The ICBT

Journey
YOUR GUIDE TO ICBT MODULES FOR OCD
RECOVERY

by Christina Ennabe, LCMHC, LPC

www.christinaennabe.com
Hello!
I'm a licensed therapist & Coach specializing in
Anxiety and OCD. I'm a clinician with lived
experience which means, I know what it's like
to struggle with distressing intrusive thoughts
and to feel as if you have no control over your
life. But the good news is-recovery is possible!
You can have a fulfilling, purposeful life despite
OCD.

This free guide has been adapted from:

O'Connor, K., & Aardema, F. (2012). Clinician's
handbook for obsessive compulsive disorder:
Inference-based therapy. Chichester: Wiley-
Blackwell.

Christina Ennabe, LCMHC

www.christinaennabe.com
info@christinaennabe.com
@christinacounsels
ICBT Modules
01
OCD SEQUENCE
A doubt is about possibility
Obsessions aren’t random
Consequences, distress and compulsions logically
follow from the doubt

02
OCD LOGIC
There is ‘logic’ behind obsessional doubts.
OCD uses logic from: hearsay, general facts,
personal experiences, rules, and possibility

03
OCD STORY
Obsessions feel real because there is a credible story
behind it.
Your OCD story is just a story.
The story becomes more real when you act on it.

04
VULNERABLE SELF
The OCD self is a possible self you’re afraid you
could become if you don’t do your compulsions
The OCD self is against your real self

- 3 -
ICBT Modules
05
OCD LIVES IN IMAGINATION
Obsessional doubt occurs without direct evidence in
the here and now.
The reasoning behind obsessional doubt is 100%
based in the imagination.

06
DOUBT & POSSIBILITY
Just something being hypothetically possible does
not make it relevant to the here and now.

07
OCD BUBBLE
OCD takes you beyond the senses into more doubt –
the OCD Bubble.
There is certainty before the obsessional doubt.

08
REALITY SENSING
Reality sensing is staying with the information from
your senses in the here and now.

- 4 -
ICBT Modules
09
ALTERNATIVE STORY
Stories can change our feelings and beliefs and
choices.
Changing our stories changes how we live.

10
OCD’S TRICKS
The tricks of OCD include mismatching, living the
fear, out of context facts, reverse reasoning, double
jeopardy, testing it out, going deep, and a distrust of
the senses (or self).

11
THE REAL SELF
When you base your actions on your true self, you
stay grounded in the present, connected to who you
genuinely are.
The "OCD self" tries to cover up that true version of
you, wearing a mask of doubt and fear that makes
you believe you might be someone different.

12
RELAPSE PREVENTION
ICBT principles and tools must be practiced regularly
as part of your recovery
- 5 -
What is ICBT?
ICBT (Inference-Based Cognitive Behavioral Therapy) is an
evidence based treatment for OCD that focuses on obsessional
doubts and inferential confusion rather than traditional exposure
therapy. To better understand this approach, think of OCD as a
faulty GPS system that constantly leads you in the wrong
direction. The GPS keeps giving you incorrect directions based on
assumptions, causing you to feel lost and anxious. ICBT works
like recalibrating your GPS, helping you question the incorrect
assumptions and doubts, and helping you make decisions based
on reality instead of imagination.

- 6 -
What is an
Obsessional Doubt?
In OCD, the obsessions are doubts that often take the form of
"What if...?" or "I might...". For example, if you have the
obsession, "I might have left the stove on," you're overwhelmed
with the doubt that something dangerous might happen because
of it. These thoughts create anxiety, pushing you to perform a
compulsion, like checking the stove multiple times to reassure
yourself.

Obsessions are the trigger for compulsions. Without the

obsession, you wouldn't feel the urge to do anything. Think of it
like a loop: the obsession raises doubt ("What if I left the stove
on?"), leading to anxiety, and the compulsion (checking the
stove) is the attempt to reduce that anxiety and confirm safety.
But the compulsion doesn’t actually erase the doubt—it's only
temporary relief.

What makes OCD tricky is that the doubts and the need to check
often feel just as real as the fear of the actual threat. The key
difference with ICBT is that it helps you understand that these
doubts aren’t grounded in reality—they are just possibilities, not
probabilities—and teaches you how to accept them without
acting on them. They don’t arise from reasonable, evidence-
based thinking like regular doubts do. Obsessional doubts come
from irrational reasoning and don’t reflect the here-and-now.

- 7 -
What is Inferential
Confusion?
OCD often causes you to make irrational inferences, where you
jump to conclusions based on incomplete or incorrect
information. ICBT helps you recognize these faulty
interpretations and understand how they contribute to anxiety,
rather than reinforcing the compulsions.

In ICBT, you are encouraged to trust your inner and outer senses
—that is, to trust what you know from actual experiences and
evidence. If you feel unsure about something, ICBT helps you
recognize the difference between a legitimate doubt (based on
facts) and an obsessive one (based on irrational fears).

The good news is that people with

OCD already reason just like everyone
else in most situations. You don’t
need to learn how to think differently;
you just need to apply that same
logical thinking to your OCD doubts.
By applying this approach to the
doubts caused by OCD, you stop
getting caught in the cycle of endless
mental checking or rituals.

By focusing on challenging these faulty reasoning patterns at the

core of OCD (rather than just trying to expose yourself to feared
situations), ICBT works to reduce the power of obsessions and
allows you to live without the need for compulsions.

- 8 -
 Noticing Inferential Confusion
Inferential confusion happens when your mind makes conclusions that
don’t align with reality. It’s like being convinced of something that
doesn’t make sense, even though the facts say otherwise. For
example, you might have the thought, "What if I accidentally harm
someone?" and then become convinced that you could’ve hurt
someone, even though you have no evidence of it. Your mind creates
a false connection—this thought seems real, even though your senses
or logic show there’s no danger. In these moments, your brain is
making inferences, or conclusions, that are not based on real
evidence, but are instead based on imagined fears.

EXERCISE:
Take a moment and write down the doubt or fear you're experiencing,
then jot down the facts that directly contradict it. For example, “I’m
afraid I’ve hurt my friend’s feelings” could be countered with, “My
friend didn’t show any signs of being upset, and they’ve always been
open with me.” By looking at the facts, you can start to see how the
doubt isn’t grounded in reality and can work to release it. The goal is
to slowly train your brain to recognize when it's falling into inferential
confusion and ground yourself in what is actually true.

- 9 -
01 Identifying Obsessional Doubts
Module 1
THE OCD SEQUENCE

A doubt is a thought about what could happen or might happen—it's a possibility. OCD
starts with this doubt, like wondering, “What if I didn’t lock the door?” This doubt leads to
anxiety, and suddenly, you’re not just wondering anymore—you start to feel certain that
something bad might happen. As a result, your mind is overwhelmed with worries about
the consequences—like your house being robbed or your family being in danger. The next
step is the compulsion, which is your attempt to relieve that anxiety—checking the door
repeatedly. But none of these actions would be necessary if you didn’t have the original
doubt in the first place. Without the doubt, you’d stay grounded in reality and not feel the
need for compulsions or the distress they cause.

OCD always follows a sequence: Trigger-Obsession-Consequence-Emotion-Compulsion

EXERCISE:
When you experience a doubt today, pause and ask yourself, “Is this doubt about what
could happen, or about something that has actually happened in the present moment?”
Write down the doubt and try to recognize it for what it is—a possibility, not a fact. Next,
try grounding yourself by focusing on what you know for certain. For example, “I know I
drove safely because I have no evidence to the contrary.”

- 10 -
02 Module 2
OCD’S LOGIC

Obsessional doubts don’t just appear out of nowhere; they arise from some kind of
reasoning or logic, even though that logic might not always make sense. These doubts are
often based on hearsay (things you’ve heard but aren’t personally proven), general facts
(broad, non-specific information), past experiences (memories that may not apply to the
current situation), rules (something you’ve learned or decided to follow), or the
possibility of something bad happening.

These sources of reasoning set the stage for the doubt to creep in, making it seem very
real. Example: Let’s say you’re walking down the street and think, "What if I trip and hurt
myself like I did before?" This doubt might come from a past experience where you
tripped and injured yourself. Or maybe it’s a general rule you’ve created for yourself, like
“People who don’t pay attention when walking often get hurt.” This logic feels true, but
it’s still based on reasoning that may not be relevant in the current situation.

EXERCISE:
Stop and try to identify the doubt that led you to feel anxious or made you carry out a
compulsion. Write it down, and then rephrase it in terms of what could or might happen—
like, “What if I left the stove on?” Next, take a moment to figure out what kind of
reasoning is behind the doubt. Is it based on hearsay, like something someone told you?
General facts that don’t apply to you? A past experience that isn’t relevant now? Or just a
possibility that feels like a real threat? If you can’t pinpoint the reasoning, ask yourself,
“Why does this doubt feel real?” Take a step back and slow down your thinking to
evaluate each part of your reasoning. This will help you see how one assumption leads to
another, and how it all builds up to create doubt where there’s no need for it.

- 11 -
03 Module 3
THE OCD STORY

OCD doubts feel real because there is often a credible story behind them, a narrative that
seems to explain why the doubt exists. For example, if you’re wondering, “What if I hurt
someone by accident?” it’s not just an abstract thought—it’s a story your mind has
created, like “I’ve heard about people accidentally causing harm before,” or “I’ve had bad
experiences in the past that make me worry about it.” In OCD, your personal OCD story
feels as valid as anyone else's, but the truth is, it’s just a story your mind is telling you. It
becomes real only when you act on it—for example, checking, reassuring, or avoiding. If
you change the story, you change the doubt, because the narrative drives the belief that
the doubt is something to act on.

EXERCISE:

Try creating both positive and negative stories about things around you. For example,
consider your shoes: What if these shoes were worn by a world traveler who took great
care of them? Or, what if they were the shoes of someone who never bothered to clean
them and wore them through all kinds of rough conditions? Notice how these different
stories affect how you feel about the shoes. When OCD doubts show up, pause and
examine the story behind them. What’s the narrative you’re telling yourself—like “I could
make a mistake and cause harm” or “This situation is too risky”? Notice how repeating
that story makes the doubt feel real, and practice shifting it to see how the doubt changes
as a result.

- 12 -
04 Module 4
OCD FEARED SELF

Your OCD self is often a version of yourself that you're afraid you could become if you
don't perform your compulsions or rituals. It’s built on a story or narrative that your mind
creates, telling you that if you don't act in certain ways, you will turn into this feared
version of yourself. This OCD self is not the real you—it's a false identity that contradicts
who you truly are. The fear of becoming this person, the fear that you might lose control
or do something wrong, fuels your OCD doubts and drives your compulsions.

Example: Let’s say your OCD makes you fear that you might harm someone by accident.
The OCD self in this case could be someone who is reckless and dangerous. However, in
reality, you're someone who is thoughtful and careful, like a parent who always takes
extra time to ensure their child is safe. The fear of becoming the "dangerous person"
makes you repeatedly check to make sure everything is in order, but it’s based on a false
idea of who you are or could be.

EXERCISE:
Each day, pay attention to the role your OCD feared self plays in your thoughts and
actions. What are you afraid of becoming if you don’t follow through with a compulsion or
ritual? Now, monitor your actions and accomplishments throughout the day and reflect on
how these actions support or contradict the feared version of yourself. How do your
behaviors show that you're not becoming the feared OCD self? Would you act the same if
you believed you were already your authentic self? Write down specific examples that
show your true character, and see how this image differs from the one OCD wants you to
believe.

- 13 -
05 Module 5
OCD LIVES IN
IMAGINATION

Obsessional doubt comes from within you, not from external reality. This means that the
doubts you experience are not based on any facts or evidence in the here and now, but
are completely imagined. These doubts arise from your mind, not from anything you can
see, hear, or touch. When you feel that doubt creeping in, it’s important to recognize that
it’s not based on real or current evidence, but rather is part of your mind’s tendency to
overthink possibilities. The reasoning behind these doubts is entirely constructed in your
imagination, making them highly subjective and unreliable.

For instance, you might have the thought, "What if I left my phone in the fridge?" There is
no evidence to support this, and yet, the thought seems very real in the moment. You may
search the fridge, but even if you don’t find your phone there, the doubt persists, because
it wasn't based on anything real—it was just your mind imagining a scenario that didn’t
happen.

EXERCISE:
Every time you experience an obsessional doubt, ask yourself: Is there any real, direct
evidence to support this? Try to find something in the here and now that justifies the
doubt. Is there anything from your senses—what you can see, smell, taste, hear, or touch
—that points to this being true? Then, take a moment to compare the doubt with real
information. Does it hold up when you compare it to your senses, perception, and
common sense?

- 14 -
06 Module 6
DOUBTS & POSSIBILITY

Obsessional doubt is completely disconnected from reality. Just because something is

possible doesn’t mean it’s relevant to the present moment or your current situation. In
everyday reasoning, you typically don’t entertain possibilities that have no grounding in
what’s actually happening. For example, if you’re walking through a store, you don’t
question whether the store might suddenly disappear just because it could happen. That
would be an irrelevant possibility. Yet, with OCD, you might entertain all sorts of unlikely
scenarios that are disconnected from reality, even though they don’t serve any practical
purpose.

Example: Suppose you have the thought, "What if I accidentally poisoned someone while
cooking dinner?" While it's theoretically possible, there’s no evidence supporting that it
actually happened. In your daily life, you’d never entertain such a possibility in a similar
situation, because it has no real basis in the here and now. You know you followed the
recipe and took proper precautions, so there's no reason to entertain the idea of
poisoning someone. It's irrelevant to your actual experience.

EXERCISE:
Each time you experience an obsessional doubt, pause and ask yourself: Is there any real
evidence or direct information that justifies this doubt? Then, think of a situation in your
daily life where you would never consider an irrelevant possibility. For example, imagine
walking into a room and wondering if the walls are going to collapse. This possibility is
irrelevant and doesn’t align with the present moment, so you would never entertain it.
Apply the same reasoning to your obsessional doubt. Is it just as irrelevant to your here-
and-now experience?

- 15 -
07 Module 7
THE OCD BUBBLE
OCD often pulls you away from what your senses are telling you and into a world of doubt
and fear, which we like to call the "OCD Bubble." In this bubble, you're constantly
questioning things and imagining worst-case scenarios. However, in reality, there is
already certainty before the obsessional doubt even begins.

Imagine you're leaving your house, and you have the thought, "What if I left the door
unlocked?" Your senses tell you that you locked the door because you remember doing it,
and the door feels secure, but OCD takes you beyond that—into the world of doubt. In the
OCD Bubble, you start imagining the worst-case scenario: someone breaking in because
you didn’t lock it properly. In reality, your senses gave you all the certainty you needed,
but OCD tricks you into thinking you need more proof or safety.

EXERCISE:
Step 1: Throughout the day, notice the thoughts that pull you beyond what your senses
are telling you.
Step 2: Hold off on performing any compulsion for at least one minute. During that
minute, you are standing at the crossroad between the world of your senses (where
certainty exists) and the world of your imagination (where doubts thrive). Look in both
directions and recognize that you have a choice.
Step 3: Once the minute is up, make a conscious choice. If you allowed yourself to enter
the OCD Bubble and performed a compulsion, reflect on whether anything was truly
resolved. If you resisted the urge and stayed grounded in your senses, notice what helped
you remain in the here-and-now.
Step 4: Write down the thoughts that led you to doubt reality and veer into the OCD
Bubble. This will help you track how your OCD pulls you away from certainty and reinforce
that the real world, based on your senses, is all you need to stay grounded.

- 16 -
08 Module 8
REALITY SENSING

Obsessions are powered by doubts that aren’t just unlikely—they’re actually false and
conflict with reality. These doubts rely on imagination rather than what is immediately in
front of you. To manage OCD effectively, we can practice “reality sensing,” which is the
ability to stay present with what we can see, hear, and feel right now. Each time you trust
your senses, you’re building confidence in your ability to stay grounded in what’s real. The
goal is to trust the information available to you in the present, without being pulled into
“what if” scenarios.

Example: You might be spending time with your partner and suddenly feel a surge of
doubt, like, “What if I don’t truly love them?” This doubt might urge you to mentally
review all your past feelings, looking for signs of “proof” that your relationship is right or
wrong. Instead of giving in to these mental compulsions, you can use reality sensing to
focus on the present moment. Notice your partner’s company, how you feel with them
now, and resist the pull to question and review.

EXERCISE:
Step 1: When a doubt arises, pause and imagine you’re standing on a bridge between
reality and imagination. Focus on what you see, smell, taste, hear, or touch in the present
moment.
Step 2: Notice any discomfort from not “solving” the doubt. Recognize that this
discomfort is simply a gap left when you don’t engage with the doubt.
Step 3: Gently refocus on what’s real and tangible. Each time you choose this grounded
reality over engaging with the doubt, you strengthen your trust in the present moment.

- 17 -
09 Module 9
ALTERNATIVE STORY
We all carry stories in our minds about ourselves and our lives. These stories become so
detailed and vivid that they can feel like absolute truths, especially the more we repeat or
dwell on them. When you think about it, stories are powerful—they can shape how we see
ourselves and influence the direction of our lives. But just because a story feels real
doesn’t mean it’s factual. Changing these internal stories can change how we perceive and
live in our world.

Imagine someone with scrupulosity OCD who has a story that they are "morally flawed"
and constantly at risk of committing some grave sin without even knowing it. This story
might get triggered whenever they’re in situations where they could potentially “offend”
or “sin,” even if the likelihood of doing so is minimal. Over time, the story becomes
detailed with layers, making it seem like a deeply ingrained truth rather than a reflection
of an imagined fear.

EXERCISE:
Notice Your Stories: Begin by noticing when you’re telling yourself stories throughout the
day, especially ones that impact how you see yourself. Be mindful of stories that may not
be based on facts but are tied to OCD themes.
Catch the OCD Story and Reverse It: When you notice an OCD story, like "I’m a morally
flawed person," pause and wind it back to the start. Break it down detail by detail,
replacing each OCD-driven point with an opposing fact from reality. For example, if your
OCD says, “I might accidentally do something wrong,” remind yourself of times when you
acted responsibly and consider the real, here-and-now evidence of your integrity.
Rehearse the Alternative Story: Build a new, fact-based narrative that reinforces your
sense of reality and who you truly are. For instance, instead of “I am morally flawed,” try,
“I strive to live in alignment with my values, and my actions reflect that.” Rehearse this
new story and notice how much credibility it holds compared to the OCD-driven story.
Reflect on the Impact: Observe how this practice affects the strength and believability of
the OCD story. The goal is to see that the OCD story is just that—a story—not a fact.

- 18 -
10 Module 10
OCD’S TRICKS
OCD is clever at using “tricks” to make obsessions seem relevant to reality, even when
they’re not. Here are some common tricks it uses:

Mismatching: OCD pairs two unrelated ideas to make them feel connected. For instance,
if you’re a new parent, OCD might create the thought, “If I think about harm, I must be a
danger to my baby.” Here, the normal worry of being a good parent mismatches with an
unfounded fear, causing you to question your intentions when there's no valid reason to.

Living the Fear: OCD makes the fear feel as though it’s already happening or is inevitable.
For example, someone with contamination OCD might feel as though they’re already
covered in germs the moment they touch a doorknob, making the fear feel real in the
present.

Out-of-Context Facts: OCD uses true information out of context to justify its concerns. For
instance, if you hear a news story about a break-in, OCD may jump to the thought, “This
could happen to me if I don’t check my locks repeatedly.” The fact of the break-in is real,
but it has no direct relevance to your situation.

Reverse Reasoning: This trick makes you think, “If I feel this way, there must be a reason.”
For example, someone with harm OCD might think, “If I feel anxious around knives, I must
secretly want to harm someone,” when in reality, the feeling of anxiety is just a reaction
to the intrusive thought itself.

Double Jeopardy: OCD gets you if you do or you don’t do what it wants you to. “If I use
knives I might stab someone, but if I avoid using knives then I might be giving into OCD”.

Testing It Out: OCD may encourage you to “test” the fear by engaging in a compulsion. For
example, someone with fear of contamination might wash their hands repeatedly “just to
be sure” they’re clean. Testing feels comforting momentarily but ultimately reinforces the
fear by keeping you stuck in the cycle.

Going Deep: This involves overanalyzing minor details that would otherwise be ignored.
For example, someone with relationship OCD might scrutinize every interaction with their
partner, thinking, “Did I show enough love today? Maybe my lack of excitement means I
don’t love them as much as I thought.”

Distrust of the Senses: OCD makes you doubt what you see, feel, or remember. A person
may lock the door and, moments later, doubt whether they actually did it, convincing
themselves, “I didn’t feel the lock click, so maybe I left it open.”

- 19 -
10 Module 10
EXERCISE:
ALTERNATIVE STORY

Identify any OCD trick you notice throughout the day, then write down what the trick tried
to convince you of. Then, rewrite this statement to reflect what is truly happening based
on reality. For instance, if you wrote, “If I don’t wash my hands, I could harm someone,”
reframe it as, “I can wash my hands to a reasonable standard and trust that they’re
clean.”

- 20 -
11 Module 11
THE REAL YOU

OCD often convinces you that you have an “OCD self”—a distorted version of who you
really are, one that seems to be driven by fears, doubts, and imagined risks. However, this
“OCD self” is fundamentally the opposite of your authentic self. Grounding yourself in
your true qualities and values can help dissolve the mask that OCD tries to put on you.
Every time you base your actions on who you genuinely are, rather than on the identity
OCD imposes, you root yourself in reality, which strengthens your resilience against these
doubts.

When someone with existential OCD experiences doubt, they often feel disconnected
from who they truly are. For example, they might constantly question, “Do I really exist?”
or “What if life has no meaning?” This can lead them to feel out of sync with their real self
and disconnected from the meaningful activities that once grounded them in daily life.

EXERCISE:
Each time you complete a task or receive positive feedback, ask yourself, “What does this
say about the real, authentic me?” Perhaps it shows that you’re responsible, resourceful,
or kind. Compare these traits to the “OCD self” image, which may have you believe you’re
careless, a threat, or incompetent. Write down the contradictions you notice between
your real self and the traits OCD imposes. For instance, if OCD says you’re a danger to
others, yet you regularly help and support people in meaningful ways, note this
inconsistency. This practice helps to break down the “OCD self” by consistently reinforcing
your true qualities and values.

- 21 -
12 Module 12
RELAPSE PREVENTION

Overcoming OCD isn’t about reaching a final endpoint but rather building ongoing
resilience by consistently applying Inference-based CBT (ICBT) principles to real-life
situations. Successfully managing OCD for about six months can set a strong foundation
that lowers the risk of relapse. However, if you do encounter challenges, see it as an
opportunity to identify where things went off course, revisit relevant ICBT modules, and
apply those techniques again. With each success, the insights and strategies you’ve gained
become tools for long-term remission

EXERCISE:

Anticipate potential stressors, such as high-pressure events, that could activate old OCD
themes. Plan coping strategies in advance, including non-OCD activities that reinforce
your sense of your real self, such as hobbies, work, or social interactions that bring out
your natural strengths. Think of yourself as in “OCD remission” and continue building a life
grounded in these true qualities and values, reminding yourself regularly of the tools you
now have to manage any challenges.

- 22 -
 II TRUST
TRUST IN
IN MY
MY SENSES
SENSES AND
AND MY
MY
INNER AWARENESS
INNER AWARENESS TO TO GUIDE
GUIDE ME
ME
TOWARD REALITY.
TOWARD REALITY. OBSESSIONAL
OBSESSIONAL
DOUBTS ARE
DOUBTS ARE CREATIONS
CREATIONS OF
OF MY
MY
MIND, NOT
MIND, NOT REFLECTIONS
REFLECTIONS OF
OF TRUTH.
TRUTH.
II CHOOSE
CHOOSE TOTO REMAIN
REMAIN CONNECTED
CONNECTED
TO WHAT
TO WHAT ISIS REAL
REAL AND
AND PRESENT,
PRESENT,
ALLOWING MY
ALLOWING MY AUTHENTIC
AUTHENTIC SELF
SELF TO
TO
LEAD ME,
LEAD ME, FREE
FREE FROM
FROM
UNNECESSARY DOUBTS.
UNNECESSARY DOUBTS.

- 23 -
Notes

- 24 -
Notes

- 25 -
Notes

- 26 -
Want to learn
MORE?
CHECK OUT MY ICBT BASED COURSE

WWW.CHRISTINAENNABE.COM