FAQs on the differences between ERP and I-CBT
Trying to decide between Exposure and Response Prevention (ERP) and Inference-based Cognitive Behavioral Therapy (I-CBT) for OCD treatment?
You’re not alone. Both are evidence-based approaches, and while they take different paths, they share the same goal: helping you take your life back from OCD. One isn’t better than the other—it’s about finding what works best for you. This FAQ breaks down the key differences so you can make a more informed decision about which approach feels like the right fit.
Does I-CBT use exposures?
Nope! I-CBT doesn’t use exposures. While ERP is a behavioral approach that helps you face your fears head-on, I-CBT is a cognitive therapy that focuses on how you reason. If you feel ready to confront your fears directly, ERP might be a better fit and often works more quickly. But if exposures feel too overwhelming or haven’t helped in the past, I-CBT gives you another path—one that doesn’t rely on exposure work.
I do find it helpful to use behavioral exercises within I-CBT. But unlike ERP, these exercises aren’t designed to trigger anxiety or increase your ability to tolerate distress. Instead, they’re used after you’ve already worked through the faulty reasoning behind your obsessional doubt. At that point, behavioral exercises help you practice staying grounded in accurate reasoning and build even more confidence in what you already know to be true. So while ERP uses exposures to increase your tolerance for uncertainty and discomfort, I-CBT uses behavioral exercises to reinforce clarity and trust in your senses and self.
How do I know which OCD treatment approach (I-CBT or ERP) is right for me?
Great question! Both I-CBT and ERP are evidence-based treatments for OCD, and while they share the same goal—helping you reclaim your life from OCD—they take different paths to get there.
If you’re someone who feels ready to face fears directly through exposures and want to focus on changing behaviors first, ERP might be the right fit. It helps you gradually approach situations or thoughts you’ve been avoiding, and teaches you how to respond differently—without relying on compulsions. Because it directly targets compulsions, it often leads to faster, more noticeable changes in reducing OCD behaviors
If the idea of doing exposures feels overwhelming or you’ve tried ERP in the past without lasting success, I-CBT may be a better option. I-CBT focuses on helping you understand why you’re having specific doubts in the first place and teaches you how to correct the reasoning that drives your OCD—without needing to do exposures. Once you recognize the tricks OCD uses to keep listening to it again and again, those tricks start to lose their power. This helps you stay connected to what you truly know and trust—your senses—just like you do in every other part of your life when you’re not facing an OCD trigger.
I truly believe that neither approach is better or worse overall—one may simply be a better fit for you. And you don’t have to figure that out on your own. In our work together, we’ll explore what feels most aligned for you, based on your experience with OCD, your goals, and your comfort level. The good news? Both approaches are effective and can help you move forward.
Why does ERP view obsessions as random, and I-CBT say they’re not random at all?
This is one of the main differences between the two approaches. From an ERP perspective, obsessions are seen as random intrusive thoughts that get blown out of proportion. You interpret them as dangerous or meaningful, and that creates distress—so you turn to compulsions to try and make the discomfort go away. ERP teaches you to accept and tolerate those unwanted thoughts, since they’re not actually meaningful and don’t require action.
I-CBT sees things differently. It says the thoughts you struggle with aren’t random—they’re the result of specific patterns in how you reason. According to I-CBT, your obsessional doubts are built from real information: facts, rules, past experiences, hearsay, even logic. The problem isn’t that you don’t have good information; it’s how your brain misuses that information in the present moment. You might over-rely on what could happen, and stop trusting your senses or judgment right now.
Two Different Perspectives on Uncertainty
ERP helps you learn to live with uncertainty. You stop trying to feel totally sure about things and instead accept that uncertainty is part of life. That shift allows you to lean into your fears and break the cycle of compulsions.
I-CBT doesn’t focus on uncertainty in the same way. Instead, it views the need for certainty as a reactive response to obsessional doubt—one that’s created by distorted reasoning.
By addressing the root cause—called inferential confusion—we can eliminate these reactive responses such as the need for certainty, as this need, as well as the anxiety naturally fades away once the underlying reasoning errors are corrected.
It’s not saying you can predict the future—because of course, you can’t. But I-CBT doesn’t believe OCD is about an intolerance of uncertainty. Instead, it sees OCD as doubting the information you already have—a deeper mistrust of your own perceptions, judgment, and common sense. I-CBT helps you reconnect with your ability to know what’s real in the moment.
It also makes an important distinction: true uncertainty means there’s an actual lack of information available. But with OCD, you do have the necessary information—you’re just not trusting it. It’s this doubting that creates unnecessary uncertainty you’re experiencing. That’s the kind of confusion I-CBT helps you work through.
But isn’t cognitive therapy for OCD ineffective? Isn’t I-CBT just arguing with the obsession?
This is a common misunderstanding. I-CBT is not traditional cognitive therapy—it doesn’t involve challenging or debating your obsessions or trying to talk yourself out of them. I-CBT agrees: you can’t argue your way out of OCD, and if you’ve tried, you know it doesn’t work. Instead, I-CBT helps you recognize when your reasoning has been hijacked by OCD. Once you can spot the OCD story for what it is, you can step back from it. The therapy teaches you to distinguish between normal, everyday doubts grounded in your senses, and obsessional doubts that are never about what is, but always about what might be. That’s why I-CBT is very different from general CBT, and why it’s important to work with someone specifically trained in it.
What is Inferential Confusion?
Inferential confusion is the reasoning process behind OCD. It’s when your brain confuses something imagined for something real—something you feel like you have to act on, even though there’s no actual evidence connecting it to this moment in your reality.. You end up doubting what you see, hear, or feel in the moment, and instead get stuck in a hypothetical story that feels urgent, true and terrifying.
That’s how OCD tricks you: by replacing what’s real with a made-up narrative built from bits and pieces of logic, experience, or fear. Inferential confusion is what causes you to trust the story more than your senses—and I-CBT is designed to help you stop doing that.
Whether you are already leaning toward one approach — or still feel torn I’m happy to talk it through with you.
Part of my job is helping you explore what aligns with your goals and how you want recovery to look. You can schedule a free consultation and ask me anything about ERP, I-CBT, or how I tailor treatment to each person’s needs. You don’t have to figure it out alone.
