Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and Adolescents

Inference-Based Cognitive-Behavioral Therapy (I-CBT) offers a distinct approach to obsessive–compulsive disorder (OCD) that is conceptually different than the traditional CBT model, emphasizing inferential confusion – the tendency to treat imagined possibilities as equivalent to reality – and how compulsions reinforce this misperception. By highlighting the difference between imagination and reality, I-CBT targets the cognitive processes that maintain obsessive thinking. Although studies on adults have shown promising outcomes, its application in children and adolescents remains limited. This article reviews the theoretical foundations of I-CBT, considers the key developmental factors, and illustrates its clinical application through a case report of a 13-year-old girl with danger-related intrusive thoughts and compulsive rituals. Developmental aspects such as heightened imaginative capacity, evolving metacognition, and family accommodation in cases of pediatric OCD are examined as contributors to symptom maintenance and potential therapeutic leverage points. By integrating the evidence obtained from adult-based I-CBT studies with established pediatric OCD interventions, the discussion identifies the opportunities for innovation and adaptation. Despite the lack of controlled pediatric trials, preliminary clinical observations suggest that I-CBT may serve as a developmentally sensitive alternative or complement to exposure-based CBT for children. Future studies should evaluate the feasibility, mechanisms of change, and the role of parental involvement. Overall, I-CBT represents a promising emerging intervention capable of expanding the treatment options for children and adolescents with OCD.