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Just as there are only a few safe, efficient passages to Mount Everest, observes OCD specialist Stuart Ralph, only a handful of treatments approaches exist for OCD. Triumphant approaches will be found but first, they must be forged.
What is I-CBT?
Inference-Based Cognitive Behavior Therapy (I-CBT) is one of these new approaches. Effective for a variety of OCD subtypes, I-CBT focuses on the preparation to ascend the mountain, instead of intervening at the most grueling part of the expedition: up at the summit where the air is thin and each step is perilous.
Starting From the Top
The most popular treatment for OCD, exposure-response prevention (ERP), starts at the top, when compulsions are throwing everything they’ve got at you. You’re struggling to catch your breath in the blizzard while managing your footing on the steepest part of the climb.
Maybe you’re compulsively checking to make sure your stove is really off or scrolling between medical websites to confirm which terminal disease is now lurking behind the next corner. It’s not only difficult to think straight when you’re at this point, your emotions are swirling too.
Become a Buddha: Sit Through the Discomfort
ERP views OCD as a fear that your brain will only give up if you tolerate the discomfort of staying through the storm of anxiety. Just as Mara, the god of death, has monsters hurl arrows at the cross-legged Buddha meditating under the bodhi tree, so too must you learn to sit with equanimity.
Your biggest fears will rain down like lotus blossoms instead of the destructive weapons your mind makes of them, and you too can attain enlightenment. But this bodhi tree is up on the remote peaks of Everest. It’s terrifying and lonely.
I-CBT focuses on how to start from the ground up and traverse a path that isn’t so steep and overwhelming. It helps you rediscover trust in your own sensations and body to size up each step.
Your Feared Self Isn’t Your Full Self
According to I-CBT, you are quick to identify with the self you fear most–a nightmarish future self you just may become–and in so doing, you crowd out room for more confident and trusted self right here in the present. You are already ascending the mountain before you’ve even had the right to feel comfortable in your own shoes.
Inferences Are the Source of Doubt
I-CBT highlights the quick and inaccurate inferences you make about yourself. You don’t allow yourself to think your way through these issues fairly. You let the feared self take over and capitalize on your wild imagination, shooting you down before you even venture to place your flag on the mountaintop.
I’m a fan of I-CBT treatment for my OCD clients, but I wish it would add just two things to make an easier ascent up the mountain: using the compass points of your feelings and learning from an emotional sherpa.
Find Your Emotional Compass Points
With OCD, it’s easy to lose track of your own emotions, especially when they involve taking on your own independence, authority, and agency. Instead of befriending those feelings, they spiral into fear, guilt, and doubt.
When that compass is spinning, it’s easy to feel terrified that you’ll get lost or even die on that mountain. But it’s possible to find your own sense of due north again by finding the stars.
Tracking your emotions is much like noticing the patterns of the constellations; you start to get better at noticing the shapes in which your emotions line up. Are you feeling guilty, frightened, and sad? Are you feeling prideful, angry, and frustrated? In what ways do these emotions get blurry so that all you have left is the chaos of your worrying mind?
You Deserve an Emotional Sherpa
Research shows that people with OCD have profound empathy, but they do not typically lend themselves back this same self-compassion. They may even feel undeserving of being anything other than responsible for others (and their potential misfortune) rather than rightfully in need of an emotional sherpa too.
OCD sufferers need the same sensitivity and kindness reflected back at them to feel more confident in the steps they are taking to climb the mountain. They must learn to trust not just with their heads but also with their hearts. This takes practice in the context of supportive and emotionally attuned relationships, both outside and inside of therapy itself.
Climbing The Mountain Takes Heart
Climbing the mountain doesn’t just involve intellectually surveying and planning the ascent or taking risks; it’s about noticing how you feel every step of the way to make proper adjustments. It is no coincidence that the english word ‘courage’ is derived from the french word for heart; these two traits are inseparable.
Many a mountaineer has made the fatal mistake of disregarding their emotions at their own peril, and it’s no different with OCD. Without proper appreciation for the full scope of their feelings, OCD sufferers will easily succumb to the vertigo of their own obsessions and lose all sense of emotional place.
Towards a Fuller View of OCD
It is likely that we will continue to find new ways to ascend the treacherous and winding paths up the OCD mountain. Without a doubt, we will be rewarded with not just more inspiring views but also a deeper appreciation for what it takes to scale our way safely to the summit.