When ERP Isn’t Enough: Why I’m Integrating Inference-Based CBT Into My OCD Work

As an OCD therapist, I’ve watched clients make incredible progress with Exposure and Response Prevention (ERP). It’s one of the most effective, evidence-based treatments we have. But over time, I noticed a pattern many OCD therapists see but don’t always name.

Some clients weren’t stuck because of avoidance.
They were stuck because of doubt.

Not everyday doubt, the deep, sticky “what if…?” that feels both emotionally overwhelming and logically convincing. For clients with lower insight, or those more prone to believing their obsessions, ERP alone sometimes wasn’t enough.

This led me to Inference-Based Cognitive Behavioral Therapy (I-CBT), and I recently completed a 12-week training with Amanda Petrik-Gardner, a leading clinician in this model.
And I’m genuinely excited to bring this approach into my work.

What Is Inference-Based CBT?

I-CBT is a specialized OCD treatment that focuses on the reasoning process behind obsessions, not the content of intrusive thoughts, but how a person comes to treat those thoughts as meaningful or threatening.

Rather than “Why did I have this thought?”, I-CBT looks at:

• When a person enters the OCD story

• How imagination overrides real evidence

• Why the brain treats a possibility like a probability

• What pulls someone away from the “real self” and into the “inference self”

This approach helps clients recognize that obsessions don’t arise from danger.
They arise from misinterpretations and mental habits that create doubt.

Why I’m Adding I-CBT to My OCD Work

Even as someone who loves ERP, values evidence-based care, and has watched ERP transform lives, I also believe in therapeutic flexibility. Not every modality works the same way for every person.

Here are the patterns I noticed that led me to I-CBT:

1. Some clients fully believed their obsessions.

When insight is low, asking someone to do an exposure can feel like asking them to ignore “real danger.”
I-CBT gives language and structure to this experience.

2. Some clients needed work before exposures.

ERP focuses on behavior.
I-CBT focuses on the reasoning that creates doubt in the first place.

Strengthening this insight often makes ERP more effective later.

3. It helps with vivid “what if?” scenarios.

When someone’s imagination feels convincing, the OCD story can override logic, values, and evidence.
I-CBT teaches clients to step out of that narrative.

4. It’s compassionate, logical, and empowering.

I-CBT helps clients understand why their brain treats the obsession like truth — reducing shame and increasing clarity.

My Experience Training With Amanda Petrik-Gardner

During my 12-week training with Amanda, I learned:

• How doubt functions as the “engine” of OCD

• How to help clients map their OCD storylines

• Ways to identify the exact moment imagination overtakes reasoning

• How to reconnect clients to their “real self”

• How to integrate I-CBT with ERP when clinically appropriate

Her teaching was practical, clear, and grounded in real clinical experience.
I left the training feeling confident, energized, and inspired to use this model in my practice.

Who I-CBT Can Help

I-CBT can be especially helpful for clients who:

• Have lower insight into their obsessions

• “Believe” their intrusive thoughts more easily

• Feel stuck in constant doubt

• Have vivid, imaginative fears

• Experience thought–action fusion

• Struggle with shame or moral themes

• Have difficulty separating intrusive thoughts from identity

These clients often feel relief when they learn why their brain treats their obsessions as meaningful.

Why This Matters for Clients

You deserve treatment that adapts to you as a whole person.
ERP is life-changing.
I-CBT is life-changing.
Together, they create a powerful, flexible, compassionate path to healing.

My goal is never to force one modality, but to use whatever approach helps you move toward your values with more clarity and less fear.

OCD is complex.
People are complex.
Therapy should honor that complexity.

Ready to Start Therapy?

If you’re experiencing intrusive thoughts, anxiety, doubt, or OCD that feels overwhelming, you don’t have to navigate it alone.
I support clients using ERP, I-CBT, ACT, CBT, DBT-informed, and IFS-informed modalities.

I offer OCD and anxiety therapy in Lakeland, Florida and via telehealth statewide.

👉 You can book a free consultation at Untethered Therapy.