Overcoming OCD without fear

The standard treatment for obsessive-compulsive disorder (OCD) is exposure and response prevention (ERP), which gradually exposes individuals to their fears to help them better tolerate the anxiety they trigger. But because ERP doesn’t result in full remission for everyone and can cause significant distress, many patients ultimately refuse or discontinue treatment. To tackle these roadblocks, Dr Frederick Aardema, a researcher at the Institut universitaire en santé mentale de Montréal and professor at Université de Montréal, set out to validate a more tolerable therapeutic approach called inference-based cognitive-behavioural therapy (I-CBT).  

His work is grounded in over 100 empirical studies showing that obsessions arise from dysfunctional reasoning and imaginative processes, which require an approach that’s different from those used in patients with anxiety. Indeed, the core issue is inferential confusion: the tendency to blur the line between imagination and reality. I-CBT aims to help individuals with OCD recognize that their doubts aren’t rooted in reality.

Over four years, two randomized controlled trials compared I-CBT to ERP, with the results showing that I-CBT is just as effective as the standard treatment while being more acceptable and more tolerable for patients. The first trial confirmed its effectiveness across all aspects of OCD symptoms. The second, conducted during the COVID-19 pandemic with over 150 participants across Québec, demonstrated that the therapy could be effectively delivered remotely via video conferencing.

The benefits of the research are already being felt: I-CBT is now recognized by the International OCD Foundation and is part of hundreds of clinical guidelines, including those of the Scottish government. In Canada, a new study is underway to assess whether the therapy can improve outcomes for individuals who don’t respond well to ERP and determine predictors of therapeutic success. I-CBT is also gaining more attention internationally, supported by an online network of nearly 5,000 mental health professionals who are either using it or actively interested in it.

This represents a significant step towards more personalized medicine, providing people with OCD a treatment option that’s better tailored to their specific profiles and needs.

References

• Aardema, F., Bouchard, S., Koszycki, D., Lavoie, M., Audet, J.-S., et O’Connor, K. (2022). Evaluation of inference-based cognitive-behavioral therapy for obsessive-compulsive disorder: A multi-center randomized controlled trial with three treatment modalities. Psychotherapy and Psychosomatics, 91(5), 348-359. https://doi.org/10.1159/000523573
• Baraby, L.-P., Bourguignon, L., et Aardema, F. (2023). The relevance of dysfunctional reasoning to OCD and its treatment: Further evidence for inferential confusion utilizing a new task-based measure. Journal of Behavior Therapy and Experimental Psychiatry, 77, 101728. https://doi.org/10.1016/j.jbtep.2022.101728
• Aardema, F., et Wong, S. F. (2020). Feared possible selves in cognitive-behavioral theory: An analysis of its historical and empirical context, and introduction of a working model. Journal of Obsessive-Compulsive and Related Disorders, 24, 100479. https://doi.org/10.1016/j.jocrd.2020.100479