187. You Don't Have A Thought Problem. You Have A Doubt Problem. (OCD Explained)

Summary

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The OCD Whisperer Podcast with Kristina Orlova

Episode 187: You Don't Have A Thought Problem. You Have A Doubt Problem. (OCD Explained)

Date: June 5, 2026
Guests: Katherine Goldpaust (ICBT Therapist)
Host: Kristina Orlova

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Episode Overview

This episode inaugurates a multi-part series on Inference-Based Cognitive Behavioral Therapy (ICBT) for OCD. Host Kristina Orlova welcomes back Katherine Goldpaust, ICBT therapist and trainer, to challenge common views on OCD. The conversation reframes OCD as a problem of doubt, not simply “intrusive thoughts,” and highlights how meaning-making and pre-existing personal stories fuel obsessional doubt. Aimed at anyone wrestling with looping thoughts or overwhelming doubt, this episode explores how ICBT offers a different path for understanding and healing OCD.

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Key Discussion Points & Insights

1. Rethinking the “Intrusive Thought” Model

[02:11–07:43]

• Traditional Model:
  People are often taught that OCD arises from random intrusive thoughts, which treatment (especially ERP) teaches us to “sit with.”
• ICBT Perspective:
  ICBT questions the concept of thoughts as “intrusive,” suggesting that all thoughts are unplanned; what distinguishes OCD is not the thought itself but the conclusion the person makes about it.
• Example:
  “What if I want to kill my partner?” isn’t a universal human thought—rather, distress comes from the meaning assigned (i.e., maybe I am a dangerous person).

“Nobody plans a thought. The intrusive thoughts that people are talking about, the things that are really distressing, are actually conclusions that people are coming to.”
— Katherine Goldpaust [02:31]

“As therapists, as ICBT therapists, we don’t encourage our clients to tolerate those types of thoughts, those conclusions…they don’t have to tolerate thoughts like, ‘What if I’m a dangerous person?’ because those are conclusions.”
— Katherine Goldpaust [04:56]

2. Everyday Thoughts vs. OCD Doubt

[05:28–07:43]

• Non-OCD individuals may have fleeting, odd thoughts but don’t attach catastrophic meaning.
• OCD amplifies these neutral thoughts into deep doubts about one’s self or reality.
• The distress is not the random thought (e.g., “what if I kick my dog?”), but the spiral into “what if I secretly want to?”

“Thoughts like ‘what if I’m a pedophile’ are not thoughts that all humans have to deal with…in ICBT, we say that people shouldn’t have to sit with and accept the uncertainty about those.”
— Katherine Goldpaust [06:53]

3. ICBT vs. ERP: Where Focus Lies

[07:43–09:50]

• ERP (Exposure and Response Prevention):
  Tends to focus on the “downstream” response—how to live with and manage the anxiety after a distressing thought or doubt arises.
• ICBT:
  Looks “upstream”—how and why does the question, the obsessional doubt, arise in the first place?
• Analogy:
  Rather than preventing compulsive responses, ICBT looks at how the ground got slippery to begin with.

“If you’re looking at response prevention, you’re downstream. We’re looking at how you get off the ground…how do you go from hitting a bump to ‘what if I hit someone’ when there’s zero indication that’s what happened?”
— Katherine Goldpaust [08:26]

4. Obsessional Doubt and Pre-Existing Stories

[09:35–14:26]

• Triggers are only distressing when they connect to an underlying, personal story (e.g., fear of being secretly dangerous or being in denial about sexuality).
• Real-Life Example:
  Katherine describes a client worried she’s “really gay,” triggered by seeing attractive women. Katherine herself notes she isn’t triggered by seeing an attractive woman because she doesn’t have an underlying story about her sexuality.

“...the only people who will find that triggering are people who have a pre-existing story in their head.”
— Katherine Goldpaust [11:37]

• ICBT asks:
  “Why is the trigger triggering for you?”

“...for her, someone who already has a story, that seems—oh my god, that has to be evidence.”
— Katherine Goldpaust [13:37]

5. Meaning-Making and the Limits of Cognitive Reappraisal

[14:26–17:01]

• Host’s Question:
  What’s different about the ICBT approach to “meaning,” compared to CBT or ERP? Don’t those also challenge distorted thinking?
• Katherine:
  ICBT doesn’t dwell on cognitive distortions (black-and-white thinking, catastrophizing, etc.). Instead, it asks why the obsessional question arises at all. The process is about investigating upstream doubt, not just reappraising content.

“We’re not looking at the conclusion, so we don’t really care in ICBT: is someone catastrophizing?...why are you even having this doubt in the first place?”
— Katherine Goldpaust [15:49]

6. Inferences vs. Appraisals

[18:25–21:24]

• Inference:
  Connecting dots with incomplete information (e.g., two people yelling = they’re fighting).
• Appraisal:
  The evaluation or personal meaning assigned (e.g., “It would be safest to avoid them”).
• ICBT:
  Focuses on the initial inference that sets the OCD wheels in motion, not the later appraisals about what those inferences mean.

“Inferences, which are the focus of ICBT, are conclusions when you may not have every single piece of information, but you have enough to put together.”
— Katherine Goldpaust [18:36]

7. Reframing OCD as a Problem of Doubt and Trust

[21:24–24:22]

• The essence of OCD is not an inability to tolerate uncertainty, but an overactive capacity for doubt—specifically, obsessional doubt fueled by a lack of trust.
• In ordinary life, we trust our senses unless proven otherwise. OCD disrupts this natural trust, inserting persistent doubt even in the absence of evidence.

“My default assumption is that everything is fine unless indicated otherwise…What OCD does is it changes the standard. It says, ‘Yeah, but it’s possible...’”
— Katherine Goldpaust [22:21]

“The issue is not you need to learn to accept uncertainty—the goal is to return them to that place of trust.”
— Katherine Goldpaust [23:40]

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Memorable Quotes

• “The problem isn’t your thoughts. The problem is how you interpret doubt.”
  — Katherine Goldpaust [Approx. 22:50]
• “We are not looking at the conclusion...we are looking at why are you even having this doubt in the first place?”
  — Katherine Goldpaust [15:49]
• “With ICBT, we say something is triggering because there’s a pre-existing story that these things are fueling.”
  — Katherine Goldpaust [13:13]

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Timestamps for Key Segments

| Timestamp | Topic/Quote | | ----------- | ------------------------------------------------------------ | | 02:11–05:28 | ICBT’s view: OCD isn’t what you think it is | | 05:28–07:43 | Random intrusive thoughts vs. catastrophic conclusions | | 07:43–09:50 | ERP vs. ICBT: Seeing downstream vs. upstream | | 10:57–14:26 | Triggers & pre-existing stories (examples) | | 15:10–17:01 | ICBT's take on meaning-making; difference with cognitive reappraisal | | 18:25–21:24 | Inferences vs. appraisals | | 21:24–24:22 | Shift from uncertainty to trust/doubt |

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Closing and Where to Find the Guests

• Katherine Goldpaust:
  • Instagram: @ICBTtherapist
  • Website: katherinegoldhouse.com
• Host:
  • OCD Survival Kit and resources at corresults.com

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Episode Tone

The tone is open, affirming, and gently challenging of mainstream frameworks. Both Kristina and Katherine blend clinical expertise with lived experience, making the episode accessible, compassionate, and practical.

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Summary Prepared for Those New to ICBT or Seeking a Fresh Approach to OCD

Transcript

[Katherine Goldpaust]

Foreign.

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[Christina Orlova]

Welcome to OCD Whisper Podcast. If you enjoy this, please remember to subscribe and hit the notification bell on. So, guys, we have something special for you. We're going to be doing a multi series focus on inference based cbt. And for that I brought Katherine Goldpaust. So welcome to the show.

[Katherine Goldpaust]

Thank you. Thank you so much. I'm so glad to be back here.

[Christina Orlova]

Yes. So Katherine, for anybody who doesn't know who she is, was one of the first folks that I had on where she gave us a really good overview of istbt. And so we're going to be diving into specific, kind of deep diving into specific pieces of inference based cbt. And I thought, who better than to have Katherine back on? So if you don't mind, why don't we jump right in? Because I know one thing from ICBT is that it doesn't see OCD in the same way. So OCD kind of isn't quite what we think it is. So why don't we go ahead and dive into that? 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.com now let's dive into today's episode.

[Katherine Goldpaust]

Yeah. So we've kind of a lot of people, a lot of those of us, and I consider myself included, who have some training in erp. We're sort of told that we get hit with these random intrusive thoughts and we make meaning of them. And the goal is ultimately to learn to sit with the discomfort, to see them as just thoughts. With icbt, we see things differently. We don't see, we don't really subscribe to this concept of intrusive thoughts, right? Because if you, if you think about it, all thoughts are intrusive. Nobody, nobody plans a thought, right? Thoughts, the intrusive thoughts that people are talking about, the things that are really distressing are actually conclusions that people are coming to, right? So you may have quote unquote intrusive thoughts about killing your partner, right? Or flooring it when people are crossing the street. But that's not really what causes people distress because everybody has those. What causes people distress are the conclusions they have about those thoughts. Like, what if deep down this means I want to kill my partner? What if this means I'm a dangerous person? Those are not the thoughts that everybody has, right? I mean, I know as someone who doesn't have OCD anymore, I don't walk around thinking things like that. And so the idea with ICBT is, well, people with OCD shouldn't have to either. And our goal shouldn't be to help them learn to sit with the thought, to just kind of normalize it, because it's not. It's not normal to think, oh my God, what if I'm actually a pedophile, right? Those are conclusions people come to about having certain thoughts. So for example, I might. I have three dogs. I'm obsessed with them. I spend so much money on them. They are my children. And I might joke with my husband about stepping on them or kicking them or putting them in the oven or something ridiculous and morbid. Now, those are sort of intrusive thoughts, right? But I'm not going to. There's no thought that I could have about my dogs that's going to make me think, what if deep down I want to my dog, right? So while thoughts like, oh, I could step on them, I could kick them, I could cut them are sort of normal, because humans are weird thoughts that go, what if I'm really a dangerous person? What if I actually want to hurt my dog? Those are not normal, right? And so as therapists, as ICBT therapists, we don't encourage our clients to tolerate those types of thoughts, those conclusions, right? They may have to tolerate weird thoughts about imagining hurting their dog, but they don't have to tolerate thoughts like, what if I'm a dangerous person, right? Because those are conclusions. Does that make sense?

[Christina Orlova]

Yeah. So I. And so for folks who are listening, some people may know some. I'm also trained in inference based cbt and I also offer it. And you know, as you're explaining it, of course, I'm always listening with the thought in mind of, okay, for an everyday person, is this something that's really easy to grasp? So just to make sure I understood your point of view, you're saying that, okay, look, we all have some random thoughts that come into our heads because that's just part of being a human being. It's just something that happens in our Brains, in your case, you're sharing, like, okay, let's say with my dogs, I might have a thought suddenly, like, oh, what if I kick them? But what you're saying, the difference is that I might notice that and I don't do anything with it, and that's it. But in the OCD mind, it's where the person might have that thought and then go, oh, but what if I really want to do that? Or what if somehow, you know, inside of me there's something a little more sinister, hiding, and I will do that at some point, or somehow, maybe I don't know who I am and I, you know, I might want to hurt them, and that would be so terrible and so on. So you're saying that second part is really the problem. And those things are the things that people are concluding from that initial, truly kind of experience that humans share in terms of having just random thoughts, right?

[Katherine Goldpaust]

Like having a weird thought about, you know, when you're changing a baby's diaper or something. That's kind of a normal experience. And most of us are just think that's kind of weird, and we move on. So those types of thoughts, we have to learn to just live with, and they go in one ear and out the other. Thoughts like, what if I'm a pedophile? Are not thoughts that all humans have to deal with, right? Because most humans can have strange thoughts but not make these conclusions. Like, I'm a pedophile. I'm a dangerous person. I'm not really in love with my partner. Maybe I just hit someone. Those are not thoughts that in icbt, we say that people should have to sit with and accept the uncertainty about.

[Christina Orlova]

So then what's the difference again? Because I, I can imagine somebody listening right now, you know, thinking, okay, well, I mean, doesn't that sound like. Then you just do some response prevention or you would do some exposure work to, you know, let's say sticking with the dog example, be around your dogs and engaging with your dogs. Like, so what, what's. What's the difference then? I guess,

[Katherine Goldpaust]

yeah, so we're looking at how somebody comes to the conclusions that they come to. Right? We're looking at how somebody can get triggered and then wonder, what if I'm a pedophile? Or how they could hit a bump in the road and wonder, what if I hit somebody? Right? We are not looking at what happens after they ask themselves that question. Right? And that's the big difference between ICBT and erp. ERP looks at, well, what if you did Hit somebody, What would that mean? How could you learn to sit with the possibility that that could happen? In icbt, we don't care. We don't even go, we don't go down that far. We say, how is it that you can hit a bomb, not see a human in the road and then conclude you hit somebody? What's going on that you're even asking yourself that question? And so it's not about response prevention because we're not even going down. We call it upstream or downstream. If you're, once you're at compulsions, you're all the way downstream. And so if you're looking at response prevention or compulsion prevention, you're downstream. We're looking at how do you get off the ground, how do you go from hitting a bum to into what if I hit someone when there's zero indication that that's what happened at all?

[Christina Orlova]

Got it Right. And so from my knowledge, I mean, this is what we call an obsessional doubt process, right? This is where it's like, okay, the way I'm thinking in that moment isn't quite aligning with what's actually happening.

[Katherine Goldpaust]

Yes.

[Christina Orlova]

But again, what's interesting, right, is is that in ICBT we're saying, well, the issue isn't even the later, it's that, that very beginning, like you said, like how, how did you even get there though? How did you get there? And I really love the way you framed that because that's a really clear visual. And I don't know about others, but I'm very visual. But when you say something like, hey, I'm driving on the road, I hit a bump, I literally have no other, like there's no person that I saw, there's nothing else around me at all going on yet. Just the act of having that kind of that bump and that, you know, feel, feeling like that little jump up and down, suddenly I go into, oh my gosh, what if I hit someone and I missed it? I blinked, I didn't look carefully or I looked away because those I think are the common things you hear like, well, those are my reasons because, you know, I wasn't paying attention carefully or I looked down for a moment to turn the volume or I wasn't really looking hard at the road or I wasn't fully present, I was a lapse minded. Which all sound like, could be reasonable.

[Katherine Goldpaust]

Yeah. So with, with an icbt, we're looking at, why is the trigger triggering for you? Right. Because for example, in my, in the ICBT class that I teach to clinicians, I give this example of let's say somebody is reading an article about Ebola and then they wonder, oh my God, what if I have Ebola? Most people can read an article about Ebola and not think, oh my God, I could have Ebola. Right? It's only the per. The only people who will find that triggering are people who have a pre existing story in their head about something like Ebola specifically or their vulnerability to disease, or they, that they are kind of uniquely unlucky, that they're uniquely susceptible. There's a pre existing story that makes that trigger triggering. Or similarly, somebody who already thinks or already has this fear, what if I'm a dangerous person? If they're chopping vegetables with their partner in the kitchen and they have an image of, you know, lifting that knife and slicing off their partner's fingers or something, only they are going to think, oh my God, that must mean something, right? So we're looking in icbt. Why is the trigger triggering for you? And it's because there's a pre existing story that makes that triggering for you. So in my classes, for example, so I was working with a woman as a client who was engaged and she had a lot of fears about. She was engaged to a man and she had fears about what if I'm gay and I'm in denial and she would see a pretty woman and that would set her off. And I told her that when I forget when it came out, I think I was in high school or something or maybe college. The movie Zorro came out with Catherine Zeta Jones and Antonio Banderas and I do not even know what that movie was about because I just was transfixed by how beautiful Katherine Zeta Jones was. Like she was just absolutely gorgeous in that movie. And it's not like Antonio Vanderas was, you know, too shabby himself, but she was so beautiful. Now I, my, my sexuality is not a loaded issue for me. I'm, I'm very clear that I'm straight. And so I could watch that movie and be like, oh my God, she was so beautiful. It's not triggering for me. It's not going to make me doubt, right? Because that's not a loaded issue for me. But if my client had the exact same experience, you know, she'd be off to the races, right? She would see it as, as evidence because it's, there's a story that it's fueling, right? And so the, with icbt we say something is triggering because there's a pre existing story story that these things are fueling. That they seem to be providing evidence for when really if you didn't have that story, that experience would be meaningless. Right. Just like how for me, it wasn't triggering because they had no story around possibly being gay. Right. But for her, someone who already has a story that seems. Oh my God, that has to be evidence. Right.

[Christina Orlova]

Okay, so I have a couple of questions then. So first of all, you mentioned about meaning and people kind of creating and assigning meaning, and then you also mentioned the story. So I guess let's start with, with unpacking this just a little bit more. So what's different than I guess from ICBT lens when we're talking about meaning? Because in ERP and even just standard cbt, we do talk about meaning and the process of making meaning. And you know, standard, you know, we know cognitive reappraisals or cognitive distortions, if people know what that is, Right. When you're thinking is a bit skewed and biased. And so how can you reinterpret an event or a situation or a trigger? So what's different than. Why can't you just then reinterpret it?

[Katherine Goldpaust]

You mean, what's the difference between kind of cognitive appraisals or like.

[Christina Orlova]

Yeah, with icbt.

[Katherine Goldpaust]

Right.

[Christina Orlova]

Because we're talking about meaning. And so I, I know that like when I hear that, that's one of the first thoughts that comes to my mind if I didn't know icbt. Well, then how is it different then when we're talking about that we do assign meaning or we make meaning of things and you know, we, we have some tools already that we can use to, you know, you know, kind of relook at something from a more flexible, objective perspective.

[Katherine Goldpaust]

Yeah.

[Christina Orlova]

So how is that different than icbt?

[Katherine Goldpaust]

Right. So with, with traditional CBT and with, with erp, we are looking that those are both appraisal models. So we're looking at the conclusions that people come to about those doubts. Right. What if this happens? Okay, we're going to focus on what if that happened. Right. And so exposures are going to be about that playing out. Right. And learning to tolerate the uncertainty that they could play out. With icbt, we're taking one step back and we're looking at why are you asking that question in the first place? We're not looking at the conclusion, so we don't really care. In icbt, is somebody using black and white thinking? Is somebody catastrophizing? Are they over generalizing? Right. Because those are conclusions we're looking at. Why are you even Having this doubt in the first place, forget the conclusion you come to about it. Why is it even a question that you're asking? So it's, it's a focus on a different part of the thinking process.

[Christina Orlova]

Got it? Okay. So yeah, because I think anybody listening, I could see how people can get confused. And for me, I just want to summarize. So really, it's that in icbt, the, the, the question that you're even asking, it's, it's that question is, is a conclusion in on its own and that you, you got there somehow and you're saying, well, part of how you got there is because there's already a story, a kind of pre existing story that you have about yourself or about the situation, whatever it is. Like you said, it's loaded. There's, there's topic, there are topics for each person that are loaded because of these internal stories they have about them. And so that's why, you know, for, let's say if you put five people in the room and we talk about relationships, every person is going to respond differently and it's going to look different because you know, for some, for one person, it might not be a loaded topics. They, they could care less. They could see things clearly and stay, stay anchored in who they are. Somebody else might have some story about it, maybe some even trauma. Somebody else might have, I don't know, based on, let's say immigration and being rejected and having to belong somebody else, you know, is another experience. So it's like all of those things kind of color, if you will, your experience and kind of the lens through which you're looking at. And so that becomes the thing. Is that right?

[Katherine Goldpaust]

Right. Yeah. It may help to break down the difference between inferences and appraisals. Would that be helpful?

[Christina Orlova]

Yeah, I think so.

[Katherine Goldpaust]

Okay, so inferences, which are the focus of icbt, those are conclusions that you come to when you may not have every single piece of information, but you have enough to put the pieces together. So for example, if you were to see two people screaming at each other and waving their hands around and you concluded they were in a fight, you'd be making an inference, right? You're putting pieces together. Appraisals, on the other hand, are evaluations or judgments that you make about the significance or the personal meaning of your inferences. So for example, if you were to decide that it would be safest to avoid getting physically close to those two people that you inferred were fighting, you'd be making an appraisal. So if we look at this in terms of an example. So let's, let's use a similar example to my client. So let's say I asked her, okay, what is your, in icbt, we would say, why do you think that you're gay? What has led you to start worrying about this? And if she said, well, you know, I was in the locker room and I saw this woman changing and I thought she had a really nice body. And so from that I inferred maybe I could be gay, we would clarify for her, okay, but thinking somebody has a nice body is not the same as sexual attraction. Right. And so you are, you are connecting dots that aren't inherently connected. Whereas with the appraisal based approach, the focus would be on, okay, well, no one can ever truly be sure, 100% sure what their sexuality is. And so can you live knowing that you're never going to have true certainty? Can you live according to your values, knowing that, you know, you may never know for sure? So this is this difference, right? We're looking in the first instance, well, what made you even have that doubt? What made you even ask that question, what if I might be gay? Whereas in the appraisal based approach, we're looking at, okay, if that were true, how could you handle it? How could you deal with it? Whereas in icbt, we don't, we are not even like looking at the answer to that question. Right. Because we're just looking at the initial leaping off of the what if?

[Christina Orlova]

Got it. Yeah. So we're really talking about, like you said that this is not just a random intrusive process. This is, this is a way that we're doubting something and we're doubting it in a, in a really interesting way. And that we don't really do that across the board. And so it's like, okay, well, what are we doing here? How are we doing this? Why are we doing this? Why is this even a thing in the first place? And that really sounds like the beginning of the ICBT process.

[Katherine Goldpaust]

Yeah, right, exactly. Yeah. And we're looking a lot at, you know, our goal with ICBT is to get people just to sort of approach the issues that their OCD touches the same way they do their non OCD issues. Right. So when, in order to, to stand up, I don't do tests to make sure that the ground is solid. Right. I use my, my senses and if I don't see any problem, I'm going to assume it's fine. That's, that's how our, how we default in Life, I breathe in because I don't see any reason why I shouldn't. Right. I don't require certainty in order to, like, proceed in life. My default assumption is that everything is fine unless indicated otherwise. What OCD does is it, it changes the standard. It says, yeah, but it's possible. And you can't, you know, unless it's, unless you're certain, like, how could you go forward? And so the issue is not, you need to learn to accept uncertainty. When I stand up on the ground, I'm not accepting uncertainty that I might fall through. I'm trusting that I won't. Right. So it's not an issue of certainty versus uncertainty the way it is using erp. It's trust versus doubt. Right. So normally when we go through life, we have trust unless indicated otherwise by our senses. Like, we, we see something is wrong or common sense tells us that something is wrong. Whereas with, when, when OCD is involved, we have a different standard. Right. And we, we lead with doubt rather than trust. And so what we're getting people to do, the goal with ICBT is to return them to that place of trust where everything is fine unless their senses indicate otherwise. And if their senses indicate otherwise, they know that that will, they will be on alert for that and that they can trust their senses and they can carry on. Right. We're not. The goal isn't to get people to accept uncertainty. It's to have the normal trust that they have in their everyday life also, when it comes to these OCD issues.

[Christina Orlova]

Yeah, I love that. And I think, honestly, this is going to be a good place to stop for, for, for our, our first, first kind of conversation on this, because you're hitting on, you know, census and trusting, and I already know that there's a lot of questions I, I, I get, you know, through DMS and emails and just out there in terms of, you know, what does that mean? What are you talking about? There's some confusion about that, that piece. Right. But I know that we're gonna, we're gonna get into that a bit more a little later. So sorry, guys, this might be a little cliffhanger for some, but thanks so much for being here for the first part of this. And how can people find you if they'd like to find you?

[Katherine Goldpaust]

Yeah, so I'm on Instagram @ICBT therapist, and my website is katherinegoldhouse.com thanks so

[Christina Orlova]

much for coming on the show.

[Katherine Goldpaust]

All right, good to see you.

[Christina Orlova]

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 and Abe. Don't forget to grab your OCD CBT journal tracker and planner while you're there. If you found this episode helpful, 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.

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