132. Cognitive Therapy for OCD

Summary

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The OCD Whisperer Podcast with Kristina Orlova

Episode 132: Cognitive Therapy for OCD

Date: April 1, 2025
Guest: Mike Parker, LCSW (OCD Space)

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Episode Overview

In this episode, host Kristina Orlova sits down with licensed clinical social worker Mike Parker to demystify Inference-Based Cognitive Behavioral Therapy (ICBT) as a leading treatment for OCD. Together, they explore the core differences between ICBT and traditional approaches like ERP, discuss the concept of obsessional doubt, and share personal insights into how reasoning errors fuel OCD symptoms. Parker provides clear examples, practical tips, and highlights ICBT’s effectiveness for those struggling to trust themselves or escape persistent loops of doubt.

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Key Discussion Points & Insights

1. What is ICBT and How Is It Different?

• ICBT Defined:
  ICBT (Inference-Based Cognitive Behavioral Therapy) is identified as a fundamentally different “recipe” from ERP (Exposure and Response Prevention) or standard CBT.
  • “If you make it right, it'll taste exactly the same, but you can't mix them.” [02:00, Mike Parker]
• Core Focus:
  Unlike ERP, which labels reassurance seeking as a compulsion to be stopped, ICBT asks: Why are you asking for reassurance?
  • Emphasizes understanding the “obsessional doubt” process that drives OCD.

2. Obsessional Doubt: The Heart of OCD (ICBT Perspective)

• How doubt manifests:
  • People with OCD receive reality-based information but habitually reject or question it, creating a cycle of doubt disconnected from actual evidence.
• Example given:
  • When someone seeks reassurance, ICBT explores why they doubt their knowledge, aiming to help them answer their own questions by understanding their thought process.
  • “Obsessional doubt is essential to ICBT...It’s the idea that someone with OCD knows something, but they don’t really trust themselves enough to stick with what they know.” [02:00, Mike Parker]
• ICBT’s goal:
  • Help clients notice when they disregard valid information and why, in order to break the compulsion loop at its cognitive root.

3. Reasoning Errors and Internal Evidence

• Reliance on Internal Evidence:
  • Many with OCD use feelings, sensations, or mere doubt as “evidence” something is wrong, leading to self-fulfilling cycles.
  • “Someone may think that a sensation in their body is reason to go into obsessional doubt.” [09:26, Mike Parker]
• “Blank Slate” Problem:
  • People with OCD may ignore ample evidence about themselves, replacing real self-knowledge with “what ifs” and out-of-context stories (e.g., identifying with a news story about a criminal and thinking, “What if that’s me?”).
  • “If someone has harm OCD...they’ll say, ‘What if that is me?’...That person has nothing to do with who you are.” [11:11, Mike Parker]

4. Contextualizing Facts and OCD Reasoning

• Out-of-Context Reasoning:
  • OCD often fixates on general facts instead of context (“germs exist” ➔ “I must worry about every contact”).
  • “You’re very much drawn to thinking about possibilities, and then you end up thinking about general facts—not facts that are necessarily relevant to you in the moment.” [13:31, Mike Parker]
• ICBT Intervention:
  • Teaches clients to focus on present-moment, reality-based information rather than generalized or tangential fears.

5. Addressing Real Mistakes and Trust

• When feared events actually occur:
  • People with OCD usually cope well if their fear becomes reality—contrary to their expectations.
  • “When the thing they’re concerned about actually happens, they’re typically able to deal with it, like, no problem. And I’m always amazed by that.” [14:49, Mike Parker]
• Distress Root Cause:
  • The true agony is not the feared event, but the persistent inability to trust what one already knows.

6. Childhood Roots and Life Messaging

• Exploring the origins:
  • ICBT can incorporate exploration of early influences—family messages, personal experiences, or cultural factors—that helped form present OC reasoning.
  • Unlike prior CBT doctrine which discouraged examining the “why,” ICBT finds therapeutic value in tracing the roots of obsessional stories to help clients reframe and detach from them.
  • “We can start to see how long the client has been telling themselves an obsessional story about themselves…” [17:47, Mike Parker]

7. Psychodynamics vs. ICBT

• Clear boundaries:
  • ICBT isn’t psychodynamic therapy:
    • Psychodynamic models (focus on unconscious drives) can be misused or misinterpreted by OCD brains.
    • ICBT is a cognitive therapy, focusing on reasoning processes—why people accept or reject information, not hidden motives.
    • “The main reason to stay away from psychodynamic therapy is…it is founded…on an idea of an unconscious…which is…like…not helpful for a lot of people [with OCD].” [20:54, Mike Parker]

8. How ICBT Facilitates Change

• Reasoning leads to behavior change:
  • By recognizing how and when reasoning becomes distorted, clients begin to act differently—without explicit behavioral assignments.
  • “Once you understand that really the distorted reasoning processes…then you'll start to essentially behave differently.” [22:32, Kristina Orlova]
• ICBT as primarily a cognitive therapy:
  • Traditional CBT’s focus on assessing probability doesn’t address the obsessional doubt; ICBT shifts to the “why” behind the doubt itself.

9. Duration and What to Expect

• Timeline:
  • Progress ranges from 3 months to a year, depending on complexities (e.g., trauma, perfectionism, disgust sensitivity).
  • “The longest client I’ve had…was about a year…[but] I’ve probably had clients that are really doing well after like three months or so…” [27:18, Mike Parker]
• Complicating Factors:
  • Trauma, loss, perfectionism, or shame may extend therapy, but “pure OCD” often responds more quickly.

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Notable Quotes & Memorable Moments

• The “Recipe” Analogy:

  • “It is like that with ICBT. It's like you kind of have to learn, you have to get absorbed in a completely new recipe and use those tools and stick with that for a little while and see how it goes.” [02:00, Mike Parker]

• Obsessional Doubt Explained:

  • “What we're going to find is when someone who has been doing a different treatment encounters obsessional doubt or the word, they're not really going to know what to do with that. They're going to say, oh, is that a compulsion? Is that a obsession? Is that an intrusive thought? What is that? And what I have found is it is none of the above.” [02:32, Mike Parker]

• On the “Blank Slate” Problem:

  • “When you are a blank slate, lots of things can suddenly seem like they apply to you.” [11:14, Mike Parker]

• Difference from Psychodynamics:

  • “Freud wasn't saying that you could secretly be a serial killer even though you've, like, never hurt someone before. There's no way that was the point…But OCD will take it that way.” [21:22, Mike Parker]

• Automaticity of Doubt:

  • “Because it's been so long, it's like anything in life, it becomes an automatic kind of habitual way…” [25:37, Kristina Orlova]

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Important Timestamps

• [02:00] — ICBT as a whole new “recipe”; obsessional doubt explained
• [09:26] — Internal evidence and reasoning errors in OCD
• [13:31] — General facts versus context in OCD thinking
• [14:49] — People with OCD cope when feared events actually happen
• [17:47] — Validating early influences and childhood messaging
• [20:54] — ICBT vs. psychodynamic approaches
• [22:32] — The cognitive focus and change process in ICBT
• [27:18] — Expected therapy timelines and complicating factors

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Resources & How to Connect

• Mike Parker, LCSW:
  • YouTube: OCD Space
  • Therapists: ICBT training at icbttrainingonline.com
  • Website: Mike Parker LCSW

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This episode offers a clear, hopeful, and nuanced exploration of ICBT for OCD, making it a valuable listen for those seeking practical understanding and real-world strategies—whether you’re new to ICBT, a clinician, or someone living with OCD.

Transcript

[A]

Hi, I'm Christina Orlova, host of the OCD Whisperer podcast. As someone who lives with ocd, I understand the struggles firsthand. If you're here, you're not alone. Before we start, grab your free OCD survival kit at www.corresults.com to help you take control. That's K O R results dot com. Now let's dive into today's episode. Welcome to OCD Whisperer Podcast. Today with me, I have Mike Parker, who is a licensed clinical social worker in private practice in Pittsburgh, Pennsylvania. He's the host of the YouTube channel OCD Space, which focuses primarily on the ICBT approach to OCD treatment. He enjoys providing ICBT as an option for clients with ocd, as well as helping other therapists in the field learn the approach. Welcome to the show.

[B]

Thanks, Christina. Thanks for having me.

[A]

Absolutely. So today, what I would love to do is actually kind of have like ICBT 101, if we can spend a little time. And I've had some episodes before and, you know, kind of launched it to different facets or pieces, but I think it'd be great to have one now and kind of go over really, like, what. What is it really? Right. Like, what are we really treating? How does this thing work? What are we doing?

[B]

So, yeah, I love it. I love getting to talk about this. Yeah. And it's such a good point you make because you, myself and a lot of others have been slowly learning the treatment, incorporating it into our practice. And that's been, you know, two or three year process for a lot of people. And so we've had various points along the way where we kind of described it a certain way, but we're really at a point now, I feel like for a lot of people where the dust is kind of settled and you've been able to grasp all the different concepts. And it is a great time to be like, let's revisit that question. What is icbt?

[A]

Yeah.

[B]

So first of all, I would say part of the difficulty for clients, for other therapists and practitioners, it is very different from ERP and a cbt, a more typical CBT presentation. And so there is a lot to learn and there's a lot of hurdles there for people to understand it. But, you know, hopefully, like, you know, having yourself talk about it and. And me and other people, like, we can make that easier than it was for us. So I guess the one thing that I've realized, for me, the one key difference, the most important difference is this idea of obsessional doubt and Obsessional doubt is a core process identified in OCD when you're doing I cbt, it's a core thought process. The other thing I would add is with icbt, if you've been doing ERP as a client, as a therapist, and you're switching to icbt, it's sort of like you have like a really great recipe that you love and then someone else says, well, you know, here's this other recipe and if you make it right, it'll taste exactly the same, but you can't mix them. You'll get to the same point, but you have to like follow that recipe or that recipe and, and it is like that with icbt. It's like you kind of have to learn, you have to get absorbed in a completely new recipe and use those tools and stick with that for a little while and see how it goes, you know. So anyway, side note, obsessional doubt is essential to I, C, B, T. And what we're going to find is when, when someone who has been doing a different treatment encounters obsessional doubt or the word, they're not really going to know what to do with that. They're going to say, oh, is that a compulsion? Is that a obsession? Is that an intrusive thought? What is that? And what I have found is it is none of the above. So basically you have to take that CBT conceptualization where you've got trigger thought, feeling, compulsion, and then it's sort of a cycle over and over again. You have to actually wipe that from your mind and say, you know what, like I don't need that for icbt. It's going to be completely different. And what we'll find with obsessional doubt, it's its own thing, it's a thought process. And it's basically the idea that someone with OCD knows something, but they don't really trust themselves enough to stick with what they know. And they feel this need to doubt it, to question it, to dismiss it, and, and then to go further and look for more information than they have. And it's a process in, in icbt. That's the repeat process that we're looking at. We're looking at, okay, you had this information, you had this knowledge, and then you chose to question, reject it for some reason. And now you're in an imagined place and you're constructing a new story that doesn't have a lot of reality based information on it and has a lot of other stuff that kind of came from your mind in it. And so we're just looking at Obsessional doubt with icbt, and we're saying, why is that happening? And then how do we help the client to not do that? So an example might be if you have a client asking you for reassurance in a session, if you are taking a strict ERP approach, you would say, that's a compulsion. Our job is to stop doing the compulsion. And then eventually, like, when you experience life without the compulsion, you'll get some new learning. You'll realize, like, you didn't need to avoid. You didn't need to do a compulsion. And then your brain and your thoughts and your beliefs will kind of, like, rewire themselves as you go through life without this protective behavior. With icbt, we're going to say, let's figure out why you asked for reassurance, because I don't have any more information than you have, and you're asking me a question. And with icbt, I think it's very helpful to recognize, like, if a client has an obsession and you don't have that obsession, you can definitely use yourself as a model to say, you know, why don't I do what this client's doing? You know, and that's perfectly valid. With icbt, we can say clients with OCD can get to that same place. And so we would work on what happened where you didn't trust something, and then you, for some reason, felt like, you should ask me that question. Let's dive into that, and let's figure out how, like, you can start to answer these questions by yourself. And so for a lot of clients, that is just extremely attractive because there are a lot of clients that really want to know what's going on. They want to understand why they've been doing certain things. They want to understand their own mind. And the idea of just don't ask for reassurance. For some clients, it'll work, but off, but sometimes it won't, actually. Sometimes it'll be like, I guess I stopped doing the compulsion, but I still feel confused.

[A]

Right. Or I still think this stuff in the background, or maybe I'm just not saying it, but it's still in my head. Or I still, you know, go to these places. So there's still. At least that's what I keep hearing. Yeah, Novas. And I mean, myself included, that guy still would have a certain thought process that would happen and just didn't have a language or a way to really understand and would say, okay, well, globally, we'll just say, that's me ruminating, and let's just find ways to not Engage or to give ourselves like a reminder, like, okay, I've thought about this, you know, a thousand times. There's no answer, so let's drop it.

[B]

Yeah, yeah.

[A]

Versus here you're saying, well, let's actually understand why are you even asking that in the first place? Like what's driving that?

[B]

Yeah, yeah, it's really cool. It's, it's just, you know, there's so much to dive into there. You've got a client asking for reassurance. So with icbt, what you can do is let's notice all the information that the client could have used. Or if I'm talking to your audience and they have ocd, let's look at all the information you have that you could have used and let's figure out like what happened to that process where you didn't use that or it wasn't enough. And we're going to notice the behavior of obsessional doubt. And then we're going to recognize that the client actually has a lot of reasoning that goes into why they chose to not trust the information that they have available. And we can resolve, we can get someone to stop asking a reassurance question by helping them realize that they had all these reasons for doubting and those reasons were due to flawed OCD logic and there is all this information that they know that's reality based information and they have to stay in that world and just reason in that world.

[A]

So with that in mind, then I guess, you know, what would you say are some common things from the lens of ICBT that you've noticed that, that folks tend to do or what, what is some of that reasoning where, you know, if you, I guess, see it or uncover it, right, that like you mentioned the word resolve. Right. That we can then actually end that process.

[B]

That's a great question. So one thing that we'll find that clients tend to use a lot of with ICBT is internal information. A lot of the quote unquote evidence comes from inside. So someone may think that a sensation in their body is reason to go into obsessional doubt. Someone may think a certain emotion that they're experiencing is a reason to go into obsessional doubt. Someone may even think that having a doubt itself is a reason to doubt. In the case of relationship ocd, for example, if a client is saying, if a client starts doubting the relationship because of OCD reasons and then they look back on the fact that they doubted and they say, oh, if I was happy, I wouldn't have doubted in the first place, they're Suddenly now using this OCD thought process as its own evidence, and it's this repeat loop. So, you know, that's one thing I would say is a lot of clients really get convinced by internal evidence that convinces them, like the, the obsessional experience is real and it's really happening. The other thing that happens is our, you know, someone with OCD really struggles with self knowledge. It's, you know, for some people, and there's going to be almost like a sort of a void there of where you should sort of know things about yourself. You haven't spent a lot of time really trusting information about yourself because on a daily basis there's so much information you could glean. You could see what you did with your day, you could see what people told you about yourself. You could see the promotion you got. You could, whatever it could be, that could all be used to build a story about yourself based on reality. And someone with OCD will often not acknowledge any of that information. It doesn't fit in with the feared story they have about themselves. And so they don't want to trust that information. It always feels like that might be a lie or that might not be accurate. And then you end up kind of like a blank slate. And when you are a blank slate, lots of things can suddenly seem like they apply to you. And so if someone has harm ocd, one of the things you'll often hear is like, oh, yeah, you know, this true crime episode, this person just killed their whole family. What if that is me? And that's where we'll see. Like that's another reasoning error where you're using out of context information to support your doubt. And we get at that by noticing like, well, that's not you actually, that that person has nothing to do with who you are. Let's figure out like who you are because you haven't been doing that.

[A]

Yeah. And. And you also hit on something really important that I just heard, which is, and I know for anybody listening, one of the things that came to mind as well, but I, I did read this or you know, like CDC said or while germs exist or. Well, I know, I mean, we all know that, you know, dogs, you know, go pee and poo outside and then their owners clean stuff up, but stuff is there, like, right, so, so there is this interesting element where there, it's almost like the sprinkling of things from reality and things we do know. So it's not like we're, we're completely rational, but there is a point where when you're using that in a. In a really congruent way that's in context, and you're kind of synthesizing everything that's available to you right now to evaluate this moment and then what to do.

[B]

Yeah.

[A]

Versus what you just said is, oh, I'm more pulling on things I know, or that I've seen through all sorts of different places, et cetera. But I'm taking it really out of context and kind of getting stuck into an out of context possibility to the point where we can convince ourselves that, you know, I don't know, maybe I could be this horrible person or inversely, like, well, I'm just being this extra careful person and others aren't being as, you know, careful as me.

[B]

Yeah. Yeah. I think one thing we'll see is when you have ocd, you're very much drawn to thinking about possibilities, and then you end up thinking about general facts. Not facts that are necessarily relevant to you in the moment, but general facts. And those feel very convincing because, you know, a statement like germs exist is undeniably true. But then when you say, because of that I should worry about, like, everything I come into contact with, then you're like, way out of context and the moment no longer matters to you. And it's really the general fact over, you know what, this moment that I'm in right now.

[A]

Yeah, that's actually interesting. So with icbt, yeah, we're. We're getting to a place of where we're saying, okay, let's slow down and really look at that. This backend thought process that's happening that's leading you here and like you said, kind of focusing more on this fear of who I could be. Well, I guess, you know, a thought that comes to mind. Her question. Because I've certainly heard this a lot, I'm gonna, I'm gonna guess you probably have too. But, you know, what do you do when people have made mistakes? Right. Like, they have. They did actually do the thing that they're now so overly excessively concerned about and just have not been able to move on.

[B]

Yeah, well, you know, I mean, honestly, I find that with someone with ocd, when the thing they're concerned about actually happens, they're typically able to deal with it, like, no problem. And I'm always amazed by that. And, And I think a lot of therapists are. Are shocked by that.

[A]

They're like, I've.

[B]

I've been worried about you all these years, and you just had it happen. And you, You're. You're acting like you know, it was no big deal. So I, I, you know, even with something like dog poop, right? Like our clients can smell and see dog poop when it actually happens. Like, and so that's part of trusting your senses. Recognizing your senses will tell you when something's happening. You don't have to go, like, overusing them and looking. But, yeah, you know, this idea that, like, the thing is that, that what I think tends to really distress clients if you're really looking at things from an icbt, is just the inability to trust. It's a very unsettling experience. It's like, and I find this all the time with clients, they will tell me, I know I know something. Like, I know it. Like, and if I ask, actually ask point blank, like, is that true? Are you a serial killer? Are you this. No. The answer is no, you know, and they know that. And so the really unsettling part of having OCD is having something, you know, and feeling like you can't do anything about it. And so I find that much more the target of treatment than necessarily, like, getting involved in the possibility. Because if the possibility happens, you'll be fine. You'll handle it. Like, I, I'm not even worried about it. Let's figure out why you're in so much distress all the time and why this sucks to have ocd, you know, and, and it really is this experience of not trusting and doubting from an ICBT standpoint.

[A]

And would you say that ICBT would also kind of say, hey, let's maybe even look at, like, what are some earlier memories or when some of the stuff started, or some of, some of the ways that you're perceiving this, because it's not like it's out of, it's not like we're born with this innate reasoning, right? It's like throughout our life, whatever it is, whether it's the immediate home, the environment we're in at the time, whatever later on that we're picking up from the world and all the different messaging and however we're interpreting it, especially, you know, and you have your, your little child brain is going to see things one way. You get a little older, you see it another way, you get a little older, still, you see it another way. So, you know, our thought process sees, it evolves, it changes. But some things, and I'm only asking because, like, I have people who come to mind that when we pause and ask, they, they'll say, like, yeah, you know, when I was a kid, like, I saw this commercial and I remembered this thing got really kind of stuck in my head about like, oh, I have to use this thing to have this cleanliness piece. Or my parents were really rigid and so the whole concept of rules and this rigidity really kind of got stuck in the brain. But what would you say?

[B]

Yeah, I would say that is all open game. And that's, to me, from my experience, that's a big shift in our field that we typically were saying, from my experience, this is all random. Don't go looking for any reasons why you have this obsession because, like, you know, there's, there's nothing to be found there. And what we're going to find with ICBT is we do go there. We want to say like, yeah, tell me about that commercial you saw when you were a kid. Tell me about this, tell me about that. And let's look at how this all got built together and how it got turned into a story for you. And what we see when we see those earlier experiences, we. We can start to see how long the client has been telling themselves an obsessional story about themselves and about their situation, because it was even present there. Like, I still remember that commercial. I still remember my mom saying this to me. And so what we see is it was all logged in there and then all put together. And. But if we go back, we can start to see that this actually never meant that you should be locked into never ending doubt like this. You know, all these reasons and all these experiences, we're going to find out that they don't mean you shouldn't trust yourself because mom said this to you. But she, you know, she may have had ocd, but if she didn't have ocd, she probably didn't end up doing all the worrying and all the compulsive behaviors that you ended up doing after you got her advice.

[A]

Right? Or like inversely, if your mom is somebody who tends to worry so much but you are absorbing it and now you're using that as your data point to infer things inaccurately versus recognizable. Well, no, that's just my mom tends to worry a lot and we're separate and I don't need to take that on or internalize.

[B]

Yeah, I do that even more than before. Since learning icbt, helping clients really talk about their childhood experience, really talk about their parents, not to criticize or denigrate their parents. You know, in most cases, parents were like, great and loved them, but maybe did worry a lot, maybe did say certain things over and over again, and that was really, really unhelpful. And so it's so good to go into that with your adult mind and see what your parents told you and be able to say, well, they shouldn't have said that. Like, that was not helpful. Like, and they didn't know I was struggling. They didn't see that I was taking this and turning it into ocd. But I did. There's a lot to be found in those childhood messages that a lot of people.

[A]

Well, and the thing is, as I'm. As we're talking about this now, I want to ask the question, because anybody listening could be like, well, wait a minute. Are we getting to some psychodynamics? Like, like, all talking and processing stuff? I thought we said that that's actually not great for ocd. So let's clarify, like, what kind of therapy is icbt? It has CBT in it. Cognitive behavior therapy for anybody who doesn't know. And I stands for inference based. But, yeah, if you can tell us a little bit about that.

[B]

In my opinion, the main reason to stay away from psychodynamic therapy is that it is founded somewhat on an idea of an unconscious. And this idea that, like, you act a certain way, but, like, there's actually, like, more of a hidden self inside of you that, like, is driving this and you're not even aware of it, which is, like, you know, just.

[A]

Yeah, I guess that would really scare me immediately. Like, what?

[B]

I don't know what to say anymore. Right. Like, I think everybody listening knows how that sounds. Right. And how OCD is going to take that so immediately. Yeah. So, you know, it's. It's one of those things. Like, so many people benefit from that kind of approach. But it would work if you're able to take something like that with a grain of salt, because that's really how it's meant to be. Like, Freud wasn't saying that you could secretly be a serial killer even though you've, like, never hurt someone before. Like, there's no way that was the point of that, like, theory. Right. But OCD will take it that way. And we just want to watch out for, like, this focus on the unconscious. For one, a lot of it is, like, hasn't really stood the test of time in terms of really focusing on that in therapy. It doesn't seem like that's necessarily that helpful for a lot of people. And then two, we have shifted towards behavioral approaches, cbt, cognitive approaches, and not talking about that stuff so much. So, I don't know. I feel like I'm kind of, like, losing track of thought. Right now?

[A]

Well, for icbt, I mean, that was my biggest question very early on, is like, okay, is it a behavioral therapy? Is it a cognitive therapy? Is it a metacognitive? What is it? And I think from what I've understood so far is it's really more of a cognitive approach. Because once you understand that, really the distorted reasoning processes, like the way that you think about things that leads you to arrive to these conclusions, you arrive at and kind of like cognitive distortions in standard cbt, like catastrophizing or, or personalization. Right. So if you can understand and see this whole thought process and recognize the difference between, like, all the times where you don't do that, and then you do that really only when your specific, you know, triggers and vulnerabilities arise in ocd. And then suddenly you're doing something different. It sounds like. And mimics kind of standard analysis process, but really it's doing something quite different. And so if you. My understanding is that if you can understand it and learn what that is, then you'll start to essentially behave differently.

[B]

Yeah, yeah, I think you got it exactly on. On the head. That's how I think of it too. Like, you know, it's. It's primarily a cognitive therapy. And the focus really is when you're looking into reason, when you're looking into the past, when you're looking into messaging you received. We're just trying to figure out why you doubt. We're trying to figure out why when you get information, you reject it and why you think certain things are not trustworthy pieces of information. And like, you should instead think about what ifs, think about possibilities. And so that's really the focus and that. And that's really the big shift, you know, when people think of cbt, just doing talk therapy, cbt, it's got a, A mixed kind of reputation. Some people think it's just not helpful at all to even do any kind of talk therapy like that. Some people think it has some benefit. But I. CBT is, has changed it. Because the thing with CBT is it was looking at the facts. It was trying to say, like, is this thing actually possible? What's the probability of it actually happening? And it didn't take into account the client is obsessionally doubting if they have ocd. And so you're going to talk about this information, and meanwhile there's going to be this obsessional doubt process happening on their end. And as a just CBT therapist who didn't know about obsessional doubt, you're not attuned to them doing that. So you're just going through this, like, routine, and you can't do anything about the fact that they're rejecting the thinking that you're trying to encourage in the CBT session. And so now ICBT is like, well, let's actually focus on the doubt part and let's just figure out why you reject information, why you don't trust it. Oftentimes it's like, now I just immediately go into my imagination because I've been doing this for so long, I don't even notice. I'm like, not trusting anything or doubting anything. I'm just, like, living in my imagination. And the imagination and reality has just become kind of like a blurred experience at this point. But we're kind of like trying to wind that back and figure out this all started with a doubt. Let's figure out why you did that.

[A]

Yeah, I think you nailed it on the head too. That's exactly right. I think for folks living with ocd, it's that when this all first started and this whole thought process, maybe earlier on you could have seen it better, but because it's been so long, it's like anything in life, it becomes an automatic kind of habitual way that honestly, it's kind of like almost you. You start to take kind of the small things, the everyday, actual real life for granted. Like, you don't even notice it anymore because you're doing that on autopilot mode. Because it's just like, I just brush my teeth, I just get ready and off I go. And now we're saying, no, no, let's slow down and let's actually re notice and reappreciate what that actually says. Because it carries a lot of information and data that we've. We've just forgotten to pay attention to. Right? And so we're so being so paying so much attention to this piece here. And again, like you said, it's become so automatic that that's that difficulty. Right? It's like, wait, what? How do I trust this, though? This feels weird. It feels strange. Like, what do you mean? It's like, I get it, but also it just internally, it's a feeling. It starts to feel off and weird.

[B]

Yeah. Yeah, that's. That's such a great way of putting it. You know, that whole, like, daily routine that you don't even think about, like, it just really emphasizes what a big task this is to undo all that, that you really have to slow down and reevaluate everything you're doing. During the day. And it's, it's a lot of work. But you know, it's, you know, most clients are highly motivated to do the work. So.

[A]

Yeah, and what would you say, just for a last question in general, roughly, because this is a common question as well, like, what would you say is how long would it take to just kind of somewhat start to get better and see progress?

[B]

Yeah, really great question. And there's just a huge range there, I would say since I've been doing it. So, so it's, it's, it's a really tough thing because I've had clients that were like new to therapy that did icbt. I've had clients that did like years of erp that did icbt, had clients that like found out I was doing ICPD and came back to me to just give it a shot. So the longest client I've had as far as like, since I've learned ICBT was about a year. And you know, so we were doing. For anyone who doesn't know, there's one way that people do ICBT is with these 12 modules that were developed by Artema and O'. Connor. So, you know, we did those 12 modules and they're, they'll, they'll usually be like one to two to three sessions each. And then we took some sidesteps to work on some other things and then new obsession came up that really like took over unexpectedly and we worked on that kind of like from the start again. And so by the time this was all done, it was about a year. But you know, I mean, I feel like that's like a lot of people's experience with ERP as well. Like, you know, you'll see clients that it takes up and then I've probably had clients that are really doing well from, you know, after like three, three months or so, you know, so I, that's the range so far I've seen and I'm sure. But I've, I've got clients that I've got some, one or two long term clients and I think every therapist with OC has, has some clients that are a little longer term. We're doing ICBT and it's a new piece of the puzzle, but it's still hard work too, so.

[A]

Yeah, exactly. I mean, to your point, I think that's exactly right. That's kind of what I found too generally. And for some folks, it's just you, you have to take into consideration too like if there is any kind of like big traumas or losses or other things that could be there that also impact kind of that self story and self view that's really entangled in real life stuff that now we have to spend a little extra time to untangle and kind of come back to retrusting and building up our own sense of self and so on. But if it's just straight icbt. Yeah, it can be that. Some of. Yeah, I found like.

[B]

Yeah, yeah, it can. It can. If you've got someone with just pure OCD and no like complicating factor, you know. And what I mean by complicating factors like perfectionism, throw that in the mix or you know, maybe some very strong disgust response to something or shame or guilt, anxiety, sensitivity, you can see other things that will complicate things, but you know, just purely OCD from an ICBT perspective. Someone comes in and they're inferentially confused. That can go pretty quickly.

[A]

Yeah, yeah. Thank you so much for coming on the show and just talking about this kind of more broadly and globally, you know, wrapping our minds around, you know, ICBT therapy these days. And if people would like to find you, how can they find you?

[B]

So you can find me online. So OCDspace is the YouTube program that I have and then I have a website. You can find me. Mike ParkerLCSW and then I actually just started, I developed a pre recorded training for ICBT for therapists. So any clinicians out there looking for that, that can be found@icbt trainingonline.com and you'll see like ICBT training online. Mike Parker. You can find that.

[A]

Perfect. And of course everything will be in the show. Notes. Thank you so much for coming on the show.

[B]

Thanks for saying this was fun.

[A]

Thanks for listening to the OCD Whisperer podcast. Remember, freedom from OCD is a journey and you're not alone. Visit www.coraresults.com to explore self help masterclasses like Sneaky Rituals with Jenna Overbaugh or ICBT Masterclass with Christina Inabe. Don't forget to grab your OCD CBT journal tracker and planner while you're there. If you found this episode helpful, please please subscribe, share and leave a five star review to help others find the podcast. Together we can make a difference. Keep going and I'll see you in the next episode.