When you woke up today, got out of bed and went to your kitchen, there were many possibilities around you that could come true:
The microwave could fail causing a fire.
The sink could overflow causing a flood.
The power may go out and the entire contents of your refrigerator may spoil.
The roof could collapse due to termites.
But you probably didn’t even think about those possibilities. Those situations, although possible, were not relevant to that moment according to the information that his senses were providing him.
This normal reasoning process is what we use throughout the day. It guides us to make inferences about possibility based on trust in our senses and in ourselves. Normal reasoning also uses relevant associations (example: smoke and flames are indicative of fire). We don’t reason that the microwave is malfunctioning and causing a fire unless we smell smoke or see sparks or flames.
In other words, we live in a state of certainty that everything is fine until our senses tell us that there are reasons to infer that a possibility has become relevant to the moment here and now: I smell smoke and see sparks coming out near the microwave. I infer that the possibility of the microwave being on fire is relevant at this moment and I need to act.
This normal type of reasoning about possibility is not what happens in OCD. Often, people with OCD treat possibilities without direct evidence in the senses as Yeah they are actually relevant to the here now. They often even consider possibilities although what their senses tell them. Is called inferential confusion; the person confuses an imaginary abstract possibility with a relevant sense-based probability.
Some examples:
- You turn off the tap. You see that it is wrong and yet you infer: Maybe the faucet is not really turned off.
- You have no intention of hitting someone with your car on purpose, and yet you infer: Maybe I’m capable of hitting someone with my car.
- You are in a home where no one is sick and yet you infer: Maybe I could get sick from sitting on this couch.
Inferential confusion is made up of three main components:
- Overdependence on possibility
- Distrust in the senses/self
- Irrelevant associations
If you have OCD, in certain situations you:
- rely too much on possibility. Without even consulting your senses, you can walk into the kitchen and make an imagined guess based solely on possibility. Maybe the faucet causes a flood.
- Don’t trust your senses. You don’t see water dripping from the faucet and yet you ignore that information and think: Maybe the faucet is really on.
- you use information out of context. You remember a story you read about someone who left the sink on all day and you think: Maybe I could also leave the faucet running in my house.
Inferential confusion is a reasoning process that is directly addressed in Inference-Based Cognitive Behavioral Therapy (I-CBT) developed by Dr. Frederick Aardema and the late Dr. Kieron O’Connor. Historically, obsessions have been viewed as random, intrusive thoughts. But according to I-CBT, they are not random at all. they are builtand this is good news for those who suffer from OCD.
According to the strong literature currently supporting I-CBT, the key to treating OCD is addressing inferential confusion. If we decompose and demystify as When obsessive doubts arise, OCD patients have a new way to gain agency. By facing OCD triggers, people with OCD can learn how they were tricked into believing they needed to act on that trigger. They can learn to trust their senses again in triggering situations and use information in the context of that moment. They can learn that without direct evidence from the senses, just because something is possible doesn’t mean we have to act on it as if it were a reality.
The possibility only becomes relevant at this point if we have direct evidence from our senses to support it. I-CBT brings a new look to the treatment of OCD:
- If we aim for inferential confusion, obsessive doubt has no weight. Loses its power. The victim can now see how she was tricked into believing it.
- If the obsessive doubt has no weight, there is no anxiety.
- Without anxiety there is no need for compulsions.
- The trigger itself no longer fires.
Treating inferential confusion gives OCD sufferers the answers to how OCD tricks them and why they doubt specific things they do. It gives power back to people who suffer from OCD so that when they wake up in the morning to start their day, they can become firmly grounded in normal reasoning, even when faced with their triggers.
Recommended reading and more information:
- O’Connor, K., & Aardema, F. (2012). The OCD Doctor’s Manual: Inference-Based Therapy. Chichester, UK: Wiley.
- https://icbt.online/ – official website with free resources and information about I-CBT
- https://ocdtrainingschool.com/ – OCD Training School website for information on I-CBT training and consultation.
This publication is brought to you in collaboration with the ADAA OCD and Related Disorders SIG. Learn more about GIS.
