I recently learned about an evidence-based treatment for OCD that I had never heard of before, called inference-based CBT (or icbt). The icbt website has some helpful worksheets available for free for those wanting to learn more about this therapy, which a lot of my clients a have been finding very helpful as we’ve begun using it in therapy.

One of the main ideas in icbt is that those of us with OCD tendencies often go through a specific sequence leading to OCD symptoms, beginning with a trigger that leads to something called an “obsessional doubt”.

An “obsessional doubt” is a doubt or worry that a person creates with their imagination, that is not connected to, or relevant to, what they know with their inner or outer senses in the here and now.

For example, a woman may have just seen her car keys in her purse, so she knows she has her keys. However, she then imagines or thinks “What if I don’t really have my keys??”, and then starts imagining what would happen if her keys were actually missing, which leads to checking again to make sure the keys are actually in her purse, even though she already knows the keys are there! The whole process of doubting whether the keys were there, and the potential consequences of not having the keys, was all based on a remotely possible scenario created in this woman’s imagination. 

Those of us with good imaginations and a tendency to get absorbed in the stories we tell ourselves often imagine hypothetical scenarios about bad things that “could” happen to us, based on making abstract connections between unrelated things; taking things out of context and applying them to the present; or making connections or associations based on our emotions and treating those connections as facts.

We then get lost in a story or script we write in our heads about all the things that can potentially or hypothetically go wrong, imagining one thing leading to another in the made up story in our heads. This leads to increasing feelings of anxiety as we get lost in the emotional or evocative story we’re imagining and creating, and we then feel the need to “do something” to neutralize a threat that doesn’t really exist in the here and now (based on what our senses are telling us about our current reality). Some people call this OCD looping “going down the rabbit hole”, but we often don’t realize how we got into the “rabbit hole” to begin with, because we never think to challenge the obsessional doubt that triggers us away from the here and now and into the imagination, in the first place.

A common trigger for obsessional doubt has to do with worrying about becoming the opposite of who we actually are, our feared split off self.

For example, a kind person may worry about becoming a mean person, perhaps because they once had an angry thought, or perhaps because they decided that being mean is really bad (perhaps if they were treated meanly and didn’t like it). However, there is no evidence in the here and now that this person wants to be mean or is acting mean, so it’s a purely hypothetical and imaginary possibility at this particular time (and that’s what makes it an obsessional doubt). 

Aside from going to therapy where you can work through these issues with a therapist, you can also start catching your obsessional doubts on your own by asking yourself: At what point did I start imagining possibilities instead of focusing on what I know to be true right now?  Am I taking something from the past out of context and using it right now to draw conclusions that make me anxious? Am I making connections between random things and creating a story based on that in my head? What alternate story can I tell myself that is more relevant and is based on what I know to be true right now?

Creating new stories is one of our greatest tools for putting our imaginary doubts and fears to rest.