Workshop 9: Inference Based Approach: Treating Obsessive Compulsive Disorder in a nonfrightening way
Henny Visser, GGzCentraal, the Netherlands and Shiu FungWong, UNSW Sydney, Austalia
Not being able to hold your young child because you fear you might abuse it sexually. Losing your job because you repeatedly do not show up on time due to compulsively checking the stove and door locks. Ruining your skin and night’s rest because you constantly doubt whether you are clean enough even after hours of washing. These and other examples of Obsessive Compulsive Disorder (OCD) are extremely disabling. CBT outperforms other treatments for OCD, however, approximately half of the patients still meet DSM-5 criteria for OCD after this treatment. Furthermore, some patients refuse CBT or drop-out early because they find it extremely frightening and unacceptable. So, innovative and nonfrightening interventions for OCD are sorely needed. The Inference Based Approach (IBA) is a new evidence-based cognitive treatment for OCD. No exposure with response preventions is part of IBA and its focus is on resolving obsessional doubt.
Obsessional doubt forms a part of obsessional thinking in most subtypes of OCD, where the person doubts actions, information, or the self, and ruminates excessively on the chance that harm, error or other mishap ‘may’ occur/have occurred. The IBA model states that ‘inferential confusion’ creates obsessional doubt. IBA is a 10-step manualized treatment delivered in an individual format. The goal of the treatment is overcoming inferential confusion, which involves reorienting the person to trusting the senses, self, and common sense, and relating to reality in a normal, non-effortful, and non-obsessive way.
The IBA postulates that individuals with OCD use a different reasoning style in OCD situations, that they go beyond information provided by the senses in the here and now to make an inference about a possible state of affairs (“Perhaps the door is not locked properly”). These reasoning devices are situated within an obsessional narrative, which is ultimately a product of the imagination, personal experience, hearsay, out-of-context facts and ideas, and abstract general rules. These reasoning devices are hypothesized to be specific to OCD and OCD-like disorders. IBA aims to progressively modify doubting and obsessional inferences.
In the workshop, empirical studies supporting the IBA model will first be presented. IBA clinical strategies will then be described in detail using clinical case illustrations and audience interaction. A step-by-step outline of the IBA program will be provided, including identifying the doubting inference, soliciting the background reasoning narrative, unravelling the accompanying reasoning processes, and modifying the inference by replacing remote narratives with reality sensing. Distinctions between IBA and traditional CBT will be demonstrated.
- Step-by-step illustration of the IBA program using case illustrations and audience interaction will teach attendees to approach OCD differently. They will recognize that their patients’ fear of specific consequences (e.g., fire, burglary) result from particular states of affairs (i.e., stoves left on, doors left unlocked) that are inferred to be true based purely on the imagination and not the current context (i.e., stove is actually off, door is actually locked). The audience will also learn how to identify these doubting inferences and to modify these by unravelling their supporting reasoning processes and through reality sensing.
- Attendees will gain knowledge of empirical research supporting the IBA model.
Dr. Henny Visser is a psychotherapist (CBT supervisor) in the Netherlands and principal investigator of an ongoing multicentre randomized controlled trial investigating effectiveness of and brain response to IBA and CBT among patients with OCD. She leads the anxiety and compulsive disorders research program at her institution.
Dr. Shiu Fung Wong is a lecturer in clinical psychology in Australia and a collaborator of an ongoing large randomized controlled trial, funded by the Canadian Institutes of Health Research, investigating ways to improve the acceptability of treatments for OCD.
Visser, H., van Megen, M., van Oppen, P., Eikelenboom, M., Hoogendoorn, A., Kaarsemaker, M., & van Balkom, A. (2015). Inference-Based Approach versus Cognitive Behavioral Therapy in the treatment of Obsessive-Compulsive Disorder with poor insight: A 24-session randomized controlled trial.
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