Inference-based therapy

Inference-based therapy (IBT), also known as inference-based cognitive behavioral therapy (I-CBT), originated as a form of cognitive therapy developed for treating obsessive-compulsive disorder. IBT followed the observation that people with OCD often inferred danger on the basis of inverse inference (inferring reality from hypothetical premises). Later the model was extended to inferential confusion, where inverse inference leads to distrust of the senses and investment in remote possibility. In this model, individuals with obsessive-compulsive disorder are hypothesized to put a greater emphasis on an imagined possibility than on what can be perceived with the senses, and to confuse the imagined possibility with reality (inferential confusion). According to inference-based therapy, obsessional thinking occurs when the person replaces reality and real probabilities with imagined possibilities; the obsession is hypothesized to concern a doubt about a possible state of affairs.

According to inference-based therapy, individuals with obsessive-compulsive disorder attempt to resolve the doubt by modifying reality (via compulsions and neutralizations) which merely increase the imaginary pathological doubt rather than resolve it since reality is not the problem. Obsessions are hypothesized to begin with the initial doubt (“Maybe I could be dirty”) which is not a normal intrusion but a sign that the person is already in obsessional thinking.

Inference-based therapy hypothesizes that the doubt and investment in possibilities leave the person vulnerable to spiral into further imagined connections and dissociative absorption in what could further transpire.