Finding Freedom from Fear: Understanding I-CBT for Persistent Anxiety

So you've done therapy before. Maybe you even tried Cognitive Behavioral Therapy (CBT). You learned about cognitive distortions, completed thought records, and challenged irrational thoughts. It helped — maybe a little, maybe a lot — but the loop kept looping. The what-ifs kept coming. You figured either you weren't doing it right, or this was just how your brain was wired, or therapy just wasn't going to be the thing that fixed this.

"I'm just an anxious person. This is just who I am," you think as you sit in the chaos of your mind and body, caught in the loop of existential dread, horrible images that won't go away, and fear that won't let up.

Here's what I want you to consider instead: maybe the tool wasn't the right fit for the specific problem. Not because CBT is ineffective — it isn't — but because obsessive, intrusive thinking operates differently than the kind of anxiety CBT was originally built to address. Different problems need different tools.

That's where Inferential CBT comes in.

Understanding CBT: What It Is and What It Was Built For

Standard CBT is genuinely effective for many issues. Depression, situational anxiety, and black-and-white thinking are just a few examples. The core premise is straightforward: identify the distorted thought, examine the evidence for and against it, and replace it with something more balanced and realistic. It works because it interrupts the relationship between thoughts, feelings, and behaviors.

The problem isn't CBT. The problem lies in applying it to a type of thinking it wasn't specifically designed for.

When your anxiety is primarily obsessive — when it manifests as what-if loops that migrate from topic to topic, never quite resolving — challenging the content of the thought doesn't address the root of what's happening. You argue down one what-if, and your brain generates another. You challenge "what if I said something offensive," and by the time you've convinced yourself you didn't, a new doubt has already taken its place.

Standard CBT also assumes that if you can find the flaw in the logic, the thought loses its power. But here's the thing obsessive thinkers know all too well: these thoughts often aren't obviously illogical. They're built on real history, real possibilities, and genuine events that have happened to real people. That's what makes them so convincing and so hard to argue against. You can't win an internal debate with a mind that keeps finding new evidence.

Why Managing Worry Is Getting Harder — Not Easier

There's something worth naming before we go further, because I think it's making this particular flavor of anxiety significantly worse for many people right now.

We are living through a moment in history that is specifically, almost engineered, to destabilize three things that obsessive anxiety already attacks: your trust in your senses, your relationship with what's real versus what's imagined, and your confidence in your own common sense.

Deepfakes mean what you see may not be real. AI-generated audio means what you hear may not be real. The internet serves you an endless buffet of plausible worst-case scenarios, and now AI will sit with you and help you develop them in exhaustive detail. For a brain that already has a hair-trigger for "but what if that's not true," the current information environment is genuinely hostile in a way that nothing in the history of CBT's development accounted for.

And here's the one that concerns me most clinically: AI has become the world's most sophisticated reassurance-seeking machine. You can describe your worry to an AI at 2 AM, and it will engage thoughtfully, ask clarifying questions, and generate a thorough response. It feels helpful. It provides brief relief. But for someone caught in an obsessional loop, it does exactly what Googling symptoms does: reduces anxiety in the short term and feeds the cycle in the long term.

I'm not saying don't use AI. I'm saying if you notice you're using it to manage anxiety — checking, verifying, seeking reassurance about things your common sense already knows — that's worth paying attention to. Because the skills I-CBT builds are specifically the ones this moment in history is eroding: trust in your senses, confidence in your own reasoning, and the ability to distinguish what's real from what's an elaborately constructed what-if.

Learning to do that now, in a world actively working against it, might be the most useful thing you can do for your mental health in 2026.

What I-CBT Understands That Regular CBT Doesn't

Inferential CBT — developed by researchers Kieron O'Connor and Frederick Aardema out of the OCD Study Center in Montreal — starts from a fundamentally different premise.

Rather than focusing on the content of the anxious thought, I-CBT focuses on the reasoning process — what the founders call "inferential confusion" — that gives rise to the doubt in the first place. In other words: we're not asking "is this thought rational?" We're asking "how did your mind decide this thought was worth entertaining at all?"

The key distinction is this: ERP helps people cope with the effects of obsessional doubt. I-CBT helps people stop creating that doubt in the first place.

That's a distinct difference.

Here's what inferential confusion actually looks like in practice. Your brain takes an imagined possibility — what if I left the stove on, what if I offended someone, what if something is wrong with me — and treats it as if it has the same weight as something grounded in reality. It mistakes an imagined possibility for a real probability. Your senses and your common sense are telling you one thing. Your obsessional reasoning is telling you something else entirely. And the obsessional reasoning wins — not because it's right, but because it's louder and more elaborate.

I-CBT identifies what it calls the OCD Trifecta — three reasoning processes that drive this crossover from reality into imagination: distrust of the senses and self, boundless imagination, and misapplied logic and relevance. Together, they generate a convincing but entirely hypothetical story that gives rise to obsessional doubt.

Sound familiar? It should — especially if you've been living online in 2026. The world is now doing to everyone what OCD has always done to you specifically. The difference is that most people can shake it off. For obsessional thinkers, it compounds.

Let me translate that out of clinical language: your brain has learned to distrust what your eyes and your gut are telling you, go wild with "but what if" scenarios, and then apply just enough logic to make those scenarios feel plausible. That's the machinery behind the loop. And once you can see the machinery, you can start to dismantle it.

What I-CBT Actually Does in a Session

I want to be honest with you: I-CBT isn't magic, and it isn't a quick fix. But it does feel different from other approaches — and for people who've been around the therapy block, that difference tends to be noticeable fairly quickly.

Instead of sitting with your anxiety and trying to tolerate it (ERP), or arguing with your anxious thought and trying to replace it (CBT), we do something different. We look at the story your mind is telling — the narrative it constructed to convince you the doubt was worth taking seriously. We examine where that story drifts from reality into imagination. We trace the reasoning chain that got you there.

I-CBT is not a therapy of sheer effort or endurance — it's a therapy of realization and insight. The goal isn't to expose you to the thing you're afraid of. It's to expose the doubt itself — to hold it up to the light of reality and watch it lose its grip.

Part of that work involves uncovering what I-CBT calls the "obsessional narrative" — the elaborate story your anxiety constructs around your doubt to make it feel real and convincing — and learning to create an alternative narrative grounded in what your senses and common sense are actually telling you. The senses and common sense you've been learning to distrust. The ones we're going to help you trust again.

One thing my clients consistently find relieving: you don't have to set up elaborate exposure exercises. Because I-CBT focuses on reasoning rather than anxiety exposure, many people find it more comfortable and more aligned with their way of thinking. This matters especially if your compulsions are primarily internal — if there's no physical checking behavior to interrupt, just thought loops running inside your own head. Exposure to your own thought patterns is genuinely difficult to engineer. Examining the reasoning process that generates those patterns is something we can actually work with in a session.

Who I-CBT Is a Strong Fit For

I want to be specific here, because I think specificity is what actually helps you figure out if this is worth trying.

I-CBT tends to be a strong fit if you:

• Have obsessive what-if thinking that migrates from topic to topic — health one week, relationship the next, career the week after.

• Would describe yourself as a high achiever, overthinker, or someone whose anxiety is specific and sharp rather than a generalized background hum.

• Have tried CBT and found it helpful but not quite enough — like it addressed the surface but not the source.

• Notice that seeking reassurance — Googling, asking people, replaying conversations, or yes, asking AI, etc. — helps briefly and then makes things worse.

• Have a lot of internal mental reviewing but few obvious external compulsions.

• Are late-diagnosed ADHD or neurodivergent and find your brain generates doubt rapidly and persistently.

• Find yourself increasingly unsettled by the current information environment in a way that feels disproportionate to those around you.

  
  

I-CBT may not be the primary fit if your anxiety is mostly situational: tied to a specific life stressor that has a clear resolution. Standard approaches often work well for that. The distinction that matters is whether your worry migrates and loops regardless of circumstance. If the topic keeps changing but the theme — uncertainty, self-doubt, fear of having done something wrong — stays the same, that's the pattern I-CBT is built for.

What the Research Says

I'll keep this brief because I know you didn't come here for a literature review. I-CBT is supported by over two decades of clinical and research evidence. Randomized controlled trials have shown that I-CBT is as effective as exposure-based therapy, with large treatment effects and high acceptability among participants. Dr. Aardema at the University of Montreal has led large-scale registered trials directly comparing I-CBT with ERP, and the results are consistently strong.

It's worth knowing that I-CBT is still less widely known than CBT or ERP — which is exactly why relatively few therapists are trained in it. If you've been in therapy before and no one mentioned it, that's not a reflection of your case. It's a reflection of how recently this approach has been making its way into mainstream clinical training.

A Note on How I Use It

I don't apply I-CBT as a rigid protocol. It's a lens I bring to our work together, alongside EMDR when trauma is part of the picture, nervous system work throughout, and practical tools you can use between sessions. Therapy with me is integrative, meaning I'm always adapting to what you actually need rather than following a script.

What I can tell you is that for the clients I work with who have this specific flavor of anxiety — the looping, migrating, certainty-seeking kind — I-CBT is often the piece that finally moves the needle in a way that other approaches haven't.

If You've Tried Things Before and You're Still Stuck

Reading about a different approach and actually experiencing it are two very different things. I know that. And I know it takes something to try again when previous attempts haven't fully landed. I also recognize that it takes immense trust to put yourself out there again to a therapist, especially if you've never met me before or you've been burned by the mental health treatment machine previously.

But if the loop is still looping — if you've done the work and the what-ifs keep coming anyway — it might not be that you're doing anything wrong. It might be that you need a different tool entirely.

That's what I do. Schedule a consultation here if you'd like to talk about whether this approach might be the right fit for you.

Take Exquisite Care of Yourselves,

Megan

Why Telling Yourself to Stop Obsessive Overthinking Doesn't Work (And What Actually Does)

Can I take a second and describe something that may have happened in your mind recently?

Something happens. Could be anything.

Perhaps you noticed a mole on your skin that looked 'funny', and then you found yourself googling Melanoma late into the night. You've convinced yourself in a span of 30 minutes that you've got stage III skin cancer and it's metastatized into your lymph nodes, obviously.

Or you got an unexpected meeting invite for 3pm on Friday from your boss. You even emailed them and said, "Hey, do you mind telling me what this meeting is about?" while everything inside of you is screaming, "Am I in trouble? Am I going to get fired?"

Maybe you got into the car and backed out of your driveway without looking first, and then you thought, "Oh shit. What if I hit a child and didn't realize it?" So you find yourself double-triple checking your mirrors to make sure you don't miss anything during your commute to work.

Or your partner seemed quieter than usual at dinner, didn't respond to your text for two hours, and now you're mentally replaying every conversation from the last week trying to figure out what you did wrong.

Just because you've always thought everybody thinks like this doesn't mean it's true. And yet, you aren't alone. Many folks have similar anxiety loops they get caught in. They almost always think to themselves at the end of such an episode some variation of "I know this worry isn't rational. I know that. So why can't I just stop?" Let me tell you why and what to do about it!

The Advice That Doesn't Work (And Why Everyone Keeps Giving It)

I promise I'm reading your mind. I've just heard these thoughts so many times in my career — and honestly, anxious obsessive overthinking is rarely talked about in helpful ways in the sea of pseudo-therapy content online. So here I am to actually make sense of it.

The standard arsenal prescribed to "manage" anxiety doesn't work for these specific, painful kinds of worries. And I mean that plainly:

If journaling worked, you wouldn't be Googling into the night. If deep breathing silenced your mind, you wouldn't feel like you're sucking wind all day just to stay calm. If thought records fixed this, you wouldn't be doing them over and over. If positive affirmations could crowd out the obsessive thinking, you wouldn't have three new what-ifs waiting in line to replace the one you just talked yourself out of.

If telling yourself to stop worrying worked, you wouldn't be here. On this blog post. Today.

So why don't they work?

Standard CBT assumes the problem is the content of the thought — so it tries to challenge the thought directly. But for obsessive overthinking, the problem is the reasoning process that generates the thought in the first place. Challenging "what if I lose my job" doesn't work because your brain just manufactures a new what-if the moment that one loses steam. It also assumes that if you can identify the flaw in the logic, the thought will lose its grip.

But here's the thing: obsessive thoughts often aren't illogical. They're built on real history, real evidence, real things that have happened to real people you know. That's what makes them so sticky.

What's Actually Happening in Your Brain While You Experience Obsessive Overthinking

Your mind is a clever organ. It genuinely believes that if it thinks hard enough and long enough, it can solve its way to certainty — and that certainty will make the anxiety stop. I wish it were that simple.

Here's what's actually happening. I call it the Anxiety Cycle:

A trigger occurs. Your mind produces a what-if thought, which produces anxiety. Then — before you've learned anything different — you do one of four things: you avoid the trigger, you overthink and obsess, you check, or you seek reassurance. These are what I call safety behaviors, and they work beautifully in the short term. The anxiety dips. Relief floods in.

And then the worry comes back — louder, and sooner than before.

This is the trap. Every time you engage in a safety behavior, you're teaching your brain that the threat was real and worth responding to. So the next time, it responds faster and stronger.

A simple example: you leave for work and think, "Did I turn off the stove?" Your brain starts running the morning back like a reel of footage, checking and rechecking. The more you engage with the checking, the less certain you feel — until some of my clients find themselves physically going back home to verify the knob is off. Every single day.

This isn't a personality trait in and of itself. It's a pattern, and it's one that can be interrupted.

The Difference Between "What If" Anxiety and Regular Stress

Here's the thing: boring ol' regular stress has an identifiable source and resolves — or at least reduces — when the situation does. Obsessive overthinking doesn't end when the trigger does. It migrates. It finds new material.

Obsessive worrying is a bit like playing Whack-A-Mole. You hit one worry with the mallet and two more rise to take its place.

The theme is never really the topic — not the job, the relationship, the health scare, the fear that you've done something terrible. The theme of these obsessive what-if loops is uncertainty itself.

Normal stress would go away once the problem was solved. But because you are a thoughtful, self-aware, and genuinely intelligent person, your brain works overtime trying to prevent the discomfort that uncertainty brings. It believes — deeply, sincerely — that if it can just think hard enough and long enough, it can outrun the unknown.

Here's the reframe I offer my clients, and I want to offer it to you too: your what-if anxiety is actually showing you what you care about most. What you're afraid to lose. Your worry has an underlying message — I don't want to lose this relationship. This career. This person. This life. The anxiety cycle begins as a desperate attempt to keep spinning so you don't fall into the abyss of uncertainty.

Exhausting, isn't it?

What Inferential-CBT Does Differently

Inferential CBT targets the part of the anxiety cycle that we can actually make a dent in: your doubt and the inferential process you used to get there. The reasoning that convinces your brain that this specific worry is worth entertaining in the first place, rather than the content of the worry itself.

We're not challenging the thought or arguing with it. Or putting it on trial. Or any of that other standard CBT work. We're examining how and why our mind chose to give this obsessive worry airtime. This is fundamentally different than traditional CBT, and actually allows for significant changes in the worry loops that many of my clients get caught in.

We're creating space between us and the obsessive story, you know, the giant slide of thoughts leading to you picturing living in a box on the sidewalk, homeless (after you got the email from your boss about the unexpected meeting on Friday afternoon). If you can get un-hooked from the story, you can notice the other possible ones present. This doesn't mean you'll always pick the healthier story, but at least you will start to see when you start to sink into obsession land.

What Actually Changes

I can't promise you that you'll never worry again. I wish I could, but if I could produce results like that, I'd be living on an island somewhere and donating money to various causes like the wealthy millionaire I'd be. Insert wry grin here

When we start doing this work with inferential CBT, the noise of these obsessive doubts jangling around in your head gets quieter. Decisions stop feeling like minefields, and start feeling like opportunities to trust yourself. You develop a different relationship with uncertainty, one based on the belief that no matter what, you would take care of you and your loved ones, even if the worst 'What If' were to come to pass.

With this type of therapy, you also don't have to set up elaborate exposure exercises in order to create change, which is great, and a plus compared to Exposure and Response Prevention Therapy, in my humble opinion. It's hard to set up exposure to your own thought patterns. Especially if there aren't any major physical compulsions that accompany the cycle.

You can start to trust your five senses, and your common sense again. You start to live in the 'right now' instead of the 'What If'. What a gift.

In closing, reading about a different approach and actually experiencing it are two very different things. If you've tried all the standard tools and you still feel stuck, it might not be you that's doing anything wrong. It might be that you need an entirely new approach. That's what I do.

Schedule a consultation here, if you'd like to talk about this more in detail. I'd be honored to accompany you on your journey.

Take Exquisite Care of Yourselves,

Megan

Why Healing from Trauma in Therapy Sometimes Feels Like Losing Your Identity

If therapists were being honest with you, there is typically a moment in therapy where we reach an impasse. Almost everyone does.

The blocking belief usually sounds like this question:“Who am I if I am not ________?” (anxious, suicidal, a people-pleaser, a rageaholic, careless, traumatized, a victim, etc.)

At its core, the question often becomes this: Who am I without my trauma, my anxiety, or the roles I learned to survive?

For lots of folks, this is the moment therapy stops being about fixing a problem and starts becoming about reconsidering who they have believed themselves to be for a very long time.

The Moment Therapy Gets Uncomfortable

Therapists don't always prepare clients for the impact of what it will mean to your protective system when you heal and shed the identity of your injuries.

I mean, think about it: you come to therapy because something in your life isn't working, and initially, you start working on that thing. And then, at some point, your therapist says: "I think this is related to something from your past." That's a scary point for many people.

We, as your therapist, are asking you to leave an identity behind. Letting this old role go means that you will also lose the benefits that this role has given you.

All Symptoms Have a Purpose

Now you might be saying to yourself, "Megan, there are NO benefits to my anxiety, my trauma, my suicidal thoughts, my people-pleasing!" And I'm here to push back against that thought a bit. An old supervisor of mine used to say, "All symptoms have a function."

I'm here to say that all suffering has purpose, even when it feels purposeless. Humans rarely hold onto something unless it serves a purpose or benefit, even if that benefit is negligible.

If all symptoms have a function, then the identities we build around our pain also make sense.

When people begin healing from trauma in therapy, we often discover that these identities were shaped by parts of us that were trying very hard to survive earlier experiences.

Healing from Trauma

When trauma starts to be met and shifted in the therapy room, something interesting tends to happen.

At some point, you start noticing that different parts of you show up in relationships. There may be a younger part that learned how to protect you when things were painful or unpredictable earlier in life.

In Relational Life Therapy, we sometimes talk about these as adaptive child parts. These parts learned how to survive emotionally when you were younger. They figured out strategies that helped you get through situations where you had less power, less support, or fewer choices than you do now.

And honestly, many of those strategies were incredibly smart.

But healing asks something new of you. It asks you to begin noticing when those younger parts are running the show, and to practice responding from your wise adult self instead.

That shift sounds simple, but it is not easy.

Because when you move from your injured parts into your wise adult self, you may lose some things along the way.

One thing people often lose is the strange sense of permission that comes with being hurt. When we are operating from an injured part, there can be a quiet belief that says, “I get to react this way because of what happened to me.” Anger, criticism, shutting down, or controlling behavior can feel justified.

And in some ways, it can even feel empowering.

Healing begins to take that permission away. Not because your pain was not real, but because staying inside that identity will not give you the relationships or life you actually want.

Another possible loss is more concrete.

When you begin standing up for yourself, setting boundaries, or speaking honestly about what you need, some relationships may not adjust well. If a relationship has been built around your silence, your flexibility, or your willingness to tolerate certain behaviors, changing that pattern can disrupt the entire dynamic.

Sometimes people grow alongside you.

And sometimes they don't.

For couples who are already at a crossroads, this can feel especially vulnerable. Healing does not guarantee that every relationship will survive. What it does offer is the chance to show up more honestly and more consciously in the relationships that matter most.

And while letting go of those old roles can feel disorienting at first, it also opens the door to something new: relationships where you are not just surviving, but participating as your full adult self.

What You Lose When You Stop People-Pleasing

For example, if you look at people-pleasing parts, when you have shed that role, you will find that you are no longer universally liked by people. The sense of control you had from regulating how others see you is now gone, and you may feel unmoored, undefended, and suddenly unsafe.

You may shed the good feelings related to "always being adaptable, 'chill', flexible, or the pride associated with always being able to “handle everything.” These losses will not feel good-- and then, when you've found a new, healthier way to move forward, you will feel good again.

Why Letting Go Can Feel Disloyal

Leaving behind old identities, negative beliefs, or reactive responses can be truly difficult. It can feel disloyal to our past selves, our family of origin, etc., especially if we are talking about something from our childhood. Your protective parts come alive and say things like, 'It wasn't that bad.... That's just how it was.... Other people had it worse.'

Even letting go of the beliefs that served you and kept you safe previously can cause fear to flare up. If you had a belief that "nothing ever works out for me," and then you start therapy and begin to question this belief and where it came from and how it kept you from reaching too far above reach beyond what your family of origin believed your place in life should be and therefore, never risk disappointment.... Well, there you go.

Giving up that limiting belief that "nothing ever works out for me," means you may have to actually risk it and reach for the things/relationships/jobs/opportunities you deeply desire, even if they feel out of reach.

Making the Unconscious Conscious

There's a famous quote by Carl Jung, that says, "Until you make the unconscious conscious, it will direct your life and call it fate." What Jung meant was that until we make sense of our hidden stories, implicit learnings from the past, we will inhabit lives that are directed (unknowingly) by our past selves, our protective parts, our trauma history and identities. For many of us, making the implicit explicit is the start of a serious change in behavior.

I'll share a personal story with you: my own therapist told me that I was an avoidantly attached person in love, and that I often set up 'tests' for my husband without knowing I was doing so. Ouch! In that moment during our session, there was a part of me that wanted to fire her, and then another part of me that said, "yeah, I am doing that, and I know it isn't going to get more of what I want."

The 'tests' I set up were both protective, and they were also invulnerable, and antithetical to intimacy with my spouse. Basically, Terry Real says, "You can't get angry at not getting what you never asked for." In order for me to get more of what I wanted, I had to get comfortable withsetting limits with the part of me that loves protection and distance over closeness and risk. I had to risk vulnerability and being disappointed potentially, in order to get actual joy and closeness with my spouse.

Once the unconscious became conscious in that session, I could let go of the identity of the angry, victimized wife, and take a chance on making direct requests of my spouse, which ultimately led to more happiness in our relationship.

Two Questions to Ask Yourself in Therapy

Two questions can help you begin exploring what healing might require you to release:

1. What might I lose if I heal this part of me?

2. What would I like to feel instead? What role could this part play in my future?

Once you know the answers to these questions, you will find a direction in the therapy room, and it will speed up and deepen your healing process. And you deserve healing that is deep and effective.

Healing often asks us to release identities that once protected us. That process can feel uncertain, especially if you are standing at a crossroads in a relationship, carrying grief that has reshaped your life, or living with a nervous system that is always on high alert.

You do not have to navigate that process alone.

Therapy can be a place to explore the roles you have carried, the losses that shaped you, and the possibilities that still exist for your life and relationships.

If this post resonated with you, I invite you to start with the two questions above and notice what comes up with curiosity and compassion.

Take Exquisite Care of Yourselves,

Megan