Inference Based Approach as opposed to CBT?

[Orwell1984]

http://ibaocs.com/what-is-iba/

What is OCDUK's take on this?

From the article in link above:

Treatment outcome studies have shown IBT to be an effective treatment for OCD. It is also an effective treatment for the treatment of resistant cases of OCD, and those who have been unable to benefit from other treatments.

As of 2017, around forty empirical papers have been published on inference-based therapy. In particular, two randomized controlled trials showed that inference-based therapy was as efficacious as cognitive-behaviour therapy for obsessive-compulsive disorder. For further reading, please see published scientific articles by visiting our Tools and References page.

[taurean]

It's an interesting concept, and I like the idea of it for use where standard CBT isn't producing the goods. 

Not sure if I myself like the idea, as of now, of it as a direct alternative to CBT. 

I would like to know more about who has developed this approach and why. Standard CBT has been around for a very long time but hasn't stayed still - it has grown with new thinking and is widely accepted. 

[felix4]

Quote

Another important difference between IBT and standard CBT is that IBT does not include exposure in vivo and response prevention (ERP). This behavioral technique consists of exposing oneself to feared objects and situations without engaging in any rituals or compulsions to overcome OCD. However, while this can be an effective technique, not all OCD patients benefit from ERP and there are a lot of people with OCD who have difficulty completing the exercises needed for this approach to work. However, it is still an important part of standard CBT, often more so than cognitive interventions.

It sounds good, providing that sufferers do give CBT/ERP a thorough go first & are found to be treatment resistant. But, having said that, I do have to question what is treatment resistant? For example, it might be that the sufferer has had CBT, but not found a good enough therapist yet.

Also does this mean ERP is not needed? If so, I wonder if some will opt for this technique as an avoidance to the hard work of ERP perhaps?

 

 

[dksea]

When it comes to medicine, whether it be for physical problems or mental problems, I support an evidence based approach.  I want to know that whatever solution I am being offered has been tried and demonstrated to work, or if it is a new/experimental approach that there is sufficient supporting evidence and logic to suggest it will work.

CBT has been shown to be effective in treating OCD for most people.  In some of those who don't find CBT alone effective, adding medication to the treatment plan can increase the possibility of improvement with CBT.  There is ample evidence to demonstrate that this is true.

So we set that as our baseline.  CBT is the measuring stick we should use when comparing other treatment possibilities.  

When considering alternative options such as IBT we should ask the following three questions:

1. What evidence do we have to support IBT as an effective for of treatment for OCD?  Are there studies that have been done that demonstrate this?  How many studies?  How many people were involved?  What is the stance on the relative organizations (such as the NHS in the UK, or the American Psychiatric Association in the US) towards this treatment?  Anyone suggesting a new treatment methodology should be happy to provide this kind of information.  If they are reluctant, it should raise some red flags.

2. If the treatment seems to pass the first test, the next question is:  How does this treatments effectiveness compare with the current top standard (for OCD that being CBT).  If IBT is effective in only half as many cases as CBT then you probably want to reconsider.  On the other hand if its not as effective as CBT in general, but very effective for people who struggle with CBT then it might be worth a shot in those circumstances.  But its important to say "is this as good/better for my situation than the current best option."

3. Finally, the last of the three main points to consider, is what are the risks/downsides of this kind of treatment vs the standard option.  If the new treatment is highly effective but carries more risk, it might not be worth it.  You hear, IBT can cure 90% of people with OCD!  "Great!" You think.  Then you learn that 25% of the people who do that treatment develop a different problem, possible a worse one.  Suddenly that new treatment isn't so appealing.

So where does IBT actually fall in those three areas?  Its hard to tell.  I have a few studies that seem to suggest it can be effective treatment in some situations, so thats a start.  It appears there are other studies currently underway or finishing as well.  Perhaps there is potential in this treatment, but i'd probably want to know more if i were looking at it seriously. It does not seem like there are a large number of practitioners of IBT yet, this website only lists a single reference in the US, the UK, and a number of other countries.  There are multiple people listed in Canada, which appears to be where this approach was started.

So it seems like, unless you live in Montreal or Quebec you'll have a hard time accessing this treatment methodology anyway.

[Orwell1984]

7 hours ago, felix4 said:

It sounds good, providing that sufferers do give CBT/ERP a thorough go first & are found to be treatment resistant. But, having said that, I do have to question what is treatment resistant? For example, it might be that the sufferer has had CBT, but not found a good enough therapist yet.

Also does this mean ERP is not needed? If so, I wonder if some will opt for this technique as an avoidance to the hard work of ERP perhaps?

 

 

Treatment resistant OCD is usually found if there is another condition that sits alongside. I've read studies that suggest that CBT is not very effective in some people who are in the autistic spectrum. I will try dig these studies up. I had found that doing ERP on my own did not work and heightened my anxiety to the point of 'psychotic depression with labile mood'' so a psychologist at the time labelled me. The 4 steps I have to add DID help me along with a psychologist who suggested advice and behaviours to adopt to leave an abusive relationship behind. This helped.

CBT resistant OCD in people with ASD studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559438/

https://www.ncbi.nlm.nih.gov/m/pubmed/27716920/

Edited February 15, 2019 by Orwell1984

[Orwell1984]

5 hours ago, dksea said:

When it comes to medicine, whether it be for physical problems or mental problems, I support an evidence based approach.  I want to know that whatever solution I am being offered has been tried and demonstrated to work, or if it is a new/experimental approach that there is sufficient supporting evidence and logic to suggest it will work.

CBT has been shown to be effective in treating OCD for most people.  In some of those who don't find CBT alone effective, adding medication to the treatment plan can increase the possibility of improvement with CBT.  There is ample evidence to demonstrate that this is true.

So we set that as our baseline.  CBT is the measuring stick we should use when comparing other treatment possibilities.  

When considering alternative options such as IBT we should ask the following three questions:

1. What evidence do we have to support IBT as an effective for of treatment for OCD?  Are there studies that have been done that demonstrate this?  How many studies?  How many people were involved?  What is the stance on the relative organizations (such as the NHS in the UK, or the American Psychiatric Association in the US) towards this treatment?  Anyone suggesting a new treatment methodology should be happy to provide this kind of information.  If they are reluctant, it should raise some red flags.

2. If the treatment seems to pass the first test, the next question is:  How does this treatments effectiveness compare with the current top standard (for OCD that being CBT).  If IBT is effective in only half as many cases as CBT then you probably want to reconsider.  On the other hand if its not as effective as CBT in general, but very effective for people who struggle with CBT then it might be worth a shot in those circumstances.  But its important to say "is this as good/better for my situation than the current best option."

3. Finally, the last of the three main points to consider, is what are the risks/downsides of this kind of treatment vs the standard option.  If the new treatment is highly effective but carries more risk, it might not be worth it.  You hear, IBT can cure 90% of people with OCD!  "Great!" You think.  Then you learn that 25% of the people who do that treatment develop a different problem, possible a worse one.  Suddenly that new treatment isn't so appealing.

So where does IBT actually fall in those three areas?  Its hard to tell.  I have a few studies that seem to suggest it can be effective treatment in some situations, so thats a start.  It appears there are other studies currently underway or finishing as well.  Perhaps there is potential in this treatment, but i'd probably want to know more if i were looking at it seriously. It does not seem like there are a large number of practitioners of IBT yet, this website only lists a single reference in the US, the UK, and a number of other countries.  There are multiple people listed in Canada, which appears to be where this approach was started.

So it seems like, unless you live in Montreal or Quebec you'll have a hard time accessing this treatment methodology anyway.

These are extremely good points. Definitely something to keep an eye on and see if more studies come up 

Inference based approach to OCD- studies:

https://scholar.google.co.uk/scholar?hl=en&as_sdt=0%2C5&q=inference+based+approach+ocd&oq=inference+based+approach

Edited February 15, 2019 by Orwell1984

[Orwell1984]

I would love to hear Paul Salkovskis' take on this and OCDUK's.

[Angst]

Hi    Just based on the first article cited by Orwell1984ut seems to me that the reasoning model or appraisal model of IBA is probability based with the use of the word ‘maybe’ whilst the reasoning model of CBT is based on conditional logic with the use of ‘if......then’. So, for example, with IBA I would say ‘maybe I left the tap on’ with CBT the reasoning would be ‘if I left the tap on then there would be a flood’.

For me, the if......then reasoning characterised my OCD. I am quite certain in my own mind that there will be a flood. So I return to check the tap. And ERP is the strategy for me.

[taurean]

If something else is of benefit then that would be fine by me. 

But I believe in evidence based therapy, and I also believe, massively, that ERP is needed to claw back the life restrictions OCD places on us. 

And I don't accept that probability, and maybe, maybe not, aren't part of CBT. They were part of what I was taught. 

 

[Orwell1984]

Probability and maybe/maybe not is the approach that worked for me too.

[taurean]

3 hours ago, Orwell1984 said:

I would love to hear Paul Salkovskis' take on this and OCDUK's.

But perhaps they are much too busy helping people to recover via CBT? 

CBT was the core, but not the finality, of my work. I needed to add The Four Steps mindfulness and love kindness to the mix. 

And use CBT to tackle my 4 negative thinking distortions. 

So there is no reason why beneficial elements from IBA can't be added to someone's therapy mix. 

I don't see other therapies as mutually-exclusive, but potentially a good addition to CBT if they might help. 

Edited February 15, 2019 by taurean

[Ashley]

12 hours ago, Orwell1984 said:

http://ibaocs.com/what-is-iba/

What is OCDUK's take on this?

From the article in link above:

Treatment outcome studies have shown IBT to be an effective treatment for OCD. It is also an effective treatment for the treatment of resistant cases of OCD, and those who have been unable to benefit from other treatments.

As of 2017, around forty empirical papers have been published on inference-based therapy. In particular, two randomized controlled trials showed that inference-based therapy was as efficacious as cognitive-behaviour therapy for obsessive-compulsive disorder. For further reading, please see published scientific articles by visiting our Tools and References page.

 

Another therapy approach that pretends to be new and different, but is actually CBT based and I actually don't see how it differs much, if at all from CBT understanding of the problem  (or rather how a good CBT therapist that understands OCD would approach it.

Try it, if it helps great. 

 

 

[Angst]

The original quoted article made an issue out the supposed maybe/conditional logic distinction. I personally think that therapy is a route from conditional logic (if...then) to maybe and then experiment.