Integration of Inference-Based Therapy and Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder-A Case Series

Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has not been demonstrated convincingly to offer any advantage to exposure and response prevention treatment (Rosa-Alcazar, Sanchez-Meca, Gomez-Conesa, & Marin-Martinez, 2008). Therefore innovation and improvement in CBT are a clinical priority Recently, O'Connor, Aardema, and Pelissier (2005) developed inference-based therapy (IBT) for OCD. Their protocol focuses on correcting a dysfunctional reasoning process implicated in the construction of an inference of doubt, which is the clinical starting point of the obsessive-compulsive sequence. However, the model also allows cognitive intervention into the thinking about the feared consequences if the doubt were assumed to be true, thus allowing flexible integration of insights and methods derived from existing CBT approaches. Subsequently a cognitive therapy manual (Van Niekerk, 2009) was developed integrating methods and strategies from IBT, and CBT derived from the cognitive appraisal model. This integrated approach was tested in a small case series, which found a clinically meaningful reduction in psychological distress and obsessional symptoms and beliefs.