If you’re reading this, chances are you or someone you love is struggling with obsessive-compulsive disorder (OCD). Maybe your mind latches onto upsetting “what if” thoughts, or you feel trapped in routines you have to do to feel safe. Maybe you’ve even tried therapy before—but it didn’t help, or it made you feel worse.
We want you to know something right away: OCD is treatable. At Works Counseling Center, we specialize in evidence-based OCD treatment in Nashville, and we’re here to break down two of the most effective approaches: Exposure and Response Prevention (ERP) and Inference-Based Cognitive Behavioral Therapy (I-CBT).
Let’s talk about what they are, how they differ, and how you can decide which is right for your brain.
You may already know that OCD is more than just being tidy or needing things a certain way. Real OCD involves relentless, unwanted thoughts (obsessions) and behaviors or mental acts (compulsions) that are performed to reduce distress. It’s exhausting. And because OCD can focus on almost anything—germs, harm, religion, sexuality, relationships, identity—it’s often deeply personal and hard to talk about.
That’s why choosing the right therapy is so important. And there’s no one-size-fits-all.
Let’s start with ERP therapy for OCD. ERP is considered the gold standard OCD treatment, with decades of research behind it. It helps you face your triggers and gradually stop doing the rituals that OCD says you “have” to do. Over time, you learn that anxiety goes down on its own—and that nothing terrible happens when you don’t obey OCD’s rules.
Let’s say your OCD tells you that you might get sick if you don’t wash your hands ten times after grocery shopping. ERP would guide you through touching a cart and resisting the urge to wash. You’d ride the wave of anxiety and discover you can survive it—and it eventually fades.
ERP is powerful. Many of our OCD specialists in Tennessee use it with clients who deal with obvious compulsions: washing, checking, tapping, arranging. But it can also work for those with mental rituals—like mentally reviewing conversations or seeking reassurance.
Still, not everyone resonates with ERP. Some clients find it invalidating or traumatizing, especially if their OCD focuses on scary taboo thoughts like harming a child, being a secret pedophile, or committing a sin. That’s where Inference-Based CBT for OCD comes in.
I-CBT (also known as Inference-Based Therapy or IBT) is a newer, cognitive therapy rooted in the idea that OCD isn’t just about anxiety—it’s about doubt. Specifically, it’s about a breakdown in the way we make decisions. People with OCD don’t trust what they see or know—they trust what they imagine might be true, even if it’s extremely unlikely.
Let’s take Ethan, a client who obsesses over whether he might have cheated on his partner—despite zero evidence. He replays memories over and over, trying to figure it out. ERP might ask him to tolerate the uncertainty. I-CBT would dig into how the doubt started. Did that “what if” come from the real world—or did it come from imagination? I-CBT helps clients like Ethan learn to spot the OCD “story” early, so they don’t get pulled into endless mental loops.
Instead of facing fears through exposure, I-CBT works by teaching you to think differently about those fears from the start. It helps rebuild your trust in your own perception and logic. And for many people with “Pure-O” (a term often used for OCD with mainly mental compulsions), I-CBT feels more compassionate, more relatable, and easier to stick with.
So which is better?
The honest answer? It depends on you. At Works Counseling Center in Nashville, we take time to understand what type of OCD you’re dealing with, how your mind works, and what therapy style you’re most likely to connect with. ERP might be your perfect fit if your compulsions are visible and behavior-based. But if you feel misunderstood by previous25 therapists, constantly stuck in thought spirals, or afraid to share your intrusive thoughts, I-CBT might be your best path to healing.
Here’s a quick snapshot of who might benefit most from each:
- ERP is great for folks who can face anxiety head-on and want a structured, challenge-based approach.
- I-CBT is a strong option for people with taboo or moral obsessions, Pure-O symptoms, or high levels of internalized shame and doubt.
- Some people do both, and many therapists at Works are trained in integrating both approaches, depending on what’s helpful at each stage of recovery.
What do clients say about ERP and I-CBT?
People who do well with ERP often say things like, “It was hard at first, but now I’m free,” or “I finally proved to myself that I’m stronger than OCD.” They appreciate that it gets right to the point and teaches them real-life tools to break the cycle.
Clients who love I-CBT say, “For the first time, someone understood what I was actually going through,” or “It helped me make sense of the doubt instead of just fighting it.” They often feel more validated and less pathologized—especially if their OCD themes have felt “too dark” to talk about before.
Not sure where to start? That’s okay. You’re not supposed to know the answer yet.
Here are some questions you can bring to a potential therapist to help guide the conversation:
- Have you been trained in ERP or I-CBT?
- What’s your approach to OCD with mostly mental rituals?
- How do you handle intrusive thoughts about taboo subjects?
- What kind of therapy would you recommend for someone like me?What’s expected of me between sessions?
The truth is, both ERP and I-CBT are evidence-based treatments that can help you take your life back from OCD. They just work in different ways. And your therapist should walk you through those options—not push you into a single model without your input.
At Works Counseling Center, we believe in meeting you where you are. Whether you’re ready to face fears through ERP, want to unpack doubt through I-CBT, or need a mix of both, our team of OCD therapists in Nashville are ready to support you.
We see the whole person, not just the diagnosis. We’ll walk with you through the scary stuff, help you find clarity, and cheer you on every step of the way.
You are not your thoughts. OCD lies. But the right therapy can help you tell a better story.