Slide
Centre Interdisciplinaire
de Recherche et d’Innovation
en Cybersécurité et Société
de Recherche et d’Innovation
en Cybersécurité et Société
1.
Ouellet-Courtois, C.; Bouchard, S.; Giguère, C. -E.; Koszycki, D.; Lavoie, M. E.; Aardema, F.
Cognitive mechanisms of change in OCD: Inferential confusion, obsessive beliefs, and mindfulness across three randomized treatments Journal Article
In: Behaviour Research and Therapy, vol. 201, 2026, ISSN: 00057967 (ISSN).
Abstract | Links | BibTeX | Tags: adult, antidepressant agent, Anxiety disorder, article, behavior therapy, benzodiazepine, clinical outcome, clinical trial, cognition, cognitive behavioral therapy, Cognitive mechanisms of change, confusion, confusion (uncertainty), controlled study, Depression, exposure and response prevention, female, human, Humans, Implosive Therapy, inference based cognitive behavioral therapy, Inferential confusion, major clinical study, male, Middle Aged, mindfulness, mindfulness-based stress reduction, multicenter study, obsession, obsessive compulsive disorder, Obsessive-Compulsive Disorder, procedures, psychology, randomized controlled trial, risk factor, Sensitivity analysis, Therapy, treatment outcome, Young Adult
@article{ouellet-courtoisCognitiveMechanismsChange2026,
title = {Cognitive mechanisms of change in OCD: Inferential confusion, obsessive beliefs, and mindfulness across three randomized treatments},
author = {C. Ouellet-Courtois and S. Bouchard and C. -E. Giguère and D. Koszycki and M. E. Lavoie and F. Aardema},
url = {https://www.scopus.com/pages/publications/105034701697?origin=resultslist},
doi = {10.1016/j.brat.2026.105022},
issn = {00057967 (ISSN)},
year = {2026},
date = {2026-01-01},
journal = {Behaviour Research and Therapy},
volume = {201},
publisher = {Elsevier Ltd},
abstract = {Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is widely regarded as the gold-standard psychological treatment for obsessive–compulsive disorder (OCD). Inference-based cognitive behavioral therapy (I-CBT) represents a distinct cognitive approach that targets inferential confusion, defined as a reasoning process whereby imagined possibilities are treated as reflecting reality, without relying on deliberate exposure. The present study reports further mechanism-focused analyses from a previously published multicenter randomized controlled trial (Aardema et al., 2022; ClinicalTrials.gov Identifier: NCT01794156) comparing CBT with ERP, I-CBT, and mindfulness-based stress reduction (MBSR) for OCD. A total of 111 participants with a primary diagnosis of OCD were randomized to one of three treatment conditions. Across treatments, therapy was associated with significant reductions in inferential confusion and obsessive belief domains, whereas dispositional mindfulness did not show significant change. At the bivariate level, residualized changes in inferential confusion, obsessive belief domains, and mindfulness were associated with reductions in OCD symptoms. However, when examined concurrently using mixed-effects models, only reductions in inferential confusion accounted for unique symptom improvement over time. This association was consistent across modalities and remained robust after controlling for concurrent anxiety and depression. Sensitivity analyses indicated that psychotropic medication use did not account for this association; controlling for medication strengthened the independent contribution of inferential confusion (partial η2 ≈ .29). These findings indicate that inferential confusion was independently associated with symptom improvement in OCD across therapeutic approaches. © 2026 Elsevier Ltd},
keywords = {adult, antidepressant agent, Anxiety disorder, article, behavior therapy, benzodiazepine, clinical outcome, clinical trial, cognition, cognitive behavioral therapy, Cognitive mechanisms of change, confusion, confusion (uncertainty), controlled study, Depression, exposure and response prevention, female, human, Humans, Implosive Therapy, inference based cognitive behavioral therapy, Inferential confusion, major clinical study, male, Middle Aged, mindfulness, mindfulness-based stress reduction, multicenter study, obsession, obsessive compulsive disorder, Obsessive-Compulsive Disorder, procedures, psychology, randomized controlled trial, risk factor, Sensitivity analysis, Therapy, treatment outcome, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is widely regarded as the gold-standard psychological treatment for obsessive–compulsive disorder (OCD). Inference-based cognitive behavioral therapy (I-CBT) represents a distinct cognitive approach that targets inferential confusion, defined as a reasoning process whereby imagined possibilities are treated as reflecting reality, without relying on deliberate exposure. The present study reports further mechanism-focused analyses from a previously published multicenter randomized controlled trial (Aardema et al., 2022; ClinicalTrials.gov Identifier: NCT01794156) comparing CBT with ERP, I-CBT, and mindfulness-based stress reduction (MBSR) for OCD. A total of 111 participants with a primary diagnosis of OCD were randomized to one of three treatment conditions. Across treatments, therapy was associated with significant reductions in inferential confusion and obsessive belief domains, whereas dispositional mindfulness did not show significant change. At the bivariate level, residualized changes in inferential confusion, obsessive belief domains, and mindfulness were associated with reductions in OCD symptoms. However, when examined concurrently using mixed-effects models, only reductions in inferential confusion accounted for unique symptom improvement over time. This association was consistent across modalities and remained robust after controlling for concurrent anxiety and depression. Sensitivity analyses indicated that psychotropic medication use did not account for this association; controlling for medication strengthened the independent contribution of inferential confusion (partial η2 ≈ .29). These findings indicate that inferential confusion was independently associated with symptom improvement in OCD across therapeutic approaches. © 2026 Elsevier Ltd
2.
Aardema, F.; Bouchard, S.; Koszycki, D.; Lavoie, M. E.; Audet, J. -S.; O'Connor, K.
In: Psychotherapy and Psychosomatics, vol. 91, no. 5, pp. 348–359, 2022, ISSN: 00333190 (ISSN), (Publisher: S. Karger AG).
Abstract | Links | BibTeX | Tags: adult, aged, appraisal based cognitive behavioral therapy, article, clinical effectiveness, clinical evaluation, clinical outcome, clinical trial, cognitive behavioral therapy, Cognitive-behavioral therapy, controlled study, disease severity, female, human, Humans, inference based cognitive behavioral therapy, Inference-based approach, intermethod comparison, major clinical study, male, mindfulness, mindfulness-based stress reduction, multicenter study, obsessive compulsive disorder, Obsessive-Compulsive Disorder, patient dropout, procedures, randomized controlled trial, remission, treatment outcome, treatment refusal, Yale Brown Obsessive Compulsive Scale
@article{aardema_evaluation_2022,
title = {Evaluation of Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial with Three Treatment Modalities},
author = {F. Aardema and S. Bouchard and D. Koszycki and M. E. Lavoie and J. -S. Audet and K. O'Connor},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85131012874&doi=10.1159%2f000524425&partnerID=40&md5=ff9a6095068e094c394e952eca4ca318},
doi = {10.1159/000524425},
issn = {00333190 (ISSN)},
year = {2022},
date = {2022-01-01},
journal = {Psychotherapy and Psychosomatics},
volume = {91},
number = {5},
pages = {348–359},
publisher = {S. Karger AG},
abstract = {Introduction: Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. Objective: The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. Methods: This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. Results: All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. Conclusions: I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated. © 2022 The Author(s). Published by S. Karger AG, Basel.},
note = {Publisher: S. Karger AG},
keywords = {adult, aged, appraisal based cognitive behavioral therapy, article, clinical effectiveness, clinical evaluation, clinical outcome, clinical trial, cognitive behavioral therapy, Cognitive-behavioral therapy, controlled study, disease severity, female, human, Humans, inference based cognitive behavioral therapy, Inference-based approach, intermethod comparison, major clinical study, male, mindfulness, mindfulness-based stress reduction, multicenter study, obsessive compulsive disorder, Obsessive-Compulsive Disorder, patient dropout, procedures, randomized controlled trial, remission, treatment outcome, treatment refusal, Yale Brown Obsessive Compulsive Scale},
pubstate = {published},
tppubtype = {article}
}
Introduction: Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. Objective: The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. Methods: This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. Results: All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. Conclusions: I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated. © 2022 The Author(s). Published by S. Karger AG, Basel.
3.
Aardema, F.; Bouchard, S.; Koszycki, D.; Lavoie, M. E.; Audet, J. -S.; O'Connor, K.
In: Psychotherapy and Psychosomatics, vol. 91, no. 5, pp. 348–359, 2022, ISSN: 00333190 (ISSN).
Abstract | Links | BibTeX | Tags: adult, aged, appraisal based cognitive behavioral therapy, article, clinical effectiveness, clinical evaluation, clinical outcome, clinical trial, cognitive behavioral therapy, Cognitive-behavioral therapy, controlled study, disease severity, female, human, Humans, inference based cognitive behavioral therapy, Inference-based approach, intermethod comparison, major clinical study, male, mindfulness, mindfulness-based stress reduction, multicenter study, obsessive compulsive disorder, Obsessive-Compulsive Disorder, patient dropout, procedures, randomized controlled trial, remission, treatment outcome, treatment refusal, Yale Brown Obsessive Compulsive Scale
@article{aardemaEvaluationInferenceBasedCognitiveBehavioral2022,
title = {Evaluation of Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial with Three Treatment Modalities},
author = {F. Aardema and S. Bouchard and D. Koszycki and M. E. Lavoie and J. -S. Audet and K. O'Connor},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85131012874&doi=10.1159%2f000524425&partnerID=40&md5=ff9a6095068e094c394e952eca4ca318},
doi = {10.1159/000524425},
issn = {00333190 (ISSN)},
year = {2022},
date = {2022-01-01},
journal = {Psychotherapy and Psychosomatics},
volume = {91},
number = {5},
pages = {348–359},
publisher = {S. Karger AG},
abstract = {Introduction: Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. Objective: The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. Methods: This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. Results: All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. Conclusions: I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated. © 2022 The Author(s). Published by S. Karger AG, Basel.},
keywords = {adult, aged, appraisal based cognitive behavioral therapy, article, clinical effectiveness, clinical evaluation, clinical outcome, clinical trial, cognitive behavioral therapy, Cognitive-behavioral therapy, controlled study, disease severity, female, human, Humans, inference based cognitive behavioral therapy, Inference-based approach, intermethod comparison, major clinical study, male, mindfulness, mindfulness-based stress reduction, multicenter study, obsessive compulsive disorder, Obsessive-Compulsive Disorder, patient dropout, procedures, randomized controlled trial, remission, treatment outcome, treatment refusal, Yale Brown Obsessive Compulsive Scale},
pubstate = {published},
tppubtype = {article}
}
Introduction: Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. Objective: The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. Methods: This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. Results: All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. Conclusions: I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated. © 2022 The Author(s). Published by S. Karger AG, Basel.