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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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.

Every now and then, you even see one drop. No warning. No apology. Just gravity doing what gravity has done since the beginning of time.

And that’s when my brain said:
“Hey. How many people die from this?”

Now, to be fair, coconuts are not marshmallows. They are dense, armored, aerodynamic skull-seekers. A coconut falling from a tall palm tree reaches a velocity that physics textbooks describe using words like force and impact and that’s going to hurt.

So I did what any calm, regulated adult would do.
I looked it up.

Turns out, coconut-related injuries, and yes, even deaths, are more common than people realize. Not common in the “this will happen to you tomorrow” sense, but common in the “this is not entirely made up by an anxious brain” sense.

This led to a perfectly reasonable conclusion:
Sitting directly under a palm tree may not be the best life choice.

Walking near them? Fine, but maybe with some situational awareness. A cautious person might keep their distance. A very cautious person might avoid them altogether. A me, apparently, started wondering whether helmets should be standard beachwear.

And then my OCD clinician brain woke up, stretched, and said:
“Ah. Interesting.”

Is this OCD?

Short answer: no.
Longer answer: also no, but let’s talk about why.

Thinking, “Hey, coconuts fall and that could hurt” is not OCD. That’s called having a functioning brain with access to Google. It can be explained by temporary overstimulation, novelty, or overestimating likelihoods while on vacation, an environment where your brain is already slightly drunk on sun and rum.

A coconut falling on your head is unlikely. That uncertainty is either tolerated (shrug, beach life) or managed (I’ll sit five feet over there). Problem solved. No spirals required.

But here’s where it gets interesting.

When coconuts become an OCD problem

From an inference-based perspective, OCD is not about danger, probability, or intolerance of uncertainty. It’s about how the mind decides something is relevant when it isn’t.

ICBT would say this:
The actual likelihood of a coconut landing on your head is irrelevant.

What matters is when the mind bypasses the senses and starts telling a story anyway.

OCD begins when coconuts are no longer overhead, but mentally omnipresent.

You’re not under a palm tree.
There are no coconuts nearby.
You’re indoors. Possibly in Canada. Possibly in winter.

And yet…
What if?

Now the mind starts working overtime, not to assess reality, but to manufacture relevance.

This isn’t just “anything could happen.”
This is the mind constructing a narrative where falling coconuts must be taken seriously right now, despite zero sensory evidence.

That’s the crux of OCD.

The coconut multiverse (now playing in your head)

Once the imagination is in charge, the possibilities are endless.

For example:

• Fish have been known to fall from the sky. It’s in the Bible. Science explains it with storms and waterspouts. Totally real.
  So… why couldn’t coconuts be swept up by a freak tropical weather event and dropped somewhere unexpected? Montreal, perhaps. February.
• Palm trees are planted everywhere now. Airports. Hotels. Shopping malls.
  Do they bear fruit? You don’t know. Can you know? What if one does?
• Coconuts are sold in supermarkets. On shelves.
  High shelves.
  Above your head.

And just like that, coconuts are no longer vacation props. They are airborne threats. Potentially everywhere. Waiting.

They’ve gone from piña coladas to projectiles.

This is how OCD works

If this sounds far-fetched, congratulations. You now understand OCD perfectly.

Every OCD story is built exactly like this one. Not from evidence, not from the senses, but from inverse inference: starting with an imagined possibility and reasoning backward until it feels real.

It’s not:

“There is danger, therefore I’m worried.”

It’s:

“What if there were danger? Then I should worry.”

The mind stops checking reality and starts trusting the story instead. Once that happens, the theme doesn’t matter. Germs, harm, morality, identity, or coconuts. The structure is the same.

OCD isn’t a failure to tolerate uncertainty.
It’s a failure to notice when imagination quietly replaced perception.

Final thought (helmet optional)

Coconuts can fall. That’s true.

But when coconuts start haunting you in places where no coconuts exist, you’re no longer dealing with coconuts.

You’re dealing with a mind that’s excellent at spinning stories and has started treating them as relevant, even when nothing in front of you calls for one.

No mockery required. Just clarity. And maybe a nice spot on the beach, five feet away from the palm tree.

© Frederick Aardema, PhD.— The Doubt Illusion Blog (2025)

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 in the here and now. The PDF Version can be downloaded here.

Introduction: Continuing a Pastoral Legacy Through the Lens of I-CBT

Rev. Thomas M. Santa, C.Ss.R.’s Ten Commandments for the Scrupulous (2013) has long served as a practical guide and source of relief for those suffering from scrupulosity. Building on Rev. Donald Miller, C.Ss.R.’s 1968 version, Fr. Santa updated and refined these principles for modern audiences, offering pastoral wisdom to help people navigate the relentless doubts that define this condition. This article revisits Fr. Santa’s commandments through a contemporary psychological lens—specifically, Inference-Based Cognitive Behavioral Therapy (I-CBT)—as a way of continuing his legacy of compassionate guidance.

Scrupulosity is not only a spiritual struggle but also a recognized form of Obsessive-Compulsive Disorder (OCD), characterized by intrusive doubts about sin, morality, confession, personal worthiness, or spiritual failure. Historically, scrupulosity may be the earliest documented form of OCD, with descriptions dating back to early Christian and medieval writings. As discussed in The Menace Within: Obsessions and the Self by Dr. Frederick Aardema, early spiritual texts often describe individuals tormented by blasphemous or forbidden thoughts, accusing themselves of sins they had not committed—a phenomenon that closely parallels modern understandings of OCD. Jeremy Taylor’s 17th-century observation, quoted above, captures the essence of this experience: the tragic tendency to mistake innocence for guilt and virtues for flaws.

While obsessional doubts feel like moral warnings, I-CBT shows they are rooted in reasoning and imaginative distortions—a confusion between imagination and reality—rather than in genuine spiritual failings. Fr. Santa’s pastoral writings resonate with this perspective, as he consistently emphasizes clarity, trust, and the futility of endless self-accusation.

When the Ten Commandments for the Scrupulous were first written, their advice aligned with the predominant clinical treatments of the time, such as Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT). These approaches remain widely used and effective. In recent years, however, I-CBT has emerged as a novel, evidence-based treatment for OCD that shifts the focus from exposure and habituation to the reasoning errors at the heart of obsessional doubt.

I-CBT is rooted in the understanding that OCD is fundamentally a disorder of false and artificially created doubt, disconnected from present reality and sensory experience. As Dr. Frederick Aardema, co-founder of I-CBT, has described, obsessional doubt arises from inferential confusion—a process by which imagined, hypothetical possibilities are mistaken for real threats or moral failings.

While all evidence-based approaches seek to help individuals stop giving obsessive doubts undue importance, I-CBT offers a unique explanation for how these doubts come to feel relevant in the first place. A key contribution of I-CBT is its focus on how individuals with OCD mistake abstract, hypothetical possibilities for real probabilities, treating these imagined scenarios as if they were relevant moral doubts. Instead of engaging with the content of these doubts, I-CBT helps individuals step back from the obsessional narrative and reconnect with the evidence of their senses and their authentic experience.

Importantly, I-CBT is value-neutral. It does not attempt to challenge or alter religious beliefs or moral values, nor does it require exposure to unwanted thoughts or acceptance of anything contrary to one’s values. Instead, it targets the process by which OCD hijacks reasoning, creating confusion between imagination and reality. This makes I-CBT highly compatible with faith traditions, as it helps individuals reconnect with the clarity of direct experience, restoring peace and trust while stepping out of the false, imagined doubts that distort their practice of faith.

The aim of this article is to provide insights on Fr. Santa’s commandments through the lens of I-CBT, highlighting the natural complementarity between his pastoral wisdom and I-CBT’s focus on correcting reasoning and imaginative distortions. Many of Fr. Santa’s observations—such as his emphasis on what is “clear and certain” or the pointlessness of repetitive confession—resonate strongly with I-CBT’s approach to obsessive doubt.

Faith, at its heart, involves trust—even when complete certainty is absent. Scrupulosity, by contrast, demands answers to doubts that were never real to begin with. By integrating Fr. Santa’s spiritual guidance with I-CBT’s reasoning-based framework, we aim to help people distinguish between genuine moral reflection and OCD’s false alarms, freeing them to live and practice their faith with confidence, compassion, and peace.

I-CBT and the Ten Commandments: A Shared Focus on Clarity and Trust

 Fr. Santa’s Ten Commandments for the Scrupulous offer practical, pastoral guidance for quieting the endless cycle of “what ifs” that plague those with scrupulosity. His commandments encourage trust, clarity, and an honest acceptance of what is real and certain, rather than being consumed by hypothetical fears or imagined sins. Inference-Based Cognitive Behavioral Therapy (I-CBT) shares this same foundation, although it approaches the issue from a psychological rather than theological standpoint.

I-CBT views scrupulosity as a problem of reasoning and imagination rather than belief. Obsessional doubt does not arise from genuine moral failings but from a reasoning error in which abstract, hypothetical possibilities are mistaken for real threats. For example, a person may begin to doubt whether they offended God, not because of any concrete action or evidence, but because their imagination constructs a “what if” scenario that feels compelling. This confusion is not about faith or values; it arises when an unjustified doubt replaces direct experience with imagined possibilities, giving these doubts a false sense of urgency and relevance.

In this way, I-CBT complements Fr. Santa’s guidance. While the Ten Commandments for the Scrupulous invite individuals to let go of unnecessary guilt and trust in God’s mercy, I-CBT equips them with tools to recognize and step out of the obsessive narrative that fuels doubt. Both perspectives emphasize the importance of clarity—seeing what is actually present rather than what is imagined—and both encourage a return to trust, whether that trust is placed in divine grace, in one’s own senses, or in the reality of the present moment.

 Commandment One

“You Shall Not Confess Sins You Have Already Confessed.”

 Fr. Santa emphasizes that a confession made sincerely and clearly is valid the first time. For the scrupulous person, however, OCD generates obsessional doubt—a sense that the confession “didn’t count” or “wasn’t complete,” which drives the urge to repeat it. In I-CBT terms, this urge is not a sign of unresolved sin but the result of reasoning and imaginative distortions, where the mind gives weight to imagined scenarios (“Maybe I left something out,” “What if I wasn’t fully honest?”) as if they were real evidence. This is often called reverse reasoning, where a feeling of doubt (“I don’t feel forgiven”) is mistakenly treated as proof that forgiveness did not occur.

I-CBT highlights that obsessional doubt is artificially created—it arises not from genuine moral discernment but from a reasoning and imaginative process disconnected from the senses and from reality. The sense of incompleteness or lingering anxiety after confession is not a moral warning but a symptom of OCD’s obsessional narrative. Each repetition of confession attempts to resolve a problem that never truly existed.

Resisting the urge to re-confess is, therefore, an act of trust in what is real and complete, rather than in the imagined imperfections OCD presents. By not repeating confession, the individual steps outside the obsessional narrative and aligns with what they know to be true—the original confession was valid. I-CBT reframes this stance as choosing evidence from the here-and-now (the fact of having confessed) over “what if” thinking. As Fr. Santa writes, “when you refuse to engage the feeling of doubt…the wave of anxiety passes.” Recognizing that the doubt is artificial, not a true moral signal, is a key step in breaking OCD’s reasoning cycle.

Commandment Two

 “You shall confess only sins that are clear and certain.”

 Fr. Santa emphasizes that doubtful sins “don’t count” and that confessing what is uncertain can be harmful rather than helpful. This wisdom aligns closely with I-CBT, which teaches that obsessional doubt is not evidence of wrongdoing but the product of reasoning and imaginative distortions. Obsessional doubt is not a moral signal; it does not reveal the presence of sin or moral failure. Instead, it reflects a breakdown in imagination and reasoning—where abstract and hypothetical scenarios are treated as if they were concrete realities.

From an I-CBT perspective, obsessional doubts are often abstract and disconnected from direct evidence. They rarely concern real-life uncertainty, which arises from situations that can be resolved by observation or action. Instead, they thrive on the idea of something being wrong:

• “Maybe I sinned but didn’t notice it.”
• “What if I secretly intended to do wrong?”
• “Perhaps I’m just trying to convince myself I didn’t sin.”

These doubts are rooted in imagination, not reality. They exist in a mental “what if” space, detached from the here-and-now. In I-CBT, this arises from dismissing direct experience—the evidence of the senses, memory, and self-knowledge—and replacing it with abstract reasoning or moral hypotheticals.

Fr. Santa’s call to confess only what is clear and certain aligns with the I-CBT principle of trusting what is real, direct, and observable rather than what is imagined. If a sin is not clear, it falls into the realm of abstract possibility, which does not require confession. Feelings of doubt, unease, or guilt are not evidence of wrongdoing—they are symptoms of OCD’s obsessional narrative. As I-CBT puts it, feelings are not facts.

When scrupulous doubts arise, one can presume innocence and rely on the clarity of prior actions and intentions rather than chasing hypothetical wrongdoing. As Fr. Santa notes, doubt itself is part of being human, not proof of sinfulness. I-CBT expands on this by explaining that obsessional doubt is not even normal doubt—it is artificially created by the imagination and sustained by distrust of the senses and self. Recognizing this distortion allows the person to return to reality and anchor themselves in their true moral intent.

Commandment Three

 “You shall not repeat your penance or any of the words of your penance after confession—for any reason.”

 Fr. Santa, following Fr. Miller’s earlier guidance, reminds us that penance does not need to be performed flawlessly or repeated for the sacrament to be effective. The grace of absolution does not depend on perfect concentration or exact words; it flows from the sacrament itself. Yet for the scrupulous person, the mind often generates “what if” narratives: What if I didn’t say it perfectly? What if I missed a word? What if it doesn’t count? This leads to compulsive repetition, which is essentially a form of mental checking.

In I-CBT, repetition is understood as an attempt to “fix” a problem that never actually existed. The doubt that drives repetition is imaginary, created by the obsessional narrative rather than by real evidence of error. Repeating the penance is like wiping a television screen with your hand in hopes of changing the channel—it does nothing to address the root issue because the problem exists only in the mind’s imagined scenarios. You cannot resolve an imaginary doubt through repeated action; the solution is to step back into reality and recognize that nothing was wrong in the first place.

I-CBT teaches that compulsive repetition arises from giving weight to what if possibilities rather than trusting what is already completed. The focus shifts from participation in grace to achieving a subjective “just right” feeling. Ironically, the more one repeats, the more the doubt grows, as the act of repetition signals to the brain that something is truly wrong.

To counter this, I-CBT reframes penance as an act of trust rather than performance. Once completed, it is complete—whether or not it felt perfect. By refusing to repeat penance, the individual practices “exiting the bubble”—stepping out of imagination and back into the reality of a sacrament that was already valid and sufficient.

Commandment Four

 “You shall not worry about breaking your pre-Communion fast unless you deliberately eat or drink in your mouth and swallow as a meal.”

 Fr. Santa reassures that breaking the pre-Communion fast is not something that occurs by accident or through trivial actions, like swallowing saliva or using lip balm. The fast is an intentional, devotional practice, and it is only broken through deliberate acts of eating or drinking. For the scrupulous person, however, the mind often invents “what if” scenarios: What if I swallowed something accidentally? What if I broke the fast without realizing it? What if God sees my carelessness as a sin? These doubts arise not from real evidence but from abstract reasoning disconnected from reality.

From an I-CBT perspective, these doubts are classic examples of obsessional reasoning—they start with the imagined possibility of wrongdoing and treat that possibility as if it were real. OCD’s obsessional narrative dismisses the evidence of the senses (e.g., “I didn’t eat or drink anything”) and replaces it with hypothetical fears (“What if I somehow did and didn’t notice?”). The person becomes stuck in their imagination, treating every small sensation or vague memory as potential proof of failure.

I-CBT emphasizes that real uncertainty can be resolved by looking to the present reality and direct evidence. For example, one can easily know whether they have eaten or drunk something deliberately. Obsessional doubt, by contrast, never deals with real uncertainty—it manufactures an imaginary problem and then demands an impossible level of proof to resolve it. Trying to answer these “what if” questions only strengthens the doubt, because the doubt was never based on reality to begin with.

The key, as both Fr. Santa and I-CBT suggest, is to trust one’s intentions and the direct evidence of the moment. If no deliberate action was taken, then the fast is intact. Attempting to mentally “check” or review every detail of the past hour is like trying to solve an imaginary puzzle—it only keeps you stuck inside the obsessional narrative. The path to peace lies in returning to reality, recognizing that the doubt is artificially created, and trusting both your lived experience and your sincere intent.

Commandment Five

 “You shall not worry about powerful and vivid thoughts, desires, and imaginings involving sex and religion unless you deliberately generate them for the purpose of offending God.”

 Fr. Santa reminds us that vivid or powerful thoughts—especially those involving sex or religion—are not sinful unless they are deliberately generated with the intention of offending God. Yet for the scrupulous person, the sudden appearance of such thoughts can feel deeply disturbing, as if their mere presence is proof of wrongdoing. This is precisely where I-CBT provides a critical insight: these thoughts are not signals of hidden intent or moral failure—they are phantom thoughts, mental constructs born from the obsessional doubt itself.

In I-CBT, what many call “intrusive thoughts” are not random or autonomous. They are imagined constructs created by the obsessional narrative. Once OCD plants the seed of doubt—“What if I’m blasphemous?” or “What if I’m perverse?”—the mind becomes hyper-focused, scanning for evidence of danger or hidden intent. This very act of checking and monitoring creates vivid mental images or sensations, which are then mistaken as independent proof of sin. OCD flips the cause and effect: the doubt creates the thought, but it feels as though the thought came first, validating the fear. This reasoning error is called Reversing Causal Direction.

Fr. Santa’s guidance to not worry about these thoughts or imaginings aligns perfectly with I-CBT’s principle of recognizing these experiences as products of imagination, not reality. They do not reflect your true self, intentions, or values. They are the echo of OCD’s story, not evidence of sin. Trying to suppress or analyze them only strengthens the illusion, while acknowledging their false origin weakens their power.

The key is to step back and recognize the trick at play. These thoughts and sensations are constructed by the mind’s immersion in doubt—not proof of wrongdoing. Just as phantom sensations in contamination fears (e.g., feeling sticky or dirty) are illusions, so too are these mental images or feelings of moral failure. I-CBT invites the person to exit the narrative and return to the reality of their true moral intent, which remains unblemished.

Commandment Six

“You shall not worry about powerful and intense feelings, including sexual feelings or emotional outbursts, unless you deliberately generate them to offend God.”

Fr. Santa reminds us that feelings—whether joy, anger, sadness, or even strong sexual emotions—are not sinful in themselves. They are part of the natural range of human experience and, when expressed appropriately, give glory to God. Many scrupulous individuals, however, fear that the mere presence of strong feelings is evidence of moral failure or spiritual weakness. They may try to suppress, control, or neutralize these feelings out of fear that losing emotional control somehow displeases God.

In I-CBT, this suppression of natural feelings is understood as a disconnection from original experience—the direct, unfiltered perception of reality as it is. Before doubt arises, feelings are simply felt experiences, neither good nor bad. It is only when OCD introduces obsessional doubt—“What if my anger is sinful?” “What if this feeling means I am corrupt?”—that emotions are misinterpreted as dangerous or morally suspect. I-CBT teaches that obsessional doubt is not a moral signal, but a combination of reasoning and imaginative distortions that replace reality with “what if” scenarios.

Just as Father Santa encourages us to laugh freely at a joke or cry when we feel sad, I-CBT emphasizes reconnecting with the original experience of the moment without overanalyzing it. Feelings are transient, not verdicts on character. Anger, joy, or arousal arise naturally from life’s situations, but OCD magnifies them, asking for impossible certainty: “What if this feeling means I want something bad?” In reality, feelings are simply signals of being alive—what matters is intention and deliberate choice, not the presence of emotion itself.

By allowing emotions to flow without judgment, the individual moves out of the obsessional narrative and returns to the here-and-now. Both Father Santa’s pastoral advice and I-CBT agree that the key to peace is trusting direct experience rather than mistrusting it through the lens of OCD.

Commandment Seven

“You shall obey your confessor when he tells you never to repeat a general confession of sins already confessed to him or another confessor.”

 Fr. Santa highlights how the scrupulous person often feels compelled to repeat general confessions, as though doing it “one more time” might finally resolve an imagined incompleteness. But as he wisely points out, repetition is not a remedy—it is the problem itself. The doubt that drives the repetition is not a true moral issue but an illusion created by scrupulosity.

In I-CBT, this compulsion is understood as the result of false doubt, not just due to any rigid need for certainty. The individual acts as if something is unresolved when, in fact, nothing needs fixing—the confession was already complete and valid. The obsessive urge to “go back and check” or confess again is like trying to fix a problem on a blank page: there is nothing there to fix. I-CBT shows that repeating confession is a way of engaging with the obsessional narrative—feeding an imaginary problem instead of recognizing that the doubt itself is baseless.

Obeying the confessor’s instruction to stop repeating confessions is therefore a way of returning to reality. It means trusting what is already known and experienced—“I confessed, I received absolution, it is done”—rather than being pulled into endless “what if” scenarios. I-CBT frames this as refusing to reason from imagination and instead relying on direct evidence (the memory of the confession and the sacrament itself).

Fr. Santa also warns against trying to sidestep this commandment by seeking other confessors. I-CBT would describe this as compulsive reassurance-seeking driven by a false belief that resolution lies in more confession, when the real solution is to recognize there was never a real problem in the first place. Trusting the confessor’s guidance is not about perfection—it is about refusing to participate in OCD’s cycle of invented doubts.

 Commandment Eight

“When you doubt your obligation to do or not do something, you will see your doubt as proof that there is no obligation.”

Fr. Santa draws on the teaching of St. Alphonsus Liguori, who recognized that the scrupulous person’s habitual will is to avoid offending God. When a doubt arises about an obligation, this very doubt reveals that there is no obligation—because if there were a clear duty, the person would already act without question. This principle is deeply reassuring for those trapped by scrupulosity, where doubt is mistaken for moral responsibility.

From an I-CBT perspective, this aligns with the understanding that OCD hijacks a person’s values and sense of responsibility, turning them inward as a weapon. The person’s genuine desire to be good and faithful becomes misapplied to abstract, imagined scenarios:

• “What if I failed to honor this holy day without realizing it?”
• “Maybe I had an obligation I didn’t know about, and I’ve already sinned.”

These doubts are not rooted in real-world obligations but stem from reasoning and imaginative distortions, where the mind invents hypothetical obligations detached from evidence. OCD thrives on this by conflating moral values with the endless pursuit of imaginary “what ifs.”

I-CBT teaches that moral reasoning must be grounded in original experience—in what is directly known and observable, not in hypothetical constructs. If you cannot clearly identify the obligation in the present moment, the doubt itself is proof that the “obligation” is part of OCD’s narrative, not reality. In this sense, I-CBT helps the individual reclaim their values, reminding them that faithfulness does not mean endlessly scanning for moral traps, but living according to what is real, here and now.

By seeing doubt for what it is—a misapplication of values rather than a true moral warning—the person can step out of the cycle of fear and return to authentic trust. This is fully in line with Fr. Santa’s teaching: when the doubt itself is the only “evidence” of wrongdoing, there is no obligation.

Commandment Nine

“When you are doubtful, you shall assume that the act of commission or omission you’re in doubt about is not sinful, and you shall proceed without dread of sin.”

Fr. Santa advises that when doubt arises about whether something was sinful, the safest and healthiest approach is to proceed as though no sin has occurred. For the scrupulous person, this may feel counterintuitive, because the doubt itself feels morally urgent. Yet as Fr. Santa notes, these doubts are not a sign of moral failure—they are part of the scrupulous condition itself, driven by fear rather than reality.

From an I-CBT perspective, the key is recognizing that everything stems from the initial obsessional doubt. OCD creates a false question—“What if I sinned?” or “What if I failed to do something I should have?”—even when there is no real event or evidence to support it. In omission doubts especially, OCD treats the absence of clear memory or evidence as proof that something must have gone wrong. I-CBT teaches that this reasoning is inverted: the absence of evidence means there is no reason to engage the doubt, not that the doubt is valid.

Once the initial doubt is seen for what it is—a mental fabrication rather than a real moral issue—the rest of the cycle begins to collapse on its own. Anxiety, dread, and compulsions are all fueled by this false starting point.

This is why both I-CBT and Fr. Santa encourage moving forward without engaging the doubt. There is nothing to resolve because nothing is wrong. When you stop trying to answer the doubt, the accompanying fear and compulsions lose their power. Instead of endlessly analyzing intentions or replaying events, you simply acknowledge: “This is just OCD talking, not reality.”

In this sense, obeying this commandment is not denial but clarity. It is choosing to treat false alarms as false and trusting that genuine moral concerns do not arrive in the form of relentless “what if” scenarios.

Commandment Ten

“You shall put your total trust in Jesus Christ, knowing he loves you as only God can and that he will never allow you to lose your soul.”

Fr. Santa reminds us that the heart of faith is trust—trust that God’s love is constant, unconditional, and not dependent on our feelings or performance. Many people with scrupulosity struggle to believe this because OCD distorts their perception of grace, turning God’s love into a source of fear and self-accusation. As Fr. Santa writes, “God loves me exactly as I am… He walks with me each step of the way.” This is the truth that OCD tries to obscure.

From an I-CBT perspective, obsessional doubt generates false alarms about salvation. The mind imagines scenarios such as “What if God rejects me?” or “What if I didn’t do enough to be saved?” and treats these hypothetical fears as though they were real. This reflects what I-CBT calls a confusion between imagined possibilities and reality. The presence of doubt is not a sign that grace is absent; it is simply the result of distorted reasoning and imagination.

I-CBT helps individuals recognize that no amount of mental checking, repeated prayer, or endless reassurance can create salvation or prove God’s love. These compulsive attempts only strengthen the illusion that something is wrong. Salvation is not attained through mental effort but received through grace and entrusted to Divine Mercy. By stepping out of the obsessional narrative, the person can return to the lived reality of faith: a relationship grounded in trust rather than fear.

To follow this commandment from an I-CBT perspective is to see the doubt for what it is—an illusion—and to rest in the truth of God’s presence and love, even when OCD tries to claim otherwise.

Conclusion: I-CBT and the Path Beyond Scrupulosity

Fr. Santa’s Ten Commandments for the Scrupulous offers timeless pastoral wisdom: trust, clarity, and freedom from the endless loops of fear. Viewed through the lens of Inference-Based Cognitive Behavioral Therapy (I-CBT), these principles gain an additional psychological dimension—one that focuses not on theology or morality, but on the reasoning and imaginative distortions that drive obsessive doubt.

I-CBT is not about accepting uncertainty, challenging values, or changing beliefs. In fact, people with scrupulous obsessions are often deeply committed to their values, sometimes to the point of being misled by their own sincerity. The real issue is not rigidity, but doubt—false, artificially created doubt that masquerades as moral concern. I-CBT helps individuals recognize that these doubts are not spiritual warnings but mental fabrications, created by a reasoning process that confuses imagined “what if” scenarios with reality.

When the illusion of doubt is seen for what it is, the entire chain of anxiety, dread, and compulsions begins to unravel. Both Fr. Santa’s guidance and I-CBT point toward the same freedom: the ability to live in alignment with one’s faith and values without being hijacked by obsessive questioning.

For those seeking additional support, the following steps may help:

• Find a faith‑respecting I‑CBT therapist at www.icbt.online, which offers resources and a directory of therapists that offer I‑CBT.

• Self-help: The Resolving OCD Series (Vol 1 and 2), written by Dr. Frederick Aardema, provides a detailed, step‑by‑step framework for dismantling obsessive doubt through the I‑CBT approach.
• Spiritual support: Pair I‑CBT with trusted spiritual direction to ensure that your faith and mental health efforts complement each other.

• Pastoral community: The website www.scrupulousanonymous.org offers a wealth of resources, including the free monthly Scrupulous Anonymous newsletter, decades of Q&A, and articles offering spiritual encouragement to complement both I‑CBT and pastoral guidance.

In the end, both I-CBT and Fr. Santa emphasize the same truth: faith is not found in compulsive checking or in answering every doubt, but in the clarity that comes from trusting what is real. By combining pastoral wisdom with a reasoning-based therapeutic approach, individuals can move beyond OCD’s false alarms and reclaim a life of confidence, peace, and authentic spiritual connection.

References and Resources

Aardema, F. (2024). Resolving OCD: Understanding your obsessional experience (Vol. 1). Mount Royal Publishing.

Aardema, F. (2024). Resolving OCD: Advanced Strategies for Overcoming Obsessional Doubt (Vol. 2). Mount Royal Publishing.

Aardema, F., & O’Connor, K. (2007). The menace within: Obsessions and the self. Journal of Cognitive Psychotherapy: An International Quarterly, 21(3), 182–197.

Hunter, R., & MacAlpine, I. (Eds.). (1963). Three hundred years of psychiatry, 1535–1860. Oxford University Press.

Santa, T. M. (2013). Ten commandments for the scrupulous. Liguori Publications.

Santa, T. M. (2025). Understanding scrupulosity (4th ed., rev.). Liguori Publications.

Santa, T. M. (2025). A guide for the scrupulous: Spiritual practices, critical beliefs and helpful prayers. Liguori Publications.

Scrupulous Anonymous. (n.d.). Monthly newsletter and resources. Retrieved from https://www.scrupulousanonymous.org

ICBT Online. (n.d.). Therapist directory, resources, and more information on the Resolving OCD Series. Retrieved from https://www.icbt.online

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. The idea that intrusive thoughts or urges come from protective inner parts sounds compassionate and psychologically deep. It fits the human urge to explain experience through stories of intention.

But OCD is not a disorder of inner characters. It is not driven by protectors, exiles, subpersonalities, or hidden inner agents.

OCD is a disorder of reasoning. Its machinery is built through imagination overriding the senses.

This distinction matters. Treatments must target the mechanism that creates the disorder. When metaphors are mistaken for mechanisms, especially in a condition defined by interpreting imagination as if it were reality, harm is not theoretical — it is predictable.

Inference-based Cognitive Behavioral Therapy (ICBT) did not arrive from metaphysics or narrative charisma. It came from decades of empirical work on inferential reasoning, obsessional doubt, and the cognitive errors that detach a person from the world in front of them. This research was funded by independent scientific agencies, subjected to peer review, and tested in controlled clinical trials.

IFS has not undergone this process for OCD. Not because researchers lack curiosity, but because imaginative appeal is not evidence, and narrative seduction is not a mechanism of change.

ICBT and ERP, like all treatments, began without evidence at their inception. But they did not begin as storytelling systems or commercial metaphors. They emerged from established scientific traditions such as learning theory, cognitive psychology, and reasoning research, and advanced only through the slow, demanding work of empirical validation. Their development was not funded by commercial training networks, but by competitive public research grants aimed at understanding mechanisms and improving patient care.

This is not a small difference. It is the difference between a treatment grounded in science and one grounded in story.

The Appeal of Parts Narratives in OCD

IFS proposes that inner parts have motives, intentions, and protective aims. Its language can feel intuitive and emotionally resonant, which is why many people find it appealing. But in OCD, this framework mislabels the very mechanism that generates the disorder.

OCD doubt is not purposeful. It is not protective. It does not arise from unmet needs.

It is fabricated through a reasoning error in which imagined possibilities are treated as hypotheses requiring resolution. The doubt is not uncovered. It is constructed.

When a therapist asks someone with OCD to “listen to what the part wants,” the instruction treats the obsession as meaningful. It grants agency to a phenomenon that has none. It personifies the illusion. In OCD, this personification is not neutral; it carries risk.

It invites the person to negotiate with the doubt rather than dismantle it. It increases cognitive involvement with an imagined storyline. It strengthens the very process that built the obsession in the first place.

OCD does not require inner negotiation. It requires recognizing that the narrative itself is illegitimate.

Research on self-themes, possible selves, and feared possible selves can explain why certain obsessions arise, but these constructs are representational, not agentic. They do not speak. They do not protect. They do not intend. Treating them as literal parts crosses the line from science into metaphysics.

IFS makes that leap. Cognitive science does not.

A Historical Detour: The Divided Self Reappears

This is not a new problem. In my 2007 paper The Menace Within: Obsessions and the Self, I argued that dividing the self to explain obsessions repeats an old pattern in the history of unwanted mental states.

Obsessions have been attributed, across centuries, to outside agents:

Demons. Evil spirits. Possession.

Later, the “devil outside” became the “devil within”: Freud’s divided psyche, unconscious impulses, inner drives acting against the person’s will.

The story changes. The structure stays the same.

A troubling mental content is explained by positing a hidden agent, a force within the person that means something, wants something, or acts with intention.

IFS, in secular form, risks reviving this structure. The agent is no longer Satan or the id. It is a “protector,” an “exile,” a “part” whose motive must be decoded.

In both cases, what is fundamentally a reasoning error is recast as the message of an internal figure.

From an inferential perspective, this is precisely the mistake OCD already makes.

The obsession is not an alien intrusion revealing a dark self. It is a constructed inference, a remote and hypothetical “self-as-might-be” narrative untethered from sensory reality.

The discordance between “who I am” and “what I fear I could be” is not proof of inner conflict. It is the product of misconstructed doubt.

Turning that doubt into a speaking character, whether demonic or therapeutic, gives it a status it has never earned.

When Metaphors Are Not Mechanisms

All therapies use metaphor. But not all metaphors serve the same task.

In ICBT, metaphors exist only to illuminate a mechanism that can already be described in concrete terms.

Take the magician. OCD creates a cognitive illusion that follows the same structure as a stage illusion: redirect attention, highlight the irrelevant, fill gaps with suggestion, and rely on the spectator to complete the trick.

OCD performs the same choreography with thought. The metaphor is not decorative; it clarifies the reasoning error documented in inferential confusion.

IFS metaphors operate differently. They describe what the part is claimed to be. They assign motive, purpose, and agency.

The metaphor becomes an ontological claim.

This shifts the therapeutic target away from reasoning and toward fabricated internal personalities. In OCD, where the problem already involves difficulty distinguishing what is imagined from what is real, this literalization strengthens the disorder instead of weakening it.

Metaphors are helpful when they stay metaphors. They become misleading when they are mistaken for inner realities.

This is why personification is not inherently problematic in OCD literature. Therapists have long used figures like tricksters, imps, bullies, or magicians to show how the disorder behaves. These figures represent processes, not agents. They demonstrate misdirection, inflated possibility, or narrative illusion.

Approaches that use dialogue or multiple perspectives as metaphors for shifting positions of thought can fit entirely within this framework because they do not posit inner agents or parts with independent motives (e.g. Van Hallam & O’Connor, 2002).

Personification becomes counterproductive only when the figure is treated as a part with motives.

The Real Magic of You

In their Paper, Sorcery of the Self: The Magic of You, O’Connor and Van Hallam argue that much of what we call “self” is not a fixed entity inside us but something that emerges from how we know the world. The self, they show, is sustained by metaphor, expectation, and the structure of experience.

Social constructionism makes this visible. Across cultures and centuries, the sense of self varies widely, not because people have different inner parts, but because self is shaped by language, context, and shared meanings. It is a practical construct, not a literal collection of inner personalities.

Phenomenology pushes this further. The self is not an object in the mind. It arises in how we act, perceive, engage, and care. It shows up in projects and moods, not in compartments or subselves.

As O’Connor and Hallam put it, the self appears the way a magic trick appears: not because there is an entity behind it, but because the conditions for the illusion are in place. When the structure of experience invites a “center,” we perceive one.

No metaphysical essence required. No inner agents needed.

This matters directly for OCD.

If the ordinary, everyday self is already a construction, then the idea of inner parts with motives is even less credible. It multiplies illusions instead of dissolving them. For people who already struggle to separate possibility from probability, adding further internal characters does not help; it destabilizes further.

The feared self in OCD is a perfect example. It is not a protector, not an exile, not a subpersonality with an intention. It is a narrative artifact built out of vulnerability, imagination, and misconstructed doubt. It behaves as if it were protective only because OCD frames a hypothetical version of the person as a danger that must be neutralized.

Calling the self an illusion does not trivialize experience. Lived experience is real, coherent, and meaningful, but it does not come from an inner agent. It comes from a stance: the way we meet the world.

In ICBT, the “real self” refers to this stance, the evidential, perceptual mode of knowing. OCD obscures this mode by spinning hypothetical selves and imagined identities. Recovery means returning to direct contact with the world, where evidence leads and imagination does not dictate.

The real magic of the self lies in this capacity to see reality as it is, without being pulled into invented identities or internal characters. Compared to this, the cast of IFS parts is a pale, theatrical substitute, less mysterious, not more.

The self revealed through perception, engagement, and presence is far richer than any system of protectors and exiles could ever capture.

Reincarnation, Inner Families, and the Appeal of Imagination

IFS’s popularity is not mysterious. It appeals for the same reason reincarnation appeals: it is pleasant to imagine alternative versions of oneself. It is poetic. It feels deep.

But imaginative appeal is not a mechanism of change.

Reincarnation is a compelling story, but we do not use it as a protocol for OCD. IFS’s parts model feels rich, but feeling rich is not the same as being effective.

People enjoy imagining inner characters because humans love narrative complexity. But OCD is a disorder defined by misinterpreting imagined content as significant. The last thing it needs is a treatment that encourages more of the same.

OCD is a reasoning error. It is the construction of doubt not grounded in the senses — the moment imagination overrides direct evidence and a hypothetical possibility is treated as requiring resolution.

ICBT dismantles this illusion by exposing the misinferences that sustain it. The obsession does not need exploration. It needs recognition as invalid.

Treatments must target mechanisms, not metaphors.

OCD does not arise from unmet needs in inner parts. It arises from misconstructed doubt.

A therapy that asks patients to negotiate with imagined entities validates the narrative structure of the doubt. It strengthens the illusion instead of dismantling it.

A Necessary Warning on Integration Attempts

As ICBT has gained prominence, it has become a tempting target for integration. Some existing evidence-based models try to fold ICBT into their frameworks to maintain familiar structures, despite the fundamental differences in mechanisms. And approaches like IFS try to situate themselves alongside ICBT to compensate for the absence of an evidence base in OCD.

These attempts are rarely driven by mechanism or empirical necessity. They are often efforts to borrow credibility from a model that earned it through rigorous scientific work.

They adopt ICBT’s language while ignoring the reasoning framework that gives it force. This is not innovation. It is opportunistic blending.

Not all models can be integrated without destroying their mechanism of change. And in OCD, the mechanism is everything.

ICBT focuses on correcting reasoning errors and restoring sensory trust. It is grounded in science, not story. And it speaks directly to the engine of OCD: misconstructed doubt.

People with OCD deserve clarity. They deserve treatments that dissolve illusions, not deepen them.

They deserve freedom from the doubt illusion, not a therapy that invites them further into it.

Further Reading

Aardema, F., & O’Connor, K. (2007). The menace within: Obsessions and the self. Journal of Cognitive Psychotherapy, 21(3), 182–197.

Hallam, R.S., & O’Connor, K.P. (2002). A dialogical approach to obsessions. Psychotherapy and Research, 75, 333-348.

Heidegger, M. (1962). Being and time. Oxford: Robinson.

Heidegger, M. (1993). Basic writings. London: Routledge.

Husserl, E. (1967). Ideas: General introduction to phenomenology. London: Allen & Unwin.

O’Connor, K. P., & Hallam, R. S. (2000). Sorcery of the self: The magic of uou. Theory & Psychology, 10(2), 238-264.

© Frederick Aardema, PhD.— The Doubt Illusion Blog (2025)

From its earliest ideas, Inference-Based Cognitive Behavioral Therapy (ICBT) drew on this logic of illusion.

Magicians understand how attention can be redirected, how a fictive layer can be projected over reality, and how the mind supplies what is never actually shown. They know that an illusion acquires its force not from deception but from cooperation.

ICBT emerged from this same recognition: OCD behaves not as a detector of danger but as an illusionist — using misdirection, imaginative projection, and emotional vividness to make what is unreal feel immediate and consequential.

The Mental Behind Obsessional Doubt

Every illusion begins with a small betrayal of attention.
A glint of movement.
A pause held just long enough.
A gesture that draws the audience’s eyes away from the mechanism of the trick.

The illusionist does not need smoke or mirrors.
He needs only the mind’s tendency to follow the most compelling story in the room.

OCD performs its illusions with comparable finesse.
A person sees the stove turned off, the door locked, their memory intact. Reality is unambiguous.

But then comes the shift — a moment of cognitive misdirection. The mind pulls attention inward, away from perception and toward a possibility it has begun to imagine:

What if something slipped past me when I checked the stove, a tiny glow I did not notice?
What if I did not truly see the door latch click into place, maybe it only felt locked?
What if something happened while I was driving, a bump I barely sensed or a pedestrian I somehow failed to notice?

This is the moment the illusion begins.
A second layer is cast over the real one.
The mind leans into the story, following its shadows instead of the world’s light.

This is not uncertainty.
This is illusion — a substitution of one reality for another, executed with the precision of mental sleight of hand.

The Illusionist’s Image, and the Image in the Mind

A skilled illusionist can make an apparition seem to appear out of nothing, a shape or shimmer or suggestion of presence that feels real for a moment, even though nothing is actually there. The power of the illusion lies not in the object but in the audience’s readiness to complete what has only been suggested.

Obsessional doubt works in exactly this way.
The imagined danger has no external substance, no trace, no evidence, no contact with the real world. Yet through emotional intensity and repeated attention, the mind grants the imagined possibility a sense of presence it does not possess.

The person becomes both illusionist and audience, watching an internal performance unfold and reacting as though the apparition were truly before them.

The illusionist does not need a real figure.
The audience supplies the missing form.
Likewise, OCD does not need evidence — the mind supplies the missing threat.

And just as a magician relies on the audience’s momentary absorption in the illusion, OCD relies on the person’s brief shift into the imagined narrative, vivid enough to eclipse the simplicity of what the senses are actually showing.

Where Magic, Narrative, and OCD Meet

Illusion is not only trickery; it is storytelling.
A shift in tone, a change in rhythm, a pause held for a fraction longer than expected: these are the cues that prompt the audience to generate meaning.

OCD uses the same logic of illusion.
A person performs an ordinary action.
Then imagination offers a cue: What if…?

That cue becomes a narrative seed.
From it grows a scene:
Emotional stakes, moral consequence, a cascade of imagined outcomes.

Nothing has changed in the world.
Everything has changed in the person’s internal theatre.

This is magic without a stage, illusion without a performer — the mind becomes playwright, actor, director, and audience all at once.

The Architecture of Cognitive Illusion

Every illusion follows a structure as clean as a blueprint:

1. Divert attention from reality.
   A gesture here, a shadow there, enough to shift the gaze.
2. Introduce an imagined alternative.
   Not as fact but as something the mind can lean into, elaborate, and animate.
3. Infuse the imagined with emotional weight.
   Emotion gives the illusion its gravity and urgency.
4. Allow sensation to masquerade as evidence.
   A knot in the stomach becomes “proof,” a flash of guilt becomes “signal.”

This is the architecture of obsessional doubt.
It explains why a person can know nothing happened and yet feel drawn toward checking or reviewing.
The internal illusion has succeeded.
Reasoning drifts from evidence toward narrative.

ICBT exposes this architecture.
It illuminates the misdirection.
It reveals how imagination overtook perception.
And once the mechanism is seen clearly, the illusion collapses — not dramatically, but with the quiet inevitability of something that can no longer pretend to be true.

The Return to Direct Reality

ICBT does not ask anyone to fight thoughts, argue with content, or “tolerate uncertainty.” It invites something simpler and more radical: to notice the moment the mind exits the real world and enters the imagined one.

When attention returns to the senses, to what is present here and now, the illusion dissolves like smoke under bright light. What looked like danger is revealed as a cognitive projection, a magician’s flourish, a phantom crafted by reasoning rather than reality.

Magic, at its purest, relies on a temporary disconnection from direct perception.
Obsessional doubt depends on that same disconnection.
ICBT restores the contact.

This is, at its core, the theme explored throughout The Doubt Illusion: obsessional doubt is not a riddle to solve, nor a danger to guard against, but an illusion of reasoning. And the moment you see how the trick is done, the urgency dissolves — and reality, steady and unembellished, reappears exactly where it always was.

References

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

© Frederick Aardema, PhD.— The Doubt Illusion Blog (2025)