Podcast Summary

Podcast: Divergent Conversations
Episode: 78 – OCD (Part 4): I-CBT and Neurodivergent Approaches to OCD
Hosts: Dr. Megan Anna Neff & Patrick Casale
Guest: Brittany Goff, LCSW
Release Date: November 1, 2024

Overview

This episode features Brittany Goff, a licensed clinical social worker, clinical director at Zen Psychological Center, and one of the first adopters and trainers of Inference-Based Cognitive Behavioral Therapy (I-CBT) for OCD in the United States, especially with a neuroaffirming approach for Autistic and ADHD individuals. The discussion explores overlapping lived experiences of neurodivergence and OCD, the unique fit of I-CBT for neurodivergent clients, the pitfalls of more traditional OCD models like ERP, and how personal histories and sensory experiences shape obsessive stories. The episode is rich with insights, personal anecdotes, and emerging clinical frameworks for making OCD treatment more neurodivergent-affirming.

Key Discussion Points & Insights

1. Personal Neurodivergent and OCD Overlap

• Brittany’s Story: Diagnosed with OCD at 26, Brittany didn’t recognize her autism until years later. She shares how her special interests and heightened sense of justice (especially surrounding child trafficking in Thailand) intertwined with her OCD, leading OCD to target the things she cared most about.
• Brittany on how special interests and justice sensitivity became entangled with obsessive narratives:

  "My justice sensitivity just was off the charts. And I couldn’t really understand why it wasn’t as bothersome to other people... I started to create OCD stories on doubting my own morals or intentions." (03:47)

2. The Concept of “Obsessional Stories”

• “Obsessional stories” is language from I-CBT, referencing the logical but maladaptive narratives the brain constructs to explain distressing feelings or doubts.
• Dr. Neff: "Is obsessional stories part of inference-based OCD or...Britney language? I just really like that language." (05:53)
• Brittany: "It's ICBT language...the obsession as the obsessional story or the OCD story." (06:11)

3. What Is I-CBT and How Is It Different?

• Inference-Based CBT (I-CBT): Instead of treating thoughts as random, as in traditional ERP (Exposure and Response Prevention), I-CBT sees obsessions as “inferences” — stories built from past experience, logic, rules, and context.
• Core Focus: Rather than discouraging focus on OCD story content, I-CBT validates and explores their personal, historical logic.
• Distinction with ERP:
  • ERP: Targets compulsive behaviors at the end of the OCD cycle, focusing on resisting rituals after anxiety arises.
  • I-CBT: Targets the “obsessional doubt”—the second step in the cycle—aiming to resolve it and dissolve the entire OCD sequence before compulsions or significant anxiety manifest.
  • Brittany:

    "ERP focuses on purposely provoking anxiety to prevent the person from responding...it treats OCD at the level of the compulsion. ICBT treats OCD at the second step instead of the fifth one, focusing on the obsessional doubt...When you treat the cognitive portion, the behavior isn’t there—the person just doesn’t do their compulsions anymore." (25:41)

4. Role of Sensory Experiences and Self-Trust

• Autistic people often have their sensory experiences invalidated, leading to loss of self-trust. ICBT’s approach works to rebuild this trust through “reality sensing”—grounding oneself in perception rather than imagination.
• Brittany:

  "ICBT...teaches you how to be more certain in yourself through your senses and, like, using your sensory perception to make the decision if this is OCD or if this is not OCD." (10:11)

• Discussed how difficulty with interoception and proprioception (internal and spatial body senses) create specific vulnerabilities in neurodivergent people with OCD.

5. Neurodivergent Traits and Obsessional Narratives

• Rejection sensitive dysphoria, masking, heightened social justice, hyperempathy, and confusion about identity are recurring sources of obsessional stories in neurodivergent individuals.
• Brittany:

  "Masking is a big part as well...I started to create stories about my intentions being an imposter or fraud...about harming other people, because I didn’t know why I was doing this." (13:53)

• The tendency to “fill in the blanks” due to lack of clear explanation for differences (sensory, relational, behavioral) can lead to obsessive identity doubts or stories about being “broken” or having hidden motives.

6. Building Trust Through Understanding “Why”

• The value of “why” and contextual understanding is especially important for autistic people seeking to bridge gaps in self-trust and self-understanding.
• Dr. Neff:

  "When you answer that why, you are helping build self trust...so those obsessive stories don’t come in." (21:37)

7. Adjusting I-CBT for Neurodivergent Clients

• Sensory-based approaches (including exercises from Kelly Mahler on interoception) can be foundational before or during ICBT.
• ICBT as written is neurotypical-centric and doesn’t always encompass the complexity of autistic/ADHD sensory profiles.
• Brittany:

  "Sometimes people need interoceptive exercises before they even get into ICBT...because you lose your ability to interpret different sensations...no wonder we develop difficulties understanding different sensations in our body and emotions." (32:57)

8. Identity, Masking, and the “Real Self” Module

• ICBT includes a “Real Self” module focusing on helping individuals reconstruct identity through a neurodivergent lens after years of masking, which was described as particularly affirming for late-diagnosed autistic adults.
• Brittany:

  "It helped me figure out who I was as opposed to who I was trying to be...redefining yourself at the very end and looking at yourself from a more neurodivergent lens..." (35:30)

9. Concerns and Opportunities in Neurodivergent-Affirming ICBT

• ICBT is not yet widely known or available in the U.S.; current manuals are limited and often not written with neurodivergent people in mind. Brittany is pioneering trainings and adapting materials.
• Nuanced points about clinical language (e.g., "common sense" as a problematic baseline for neurodivergent people) and the need for ongoing adaptation.
• Noted overlap between abnormal perceptions (such as proprioceptive misreadings) and fears/obsessions about psychosis among autistic individuals.

Notable Quotes & Memorable Moments

• Brittany on the core of ICBT:

  "It’s actually teaching you how to be more certain in yourself through your senses…" (10:11)

• Dr. Neff on building trust:

  "When you answer that why...you are actually doing something pretty powerful in their life, in their brain." (21:37)

• Brittany on therapy adaptation:

  "ICBT focuses on the five senses, but...there’s actually more than five senses. It doesn’t take into consideration interoception, proprioception...That’s why I’ve been working on making the treatment more affirming for neurodivergent people." (31:00)

• On the experience of finding new resources:

  "There was nothing, there was no resources. The only thing I could find was a clinician’s manual translated from French...When I read the book...my OCD drastically changed. It changed the way I looked at OCD." (37:29)

Important Timestamps

• 04:00 – Brittany’s personal intersection of special interests, justice, and OCD
• 06:11 – "Obsessional stories" explained in ICBT context
• 10:11 – Importance of building trust in self through sensory perception
• 13:53 – Neurodivergent traits fueling obsessional stories (masking, RSD, hyperempathy)
• 24:32 – ICBT vs. ERP: conceptual and practical differences
• 28:31 – Using perception vs. imagination to reality-check obsessive thoughts
• 31:00 – The need for adapting ICBT for sensory differences and neurodiversity
• 35:30 – The “Real Self” module and post-unmasking identity formation
• 37:29 – Barriers and breakthroughs in bringing ICBT to the U.S.
• 45:06 – On “common sense” and adapting ICBT for autistic/ADHD clients
• 46:59 – Discussion on abnormal perceptions, proprioception, and psychosis fears
• 50:53 – Resources and contact info for Brittany, ICBT learning, and Facebook group

Resources & How to Find Brittany Goff

• ICBT Training and Info: icbtonlinelearning.com
• Zen Psychological Center: zenpsychcenter.com
• ICBT Therapist Directory: ICBT Online
• ICBT & Neurodivergence Facebook Group: ICBT and Neurodivergence
• Workbook: ‘Inference-Based Cognitive Behavioral Therapy’ (available on Amazon)
• Interoception Resources: Kelly Mahler’s materials (kelly-mahler.com)

Final Thoughts

• Brittany:

  "I have a lot of faith in ICBT...it’s just the beginning of where it’s going to go in the United States...Just something for people to be aware of." (45:09)

• The episode closes with rich encouragement for listeners to examine the overlap between neurodivergence and OCD, consider the promise of ICBT, and approach OCD stories as the brain’s effort to assemble meaning and self-trust, rather than as purely random noise.

For show notes, resources, and to connect with Brittany Goff, see the episode notes.