Understanding Inference-Based Cognitive Behavioral Therapy (I-CBT) and Its Role in Treating OCD and Eating Disorders
Obsessive Compulsive Disorder (OCD) and eating disorders are complex, often misunderstood conditions that can deeply impact a person’s daily life, relationships, and sense of self. While Exposure and Response Prevention (ERP) has long been a gold standard for treatment, newer and more specialized approaches continue to expand how we support clients. One such approach is Inference-Based Cognitive Behavioral Therapy (I-CBT).
Below, we explore what I-CBT is, how it’s used to treat OCD, why OCD and eating disorders so often occur together, and why I-CBT is considered a neurodivergent-affirming approach to care.
What Is Inference-Based Cognitive Behavioral Therapy
(I-CBT)?
Inference-Based Cognitive Behavioral Therapy (I-CBT) is a specialized form of CBT developed specifically to treat Obsessive Compulsive Disorder. Unlike traditional CBT, which often focuses on challenging distorted thoughts or beliefs after they appear, I-CBT targets the reasoning process that gives rise to obsessions in the first place.
At the core of I-CBT is the idea that obsessions stem from a faulty inference—a mistaken conclusion that something is wrong, dangerous, or unacceptable, despite a lack of real-world evidence. Rather than responding to what is actually happening in the present moment, the mind shifts into an imagined “what if” scenario that feels urgent and compelling.
I-CBT helps individuals learn how to:
Recognize when they have crossed from reality-based thinking into imagined possibilities
Identify the specific reasoning errors that fuel obsessional doubt
Reconnect with common sense, lived experience, and present-moment information
This approach is especially helpful for individuals who feel stuck in endless mental loops of doubt, reassurance-seeking, or over-analysis.
How Is I-CBT Used to Treat Obsessive Compulsive Disorder (OCD)?
In OCD, obsessions are often experienced as intrusive, distressing thoughts that demand certainty or immediate action. Compulsions then develop as attempts to neutralize anxiety, gain reassurance, or prevent feared outcomes.
I-CBT works by addressing OCD at its root—the obsessional doubt itself, rather than focusing solely on exposure to feared situations. In therapy, clients learn to:
Differentiate between obsessive doubt and realistic concern
Trace how their mind arrived at a feared conclusion
Identify the narrative or story the obsession is telling
Disengage from compulsive problem-solving that reinforces OCD
Instead of asking, “How do I make this anxiety go away?” I-CBT invites the question, “How did my mind convince me this was a real problem to begin with?”
For many individuals, I-CBT feels less confrontational and more intuitive than exposure-based approaches alone. This is particularly true for people whose OCD is primarily mental, ruminative, or centered around themes such as morality, responsibility, identity, or certainty.
Why I-CBT Is Neurodivergent-Affirming
One reason many individuals find I-CBT approachable and effective is that it is widely considered neurodivergent-affirming. Rather than viewing differences in thinking styles as deficits to be corrected, I-CBT respects the way diverse minds process information, uncertainty, and imagination.
Neurodivergent individuals—such as those with ADHD, autism, or heightened cognitive sensitivity—often have strong analytical skills, vivid imaginations, and deep pattern recognition. In I-CBT, these qualities are not pathologized. Instead, therapy focuses on how these strengths can become misdirected under stress, leading to obsessional doubt.
I-CBT is neurodivergent-affirming in several key ways:
It honors cognitive differences rather than pathologizing them.
I-CBT does not ask clients to think “less” or suppress their natural cognitive tendencies. It helps them understand how their mind reasons and when that reasoning has shifted away from present-moment reality.It reduces shame and self-blame.
By framing obsessions as a reasoning error rather than a personal failure or lack of willpower, I-CBT helps clients move away from shame-based narratives—something many neurodivergent individuals have experienced in prior treatment settings.It does not rely solely on habituation or “pushing through.”
Some neurodivergent clients find traditional exposure-based approaches overwhelming or invalidating if not carefully adapted. I-CBT offers an alternative that prioritizes insight, understanding, and self-trust, which can increase engagement and sustainability in treatment.It supports autonomy and collaboration.
I-CBT is highly collaborative and transparent. Clients learn why their minds generate obsessional narratives and are empowered to choose how they respond—aligning with neurodivergent-affirming values of consent, autonomy, and respect.It reconnects clients with lived experience.
Rather than privileging hypothetical fears or imagined outcomes, I-CBT helps clients anchor back into real-world evidence and sensory experience, which can feel grounding and stabilizing for individuals navigating chronic cognitive overwhelm.
Why Do OCD and Eating Disorders Often Co-Occur?
OCD and eating disorders frequently overlap, and this is not a coincidence. Both conditions share underlying cognitive and emotional patterns that can reinforce one another over time.
Some key areas of overlap include:
Intolerance of Uncertainty
Both OCD and eating disorders involve a strong need for certainty and control. Food rules, body checking, calorie counting, or ritualized eating behaviors can function similarly to compulsions—attempts to reduce anxiety and eliminate doubt.
Rigid Thinking and Perfectionism
Black-and-white thinking, rigid standards, and fear of making mistakes are common in both conditions. This may appear as strict food rules, moral judgments about eating, or intense pressure to do things “correctly.”
Over-Reliance on Internal Narratives
In both OCD and eating disorders, imagined fears or internal stories can override real-world evidence—such as believing something bad will happen if a certain food is eaten or feeling compelled to act on a thought simply because it feels urgent or convincing.
Compulsive Behaviors That Temporarily Reduce Anxiety
Whether it’s a compulsion related to OCD or a disordered eating behavior, the cycle is often the same: anxiety increases, a behavior provides short-term relief, and the pattern becomes more entrenched over time.
Because of these shared features, treating one condition without addressing the other can limit progress. Approaches like
I-CBT are especially effective in addressing the underlying reasoning patterns that maintain both OCD symptoms and eating disorder behaviors.
A Thoughtful, Integrated Approach to Care
At The Current, we understand that OCD and eating disorders are not simply about thoughts, food, or behaviors—they are about how the mind responds to uncertainty, fear, and internal experience. Inference-Based CBT offers a compassionate, evidence-informed approach that helps individuals step out of obsessional doubt and reconnect with trust in themselves and their lived reality.
Our therapists bring a thoughtful blend of professional expertise and personal insight to their work with OCD, allowing us to approach treatment with empathy, nuance, and respect for each client’s experience.
Several of our clinicians have completed specialized training in Inference-Based Cognitive Behavioral Therapy (I-CBT) through the ICBT Online training and education platform created by Dr. Frederick Aardema, co-founder of I-CBT. This training ensures our therapists are skilled in identifying obsessional doubt, working with complex and primarily mental compulsions, and adapting treatment in neurodivergent-affirming ways.
Contact us today about working with Shayna Sutton, LPC or Elise Smith, LMSW who have both completed the full curriculum of the I-CBT training.
We are committed to ongoing learning and ethical, client-centered care. If you are interested in learning more about I-CBT as an approach to treating OCD, we encourage you to explore additional educational resources at https://icbt.online/.
Whether you are navigating OCD, disordered eating, or overlapping concerns, our goal is to provide care that feels informed, respectful, and collaborative—meeting you where you are and supporting meaningful, sustainable change.
Healing is not about achieving perfect certainty. It’s about learning how to live openly, flexibly, and compassionately—even when uncertainty is present.