Podcast Summary

Divergent Conversations Episode 141: FLASHBACK — OCD: I-CBT and Neurodivergent Approaches to OCD [featuring Brittany Goff]
Release Date: January 16, 2026
Hosts: Megan Anna Neff & Patrick Casale
Guest: Brittany Goff, LCSW, Clinical Director at Zen Psychological Center

Episode Overview

This episode brings together Dr. Megan Anna Neff, Patrick Casale, and guest Brittany Goff to dig into Obsessive Compulsive Disorder (OCD) through a neurodivergent lens, focusing especially on Inference-Based Cognitive Behavioral Therapy (ICBT) and affirming approaches for Autistic and ADHD individuals. Together, they explore the unique OCD experiences of neurodivergent people, why traditional methods may not always fit, the validating potential of ICBT, and Brittany's pioneering work advancing neurodivergent-affirming OCD care in the U.S.

Key Discussion Points & Insights

1. Personal Lived Experiences and OCD Special Interests

• Intersection of OCD and Special Interests:
  • Both Brittany and Patrick share how their intense, justice-oriented special interests (such as human trafficking) were co-opted by OCD, resulting in self-doubt and intrusive questioning of their own morals.
  • Brittany: “When your special interest is in something like human trafficking or something, you know, pretty, like, sad or just, yeah, awful… I started to create stories about myself, like OCD stories on doubting my own morals or intentions, which is funny because... I had way too much empathy rather than no empathy.” (05:42)

2. Reframing OCD: Obsessional Stories and Inferences

• Obsessional Stories as Core to OCD:

  • ICBT refers to the obsessive component of OCD as the “obsessional story” or “obsessional narrative,” grounded in a person’s logic and lived experiences—contrasting sharply with traditional CBT, which often treats obsessions as random intrusions.
  • Brittany explains: “ICBT refers to the obsession as the obsessional story or the OCD story or obsessional narrative. … It’s full of different logical reasons as to what makes up somebody’s OCD, which was very different from what I was originally taught—that OCD is random, it doesn’t make any sense.” (08:06)

• From Intrusions to Inferences:

  • ICBT labels the thoughts as “inferences” formed by prior experiences, not mere random intrusions.
  • “ICBT doesn’t refer to thoughts as intrusions… but as inferences because they’re being created based on our prior knowledge and experience.” (10:09)

3. Sensory Processing, Self-Trust, and OCD

• Disconnect Between Sensory Experience and External Feedback:

  • Many neurodivergents grow distrusting of their primary senses due to ongoing invalidation, leading to the loss of self-trust and fueling faulty inferences/obsessional stories.
  • Megan asks, “Would you say that predisposes a person to make faulty inferences?”
    Brittany: “One of the reasons that I gravitate more towards ICBT is because the idea behind it is to actually gain certainty in yourself through your senses, which is a very different approach…” (12:06)

• Practical Example—“Just Right” OCD and Sensory Awareness:

  • Instead of habituating to discomfort, ICBT encourages people to attend to sensory differences and address the environmental factor (e.g., taking off the uncomfortable shirt), especially important for Late Identified or undiagnosed Autistic people. (13:30)

4. Neurodivergent Traits and OCD Vulnerability

• RSD, Masking, Meltdowns, and More:

  • Brittany links traits such as Rejection Sensitivity Dysphoria (RSD), masking, and hyperempathy to the formation of specific “obsessional stories” and subsequent OCD themes (relationship OCD, moral scrupulosity, fear of losing control, etc.).
  • “If somebody is masking their whole life… I started to create stories about my intentions, being an imposter or fraud, obsessional stories about my morals, and even like obsessional stories about harming other people because I didn’t know why I was doing this.” (15:47)

• Confusion as Fertile Ground for OCD:

  • Late-diagnosed and uninformed autistic/ADHD individuals may develop tons of obsessive stories as attempts to self-explain confusing lived experiences, especially in the absence of proper education.
  • “Our brain just naturally does [this]... when we don’t have answers to things, we try and fill in the blanks and try and figure out why.” (21:17)

5. The Relationship Between Obsessive Stories and Comfort/Certainty

• Obsessional Stories as Comfort Mechanisms:

  • Even if harmful, these stories provide temporary certainty.
  • Patrick: “It almost sounds like…filling in the gaps almost feels like it’s comforting in a way. Like it’s creating some sense of comfort and relief…” (22:41)
  • Brittany: “Everything to avoid uncertainty…reading these stories gives us certainty.” (23:16)

• Building Self-Trust and Answering “Why”

  • Clarifying autistic/ADHD traits and neurodivergence can help close the “why” gap, build self-trust, and stop the formation of further obsessional stories.
  • Megan: “…when you answer that why, you are actually doing something pretty powerful in their life…” (24:24)

6. ICBT vs. Exposure and Response Prevention (ERP)

• Cycle of OCD and Key Distinction:

  • ERP (the longstanding standard): Focuses at the last step, treating compulsions by provoking anxiety and blocking compulsive behavior.
  • ICBT: Focuses on the second step—obsessional doubt—by resolving the obsession before anxiety or compulsion kicks in.
  • Brittany: “ERP focuses on…prevent[ing] the person from responding. So it treats OCD at the level of the compulsion…the very last step of the sequence. So ICBT…treats OCD at the second step, so it focuses on the obsessional doubt and resolving the obsessional doubt.” (27:38)

• Reality Sensing, Imagination vs. Perception:

  • ICBT helps clients discern when a thought is a real perception (based on current sensory evidence) versus an imagined scenario.
  • “An imagined thought is when we don’t have any direct evidence in the here and the now to support that it’s actually happening… So, when we want to use reality sensing…” (30:26)

7. Challenges and Limitations in ICBT for Neurodivergent People

• Beyond “Five Senses”:

  • Brittany notes ICBT’s “five senses” focus misses interoceptive/proprioceptive senses (e.g., internal bodily sensations, positional awareness), which are vital for many in the neurodivergent community.
  • “ICBT…doesn’t take into consideration interoception, proprioception, which are very common things that a lot of autistic people struggle with.” (32:54)

• Trust in Senses, Masking, and Dissociation:

  • Many neurodivergent people need to first repair their relationship with the senses (possibly through OT or curricula like Kelly Mahler’s interoception material) before using ICBT’s sense-based strategies.
  • “Sometimes people need interoceptive exercises before they even get into ICBT.” (34:52)

8. Evolving and Adapting ICBT for Affirming Practice

• Brittany’s Role:

  • Brittany details her journey pioneering ICBT trainings/resources, adapting the method for U.S. clinicians, and beginning to infuse affirming language and awareness of ND traits into ICBT approaches.
  • “When I figured out that I was autistic, that really changed the way that I saw OCD and putting a lot of OCD terms to or putting a lot of autistic terms to what I was experiencing.” (43:26)

• Contributions & Resources:

  • Developed ICBT workbook, runs a neurodivergent-focused Facebook community, and offers therapist trainings.
  • Maintaining transparency: “When you do explore ICBT…as it’s not created for autistic or ADHD individuals.” (47:45)

9. Complex OCD Concerns: Health Anxiety, Fear of Psychosis

• Competing/Unexplained Sensory Feedback & Intrusive Fears:
  • Patrick and Brittany discuss health-focused OCD (when doctors can’t give answers) and the common obsessive fear of psychosis or schizophrenia, especially when proprioception or interoception is misinterpreted.
  • “Oh yeah, fear of developing psychosis is a pretty common obsessive doubt…A lot of people with OCD get like, kind of visual, superimposed over their vision. It’s not like a hallucination…but that’s why OCD stories can, like, just wrap you in.” (48:54)

Notable Quotes & Memorable Moments

• On building trust in one’s senses:
  “ICBT...is actually teaching you how to be more certain in yourself through your senses and using your sensory perception to make the decision if this is OCD or if it’s not.”
  — Brittany Goff (12:34)

• On neurodivergence and filling in gaps:
  "Our brain just naturally does [this]...when we don’t have answers...we try and fill in the blanks and try and figure out why."
  — Brittany Goff (21:17)

• On the core difference between ERP and ICBT:
  “ERP...focuses on...the compulsion. So the very last step of the sequence, So ICBT...treats OCD at the second step instead of the fifth one. So it focuses on the obsessional doubt and resolving the obsessional doubt.”
  — Brittany Goff (27:38)

• On obsessive stories as a comfort:
  “Everything to avoid uncertainty. And reading these stories gives us certainty.”
  — Brittany Goff (23:16)

• On the power of answering 'why':
  “When you answer that why, you are actually doing something pretty powerful in their brain.”
  — Megan Anna Neff (24:24)

Important Timestamps

• Special interests and OCD overlap – 04:28–07:48
• Obsessional stories, ICBT language, and logic – 07:48–10:36
• Sensory experience and loss of self-trust – 10:36–13:30
• Neurodivergent traits (RSD, masking, meltdowns) as OCD triggers – 15:47–19:47
• The seeking of “why” and obsessive stories – 21:17–24:34
• Comparison between ICBT and ERP for OCD – 26:26–29:16
• Imagination vs. perception in ICBT – 30:26–32:54
• Sensory challenges, interoception, proprioception, and adaptations needed – 32:54–36:14
• Fear of psychosis, abnormal perceptions, linking with OCD – 47:45–51:18
• Available resources, trainings, and where to find Brittany’s work – 52:48–54:55

Resources & Where to Find More

• ICBT Trainings: icbtonlinelearning.com
• Practice/Contact: Zen Psychological Center
• ICBT Directory & Resources: ICBT Online Website
• Neurodivergent ICBT Facebook Group: “ICBT and Neurodivergence”
• Workbook: Inference-Based Cognitive Behavioral Therapy (Amazon)
• Recommendation for sensory work: Kelly Mahler (Occupational Therapy, Interoception Curriculum)

Closing Thoughts

Brittany Goff’s work bridges clinical expertise with lived neurodivergent experience, providing a deeply needed, affirming approach for Autistic and ADHD individuals with OCD. ICBT, with adaptations for neurodivergent realities, offers new hope in restoring self-trust, honoring sensory differences, and breaking the cycle of obsessive self-doubt. The conversation underscores how validating the “why” and understanding personal logic is not just therapeutic—it is transformative for ND folx navigating OCD.