality as the proper starting point for belief, with imagination put back in its place as a tool rather than a source of evidence. That is not epistemic naivety. It is epistemic grounding, and it is fully compatible with knowing that perception has limits and that the future is uncertain.

A final objection: “radical acceptance” and the leap of faith

A second version of the uncertainty position deserves a direct answer, because it is widely repeated and often presented as the heart of recovery. It goes like this: the key was learning to accept the presence of the thoughts and feelings, and to embrace uncertainty by acknowledging that the brain will never let me know “for sure.” It is the same uncertainty I accept when I trust my house not to collapse or trust that I can cross the street safely. This is radical trust, a leap of faith, taken fresh each day, not by accepting the scary thoughts as true, but by stepping forward into the unknown anyway.

One part of this is correct: the refusal to treat the feared thing as true, and the choice to keep living rather than keep solving. But the analogy gives the argument away, because it makes the same slide we have already seen twice. Trusting your house not to collapse and trusting that you can cross the street are not acts of brave uncertainty-tolerance at all. You are not, in those moments, enduring a live doubt. You are simply living from what the context actually supports, the house has stood, the street is clear, without the question ever being admitted as a real problem. The analogy describes the non-OCD relationship to possibility exactly. It then mislabels it as “accepting uncertainty,” when what is actually happening is that no uncertainty was ever in play. The everyday cases the analogy reaches for are not cases of accepting uncertainty. They are cases of there being no doubt to accept.

And that mislabeling has a cost. If recovery is framed as a leap of faith that must be re-taken every single day, then the doubt has been left structurally intact, granted the permanent status of a real unknown that one must forever step across. The leap eases the distress the same way acceptance does, by conceding that there is a chasm there worth respecting, and that concession will quiet the struggle for a time. But it never withdraws the doubt’s standing as a question, so the chasm is still there tomorrow, and the leap has to be made again. The mechanism that built the doubt is untouched. I-CBT’s claim is that the leap is not the destination and was never necessary. When the doubt is seen clearly, seen to have been inferred rather than encountered, there is no chasm left to leap across. You are not bravely trusting in the face of an unknown. You have recognized there was no unknown there to begin with. The endpoint is not a daily act of courage against uncertainty. It is the quiet disappearance of the question.

This is also where the popular phrase “radical trust” can be brought to its sharper, truer form. The trust that matters is not only trust in the face of the unknown. It is trust in the known: in the sufficiency of perception, in the ordinary knowing that the non-sufferer never thinks to doubt. Consider how completely a person trusts their own ongoing experience in every domain OCD has not colonized: they do not interrogate whether they really mean the words they are speaking, or whether they actually love the friend they are laughing with. Those things are simply known, never questioned. Recovery is the restoration of that same unquestioned trust to the one place the doubt had captured. Not a new uncertainty to be tolerated, but an old certainty, the certainty the senses and the present moment were providing all along, given back.

Where this leaves us

The uncertainty account is sincerely meant and widely taught, and accepting the doubt does bring some people relief. That much is not in dispute. But it is worth being clear about why it brings relief, because the relief is easy to mistake for proof that the account is right. Accepting a doubt will always ease the struggle against it, in the same way that giving in to any insistent demand quiets the demand. That tells you nothing about whether the demand was legitimate. Acceptance lowers the distress by conceding the doubt’s premise, that there is a real unknown here worth taking seriously, and a concession will of course end the fight. What it does not do is touch the thing that generated the doubt in the first place. The mechanism is left fully intact. This is why the relief is provisional and the doubt keeps returning: nothing upstream has changed, so the same manufactured doubt arrives again, and has to be accepted again, and again, without end.

And there is nothing kind in that arrangement. Asking someone to spend a lifetime accepting and re-accepting a danger that was never real is not the gentle option; it only looks like the gentle option. The kinder thing, and the truer one, is to show them there was nothing there to accept.

I-CBT’s position, held from the original clinical papers through to the latest workbooks, is both more radical and, in the end, more respectful of the person’s actual mind: there is no uncertainty crisis happening. The senses are working. Ordinary knowing is intact. Nothing about reality changed on the day the obsession began — only the reasoning did. The work is not to build a higher tolerance for a doubt, but to see that the doubt was built, and to return to the direct evidence of reality that was sufficient all along. This holds for the contamination fear with its invisible germ, for the harm thought with no act behind it, for the unanswerable metaphysical question, and for every other shape obsessional doubt takes, because the structure beneath the content is always the same.

Two short sentences hold the whole difference. Exposure-based work asks how to live with the question. I-CBT asks how the question got into the house.

References

Aardema, F. (2024). Resolving OCD: Understanding your Obsessional Experience (Volume 1). Mount Royal Publishing.

Aardema, F. (2025). Resolving OCD: Advanced Strategies for Overcoming Obsessional Doubts (Volume 2). Mount Royal Publishing.

Aardema, F. (2025). The Doubt Illusion: A Compact Guide to Overcome OCD with Inference-Based Cognitive Behavioral Therapy. Mount Royal Publishing.

Aardema, F., Wu, K., Careau, Y., O’Connor, K., Julien, D., & Dennie, S. (2010). The expanded version of the Inferential Confusion Questionnaire: Further development and validation in non-clinical and clinical samples. Journal of Psychopathology and Behavioral Assessment, 32, 448-462.

O’Connor, K., & Aardema, F. Clinician’s Handbook for Obsessive-Compulsive Disorder: Inference-Based Therapy. Wiley-Blackwell.

O’Connor, K., & Robillard, S. (1995). Inference processes in obsessive-compulsive disorder: Some clinical observations. Behaviour Research and Therapy, 33(8), 887–896.

O’Connor, K. P., Ouellet-Courtois, C., & Aardema, F. (2019). Innovative cognitive behavioral treatments for obsessive-compulsive disorder. In Practical Aspects of Obsessive-Compulsive Disorder (Ch. 17). Cambridge University Press.

Ouellet-Courtois, C., Bouchard, S., Giguère, C.-E., Koszycki, D., Lavoie, M. E., & Aardema, F. (2026). Cognitive mechanisms of change in OCD: Inferential confusion, obsessive beliefs, and mindfulness across three randomized treatments. Behaviour Research and Therapy.

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 Inference in Myers and Abramowitz’s Review of the Inference-Based Approach 

Frederick Aardema

Introduction

Myers and Abramowitz (2025) present a detailed review of the inference-based approach (IBA) and the construct of inferential confusion (IC). The review documents a consistent empirical pattern: measures of inferential confusion are reliably associated with obsessive–compulsive symptom severity, and these associations frequently persist after accounting for general psychological distress and established obsessive belief domains. The authors also note that available IC instruments typically demonstrate strong internal consistency and a robust unidimensional factor structure. These observations are theoretically consequential, insofar as they bear on attempts to identify process-level contributors to obsessive–compulsive disorder (OCD) symptom expression.

At the same time, the review uses a set of measurement-level concerns to substantially qualify the evidentiary base supporting inferential confusion and, by implication, the IBA. In their discussion, Myers and Abramowitz (2025) argue that although IC measures exhibit “excellent reliability,” unresolved questions about construct breadth, self-report accessibility of inferential processes, and questionnaire development “contextualize much of the existing evidence for the IBA.” Measurement refinement and independent replication are clearly warranted. However, several of the review’s key inferences appear to conflate limitations of particular operationalizations with limitations of the underlying construct. The inferential step from instrument critique to construct-level doubt is not fully supported by the evidence as presented.

Instrument critique and construct validity

The review characterizes inferential confusion as “broad and nebulous” and raises the concern that existing instruments may not capture its “entirety.” Breadth alone, however, is not sufficient to undermine construct validity. Many established OCD constructs are similarly multifaceted and require multiple operationalizations without invalidating the construct, a point long recognized in the construct-validation literature (Cronbach & Meehl, 1955; Campbell & Fiske, 1959). Acknowledging limitations in existing instruments reflects constraints in current operationalizations rather than indeterminacy of the underlying construct.  Within classical construct validation, individual instruments are treated as fallible indicators embedded within a broader nomological network (Cronbach & Meehl, 1955). Limitations of any single operationalization do not, in themselves, invalidate the construct, particularly when convergent patterns are observed across distinct methods (Campbell & Fiske, 1959).

Notably, Myers and Abramowitz (2025) themselves describe inferential confusion as a “genuine signal” whose effects are sometimes obscured by methodological noise. This framing supports a conservative interpretation: the field would benefit from improved measurement, clearer tests of process-level hypotheses, and stronger designs. It does not require skepticism regarding whether inferential confusion represents a coherent reasoning phenomenon relevant to obsessive doubt.

Scope of the review

The article is framed as a critical review of the inference-based approach (IBA). If the aim is to evaluate IBA as a theoretical and clinical model, the scope of the review warrants clarification. Although positioned as a broad critique, several of the review’s central conclusions regarding construct validity are derived primarily from concerns about the wording, response formats, and endorsement properties of inferential confusion (IC) questionnaires.

This focus is informative, but it is not equivalent to a comprehensive evaluation of IBA as a theoretical framework. Measurement critique is one component of construct evaluation; it does not exhaust it. Several elements central to the approach receive comparatively limited engagement, including treatment outcome and process studies of I-CBT, as well as empirical work integrating inferential confusion with fear-of-self constructs.

Importantly, the review explicitly limits its scope to the conceptual aspects of inferential confusion and thereby excludes intervention studies by design. While such a restriction can be defended as a matter of scope definition, it does not follow that intervention and process evidence are conceptually irrelevant. When inferential confusion is explicitly measured as a mechanism of change within longitudinal designs, outcome studies contribute to construct validation by situating the construct within a broader nomological network that includes temporal coherence, clinical responsiveness, and theoretically predicted patterns of change. Excluding such studies necessarily constrains the evidentiary frame within which conclusions about construct validity are drawn.

A similar narrowing occurs with respect to work integrating inferential confusion and fear-of-self constructs. Although this literature is cited as part of the broader correlational evidence base, its theoretical implications for evaluating inferential confusion as a core process within a larger inferential framework are not substantively developed. When considered alongside the exclusion of intervention research, this limited engagement yields an evidentiary base that is narrower than the broader inference-based literature would support. Under these conditions, conclusions regarding the viability or coherence of IBA risk extending beyond the scope of the evidence reviewed.

The review also suggests that the inferential confusion literature relies on a relatively limited number of clinical samples. This characterization warrants nuance. A substantial portion of the empirical work on inferential confusion and I-CBT includes diagnostically confirmed OCD samples and clinically severe groups, alongside nonclinical samples used for scale development and process testing. Moreover, the use of nonclinical and analogue samples has been explicitly defended by Abramowitz and colleagues (2014) under the continuity hypothesis, which conceptualizes obsessive–compulsive phenomena and their underlying cognitive processes as varying along a continuum rather than forming a categorical clinical divide. From this perspective, nonclinical samples are well suited for examining core processes and refining measurement, and evidence derived from such samples complements, rather than undermines, findings from clinical populations. When viewed within this broader methodological context, the evidentiary base appears more heterogeneous than the review’s framing might suggest.

Convergence across measures

A central element of the review’s critique concerns the development of the Inferential Confusion Questionnaire–Expanded Version (Aardema et al., 2010), particularly the removal of items with low endorsement in an OCD sample. The authors suggest that this procedure may have reshaped the instrument and rendered its associations tautological. This interpretation underweights convergent evidence across the broader development history of inferential confusion measures and elevates a single methodological decision to construct-level significance.

Earlier versions of the Inferential Confusion Questionnaire, developed using different item-generation and selection strategies, nonetheless show similar factor structures and associations with obsessive–compulsive symptoms. If the ICQ-EV’s findings were primarily artifacts of endorsement-based pruning, divergence across versions would be expected. That pattern is not evident. In the absence of such divergence, the claim that endorsement trimming produced spurious coherence remains inferential rather than demonstrated.

The review also acknowledges task-based measures such as the Dysfunctional Reasoning Processes Task (DRPT; Baraby, Wong, Radomsky, & Aardema, 2021; Baraby, Bourguignon, & Aardema, 2022), and reports moderate correlations between the DRPT and the ICQ-EV, describing these findings as modest evidence of convergent validity within a multitrait–multimethod framework. Yet cross-method convergence is precisely what should reduce concern that associations reflect idiosyncratic features of a single questionnaire. From a construct validation perspective, convergence across independently developed instruments employing different formats and response demands is a strength rather than a liability.

The suggestion that stronger cross-method convergence would be required for measures of the same construct rests on a particular expectation regarding effect size. An alternative interpretation is equally plausible. When distinct instruments converge across formats and response demands, this pattern more parsimoniously indicates that they are capturing a shared underlying configuration of reasoning rather than reflecting method-specific artifacts (Campbell & Fiske, 1959). For a construct defined as a recurrent pattern of misdirected relevance in reasoning, in which imagined possibilities override direct perceptual or contextual information, such convergence is consistent with functional coherence rather than conceptual vagueness.

Taken together, privileging a single procedural feature while discounting replication across versions, formats, and methods risks selective evidentiary weighting. Construct appraisal requires attention to the broader nomological network rather than isolated psychometric decisions (Meehl, 1990). When the total evidentiary pattern is considered, the inference that endorsement-based procedures undermine construct validity appears insufficiently grounded in the full body of available data.

Endorsement-based item screening

The critique of endorsement-based item screening warrants further qualification. Myers and Abramowitz (2025) note that item reduction based on endorsement can be appropriate, yet suggest that a more rigorous approach would rely on item–total correlations or factor loadings. This recommendation does not fully account for a basic statistical constraint: items with extreme floor effects yield restricted variance and unstable covariance structures, limiting the interpretability of correlational and factor-analytic indices. In such cases, endorsement screening is often a prerequisite for meaningful psychometric evaluation rather than an inferior substitute.

Classical psychometric theory has long recognized the necessity of removing extremely low-endorsement items to avoid skewed distributions and unstable factor solutions (Nunnally & Bernstein, 1994; DeVellis, 2017). Importantly, items in the ICQ-EV were removed on the basis of frequency, not symptom correlation. To substantiate claims of tautology or construct distortion, item-level evidence would be required showing that retained items merely restate symptom content or that selection was guided by associations with OCD severity. No such evidence is presented.

Even if endorsement-based trimming narrowed the measure toward more common expressions of inferential confusion, no data are offered demonstrating that the core inferential process was altered. All psychometric refinement methods privilege items that function well within a given sample. Without item-level demonstration that removed items uniquely indexed core inferential mechanisms, the claim that endorsement screening compromised construct validity remains conjectural rather than established.

Phenomenology and construct definition

The review suggests that the ICQ-EV may reflect “OCD-specific phenomenology rather than inferential confusion per se.” This objection rests on a category error concerning how inferential confusion is defined within the inference-based approach. Inferential confusion is not conceptualized as a content-free cognitive operation that exists independently of experience. Rather, it is defined as a disturbance in reasoning as it is lived and enacted, specifically a pattern in which imagined possibilities acquire sufficient relevance to override direct perceptual and contextual information.

In this framework, phenomenological expression is not an incidental byproduct of the construct but its primary mode of manifestation. Inferential confusion is primarily identified through the subjective experience of doubt, plausibility, and conviction generated by inferential and imaginative reasoning. Accordingly, measuring phenomenological features of reasoning does not constitute contamination by symptom content; it is the means by which the construct is operationalized. Characterizations of inferential confusion as “nebulous” follow naturally if the construct is evaluated as a content-free cognitive operation rather than as a disturbance in lived reasoning.

The inference that endorsement-based item trimming necessarily reshaped the ICQ-EV toward OCD symptom phenomenology is therefore underdetermined. The same procedure could plausibly have increased sensitivity to the experiential features central to inferential confusion by removing items that were rare, weakly discriminating, or insufficiently anchored to lived reasoning patterns. In the absence of item-level evidence demonstrating that retained items primarily restate symptom content rather than index inferential processes, this concern remains theoretically possible but empirically unsubstantiated.

Generalized versus context-specific measurement

The review further argues that the generalized phrasing of the ICQ is incongruent with the inference-based approach’s emphasis on the selective deployment of inferential confusion within obsession-relevant contexts. At the same time, it raises concerns that task-based measures such as the Dysfunctional Reasoning Processes Task (DRPT; Baraby et al., 2021; 2022), which rely on specific scenarios, may fail to capture the idiosyncratic content of individual obsessions. These critiques pull in opposite directions. Generality trades off with contextual specificity, while contextual realism trades off with universality. This tension is common in psychopathology research and does not signal conceptual inconsistency within the IBA.

The distinction between generalized and context-specific measurement is theoretically important, but it does not follow that generalized assessment is invalid or misaligned with selective deployment. Selectivity refers to when inferential confusion is activated in lived experience, not necessarily to how vulnerability must be assessed. Generalized instruments can index a recurrent propensity for inferential confusion to emerge in obsession-relevant reasoning, without implying that this reasoning process operates uniformly across all domains. In contrast, context-specific tasks are designed to capture the moment-to-moment enactment of this reasoning pattern under triggering conditions.

Importantly, responses to generally phrased ICQ items are unlikely to be context-free, particularly in clinical samples. Individuals typically anchor their responses to domains in which they experience recurrent distress or difficulty. As a result, even when items are phrased broadly, responses are implicitly contextualized by the situations that are most salient to the individual and within which inferential confusion most often arises. In this sense, generalized wording does not preclude domain specificity at the level of response, but rather allows inferential confusion to be flexibly mapped onto idiosyncratic patterns of obsessional reasoning.

Context-specific and task-based measures such as the DRPT therefore represent complementary measurement strategies rather than competing or conceptually inconsistent ones. Each involves unavoidable trade-offs. Highly specific measures may offer greater ecological precision but risk idiosyncrasy and limited generalizability across heterogeneous OCD presentations. Generalized measures sacrifice some contextual detail while enabling broader coverage, comparability across samples, and assessment of inferential confusion as a transdiagnostic reasoning vulnerability within OCD. This balance reflects a standard methodological tension, not a flaw in the underlying construct.

Response formats, awareness, and tasks

Concerns regarding agreement/disagreement response formats and self-report awareness raise legitimate issues for refinement but do not uniquely threaten inferential confusion. Agreement formats are routinely used to assess frequency or typicality of experiences even when the underlying construct is procedural rather than propositional. More broadly, limitations in self-report accessibility are well documented across psychopathology, particularly in conditions characterized by overvalued ideation or limited insight, including some presentations of obsessive–compulsive disorder and related disorders such as body dysmorphic disorder. In such cases, reduced insight would be expected to attenuate self-reported endorsement of inferential confusion rather than inflate it, without constituting evidence against the construct itself. Indeed, if introspective access were fundamentally compromised, one would expect random or inconsistent responding rather than the systematic patterns of association repeatedly observed between IC measures and obsessive–compulsive symptom severity. The presence of such patterned associations suggests that self-report, while imperfect, captures meaningful and nontrivial variance.

At the same time, available evidence indicates that many individuals with obsessive–compulsive disorder can recognize, at least descriptively, that their reasoning departs from direct perceptual or contextual evidence and relies on imagined possibilities. This level of awareness does not entail resolution of obsessional doubt. Individuals may accurately report imagination-based reasoning while remaining unaware that this mode of inference renders their doubts epistemically irrelevant, a distinction emphasized within the inference-based approach. Descriptive awareness of one’s reasoning, in this sense, is therefore compatible with symptom persistence and does not undermine the use of self-report measures. This distinction between descriptive awareness and metacognitive appraisal is central: individuals may report how they reason without recognizing the epistemic status of that reasoning, allowing self-report to index inferential patterns even in the presence of ongoing doubt.

Where insight is more severely compromised, limitations of self-report are best understood as a general measurement challenge rather than a construct-specific flaw. Under such conditions, group-level comparisons are more likely to underestimate, rather than exaggerate, differences associated with inferential confusion. Triangulation using task-based measures, clinician ratings, and idiographic methods therefore represents a principled response to measurement constraints rather than a corrective for construct inadequacy. Such triangulation reflects standard practice in construct validation, where no single method is presumed definitive but convergent evidence across methods strengthens confidence in the underlying process.

Concerns that some ICQ-EV items are vague or difficult to rate dimensionally reflect the same psychometric tensions discussed elsewhere. Items that apply broadly or lack temporal anchoring are especially vulnerable to restricted variance, and screening procedures are commonly used to address this. Limitations noted for the DRPT likewise underscore the inevitability of methodological trade-offs. Such trade-offs are characteristic of construct measurement and do not, in themselves, imply conceptual incoherence.

More fundamentally, the review raises concerns about whether inferential processes are accessible to introspection at all, thereby questioning the extent to which inferential confusion can be validly measured using self-report instruments. OCD is characterized by variable levels of insight, both within and across individuals (e.g., Neziroglu et al., 1999). Such variability is itself well documented and does not preclude meaningful assessment at the group level. Recent work further indicates that insight-related reasoning processes can be meaningfully assessed via self-report despite this limitation. In particular, the Cognitive Obsessional Insight Scale (COGINS) demonstrates good internal consistency, test–retest reliability, convergent validity with clinician-rated measures of insight, and sensitivity to treatment-related change (Ouellet-Courtois et al., 2024). While such findings do not resolve broader measurement challenges, they provide proof of principle that reasoning- and insight-adjacent processes are accessible to self-report in OCD.

Consistent with this interpretation, inference-based cognitive therapy has demonstrated clinical efficacy in individuals with limited or poor insight (Visser et al., 2015). This finding indicates that the reasoning processes targeted by the model remain functionally engaged even when metacognitive awareness is reduced. If inferential processes were wholly inaccessible to awareness or measurement, systematic therapeutic engagement with these processes would be difficult to document. Taken together, these observations do not eliminate the need for continued refinement of inferential confusion measurement, but they temper the inference that introspective limitations may render the construct inaccessible or unmeasurable.

Incremental validity and theory

The review appropriately emphasizes inconsistent reporting of semi-partial correlations and incremental R². Improved reporting is clearly needed. At the same time, incremental variance is a limited test of theoretical validity. When predictors are theoretically related and empirically correlated, shared variance is expected and unique variance attenuated. This reflects well-known limitations of regression-based partitioning when constructs are conceptually proximate, rather than evidence of construct redundancy (Meehl, 1990).

From an inference-based perspective, high correlations between inferential confusion and obsessive belief domains are theory-consistent, as beliefs are conceptualized as downstream products of prior inferential processes. In hierarchical or generative relationships, cross-sectional regression is a blunt instrument for adjudicating theoretical primacy. More informative tests require temporal and experimental designs that assess whether shifts in reasoning precede changes in obsessional doubt.

The review further emphasizes the limited number of experimental studies bearing on inferential confusion and concludes that evidence supporting the inference-based approach as a causal model of obsessive–compulsive disorder is confined to a single study. While direct laboratory manipulation of inferential confusion within OCD samples remains sparse, this conclusion is best interpreted as applying to direct experimental manipulation in OCD specifically, rather than to the broader evidentiary landscape relevant to evaluating inferential confusion as a process construct. Treatment outcome and process studies do not provide direct experimental tests of causal mechanisms, nor do they substitute for designs involving manipulation of inferential confusion itself. However, when inferential confusion is explicitly measured as a mechanism of change within longitudinal designs, such studies contribute to construct validation by situating inferential confusion within a broader nomological network that includes temporal coherence, clinical responsiveness, and theoretically predicted patterns of change. This body of evidence is not incorporated into the evidentiary frame used to evaluate construct validity.

In addition, randomized vignette and task-based paradigms that assign participants to experimentally varied inferential contexts, while assessing inferential confusion as a measured process variable, provide partially experimental tests of inferential reasoning mechanisms even when inferential confusion itself is not directly manipulated (e.g. Yang et al., 2021). In addition, experimental work demonstrating inferential confusion mechanisms in related disorders, such as eating disorders (e.g., Ouellet-Courtois et al., 2021), provides convergent support for the broader plausibility of the inferential framework. Considered together, these lines of evidence suggest a broader empirical foundation than is reflected in a narrowly experimental evidentiary frame.

Independent replication, affiliation, and methodological inference

The review highlights that a substantial portion of the inferential confusion literature has been conducted by the model’s developers or by what the authors describe as “closely affiliated colleagues,” and emphasizes the importance of independent replication. The call for independent verification is appropriate and consistent with best practices in clinical science. However, the characterization of “closely affiliated colleagues” is left undefined and therefore difficult to evaluate as a methodological concern.

It is unclear whether this designation refers to shared institutional affiliation, co-authorship history, training lineage, theoretical orientation, or participation in a common research program. Without explicit criteria, such language risks functioning as a rhetorical qualifier rather than as a clearly specified indicator of potential bias. Author proximity, in itself, does not constitute evidence of methodological weakness, nor does author independence guarantee objectivity. Inference about bias requires attention to study design, analytic transparency, preregistration, and reproducibility rather than reliance on imprecise descriptors of affiliation.

Researcher allegiance is a well-recognized phenomenon in psychotherapy research, particularly in comparative treatment outcome studies (e.g., Luborsky et al., 1999; Munder et al., 2013). The standard response to such concerns has been to strengthen methodological safeguards, ensure transparency, and encourage independent replication. Allegiance, however, is typically treated as a potential moderator of outcomes rather than as a construct-level validity threat. Absent identifiable design flaws or analytic bias, evidentiary weight is determined by methodological rigor and reproducibility rather than by investigator investment alone.

Independent replication is a collective enterprise rather than a unilateral obligation of theory originators. The degree of laboratory independence in a research area depends not only on the activities of its developers, but also on the extent to which external groups elect to engage with, test, and extend the framework. The absence of widespread independent replication, while warranting encouragement, does not by itself constitute negative evidence regarding construct validity.

At the same time, growing engagement from additional research groups is both welcome and methodologically valuable. Independent testing strengthens any framework. It is worth noting, however, that such engagement enters a literature that spans several decades of empirical development. Replication and extension are cumulative enterprises; they refine and expand an existing evidentiary base rather than retroactively determining whether prior work counted as evidence. In this sense, scientific maturity is marked not by replacement of earlier contributions, but by their systematic replication and extension across settings and investigators. Progress in clinical science rarely proceeds through forced alignment with competing paradigms, but through cumulative evaluation within an expanding evidentiary network.

In addition, the empirical literature on inferential confusion and inference-based cognitive therapy is not confined to a single laboratory context or methodological tradition. Correlational studies examining inferential confusion, task-based investigations of reasoning processes, and treatment outcome studies of I-CBT have been conducted across diverse research settings, using heterogeneous samples, designs, and measurement approaches. Investigations have emerged from multiple research groups and international contexts, reflecting a degree of methodological dispersion that exceeds what broad references to investigator affiliation might suggest. While continued independent replication remains essential, the existing body of work already demonstrates greater institutional and methodological breadth than such characterizations imply.

More broadly, the recurring emphasis on author involvement risks conflating investigator origin with evidentiary status. In psychological science, theory development is often initiated and advanced by those most invested in articulating and testing it. Such involvement may warrant heightened attention to methodological rigor and replication, but it does not, in itself, constitute a validity threat. Scientific credibility does not attach to geography or institutional provenance. Evidentiary weight is determined by study design, transparency, reproducibility, and convergence across independent samples and methods, not by the biographical or national location of investigators. To treat author participation as a standing source of evidentiary suspicion, independent of methodological considerations, risks substituting sociological inference for empirical evaluation.

If evidentiary status is routinely qualified on the basis of investigator involvement, an unintended corollary is that a research base would appear more independent to the extent that its originators contribute less to it. Such a standard would not strengthen the evidentiary record; it would reduce the volume of relevant empirical tests available for evaluation. Concerns about potential allegiance effects are more productively addressed through transparent methodological safeguards, preregistration, analytic clarity, and replication across laboratories than through provenance-based qualification of findings.

Conclusion

Myers and Abramowitz (2025) provide a methodologically detailed review that emphasizes measurement rigor, replication, and evidentiary standards. Several of their key inferences, however, appear to extend beyond what the data warrant. Measurement-level concerns are treated as substantial qualifications of the construct itself; endorsement-based item screening is framed as a validity threat despite psychometric precedent; phenomenology is construed as contaminating rather than constitutive; scope-based exclusions are treated as neutral rather than inferentially constraining; and generalized wording is interpreted as a theoretical mismatch rather than as a measurement choice compatible with selective deployment of inferential processes.

Additional constraints inherent to contemporary OCD research, including the predominance of cross-sectional designs, shared-method variance in self-report paradigms, and broader challenges in formal reasoning research, are not unique to inferential confusion. These background conditions contextualize the evidentiary landscape across models and therefore do not, in themselves, justify construct-level skepticism. The present correspondence has focused on what appear to be the most consequential inferential steps in the review rather than attempting an exhaustive response to all subsidiary issues.

Taken together, a more conservative interpretation is that inferential confusion remains a coherent reasoning process implicated in obsessive doubt, supported by convergent evidence across measures. As with other process-level constructs in OCD research, continued conceptual refinement and improved operational precision are both expected and welcome, and do not, in themselves, constitute grounds for questioning construct validity. Measurement can be strengthened through multi-method assessment, including context-sensitive designs that complement generalized instruments, clearer reporting of incremental effects, and direct tests of inferential processes, without conflating limitations of current operationalizations with the viability of the underlying construct.

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