1. How Conicia is built

Conicia is built on four evidence-based traditions, integrated into one prescribed course: Exposure and Response Prevention, Inference-Based CBT, Acceptance and Commitment Therapy, and OCD pharmacotherapy. The methodologies are not new. The integration is. Each is named below with its evidence base, the role it plays in a client's course, and the design choices we made because of it.

2. Exposure and Response Prevention (ERP)

The IOCDF-endorsed first-line behavioral treatment for OCD. The course content and the Exposure Tool follow Craske's inhibitory learning model, not the older Marlatt habituation model. The clinical aim is not for distress to drop during exposure. It is for the client to build new learning that the feared outcome does not require the ritual. Foa, Yadin and Lichner's Exposure and Response (Ritual) Prevention for OCD: Therapist Guide (2012) is the canonical clinical reference. Inhibitory learning principles are from Craske et al., Behaviour Research and Therapy (2014).

In the client app, ERP runs through the Exposure Tool (multi-ladder ERP planner and write-once logger) and Sitting With The Urge (response prevention container, no visible countdown, no breathing exercises, no habituation framing). The "what you'll resist" field on every ladder step is patient-authored before the exposure, in a calm state, so the client commits to refusing specific mental compulsions rather than discovering them mid-exposure.

3. Inference-Based CBT (I-CBT)

Increasingly named in the IOCDF treatment guide as the cognitive complement to ERP. I-CBT addresses the inferential confusion that lets a client treat an imagined OCD story as if it were sense data. The clinical move is discrimination, telling the OCD bubble from present-moment reality, not truth-value adjudication. Aardema's multicenter RCT (Psychotherapy and Psychosomatics, 2022, PMID 35584639) demonstrated I-CBT's efficacy. O'Connor and Aardema's Clinician's Handbook for Obsessive Compulsive Disorder: Inference-Based Therapy (2012) is the canonical clinical reference.

In the client app, I-CBT runs through the Understanding Doubt lessons, where the client practices noticing when they have crossed from sense data into the OCD story. That discrimination move also surfaces as one of the defusion techniques inside Unhook from a thought. It is a skill-building practice for calm moments, never a coping tool to reach for during active obsessions, which would make it a compulsion. The I-CBT toggle on the client header controls whether I-CBT content appears for that client; it stays on by default and can be turned off when ERP-only is the clinical choice.

A good way to learn enough I-CBT to assign with confidence. Not a substitute for I-CBT training. For that, see the Aardema team at icbt.online.

4. Acceptance and Commitment Therapy (ACT)

A supporting tradition, not a primary one. ACT plays two roles in Conicia: defusion as a skill for sticky thoughts, and values work as the orientation that makes ERP worth doing. Hayes, Strosahl and Wilson's foundational ACT work is the reference.

In the client app, ACT runs through Unhook from a thought (a single randomly-selected defusion technique per session, anti-shopping by design) and through the values content in the "A Few Things to Carry With You" module, which appears in the course not as inspiration but as the answer to "why do this hard work at all."

5. OCD pharmacotherapy

The course teaches clients, properly, how OCD works in the brain, how SSRIs work for OCD, why dosing for OCD often runs higher than for depression, what to consider when first-line treatments are not enough (augmentation, TMS), and when to ask their prescriber about a next step. The references are the IOCDF treatment guide for medication, the APA OCD practice guidelines, and the SSRI-for-OCD dosing literature.

This content was authored by Weston Scott Fisher, MD, a psychiatrist who has spent more than a decade treating OCD and co-directed the OCD clinic at UCSF. He continues to see OCD patients at Anxiety Relief Clinic.

6. Design choices that follow from the methodology

The product non-negotiables exist because of the clinical literature, not because of preference.

• No gamification. Streaks, badges, points, and completion percentages mirror the maintenance mechanism of OCD itself.
• No AI-generated patient-facing content. The reassurance-vector risk in AI tools for OCD is documented (Golden & Aboujaoude, npj Digital Medicine, 2026).
• No keyword scanning of patient logs. Clinical decisions belong to the clinician, not to a classifier.
• No reassurance vectors in patient copy. Even well-intentioned reassurance reinforces compulsions.
• Tools reward use-and-leave, not engagement. Between-session containment without time-in-app farming.
• Lesson-paired tool use. Misuse of a tool can be worse than no tool, so we recommend introducing each tool only after the patient has worked the lessons that teach correct use. In the beta tools are accessible at any time; the pairing is a clinical recommendation, not an in-app lock.
• Write-once, append-only patient logs. Built for session-prep review, not for editable retrospection.
• Crisis resources uniform and non-adaptive. An algorithm deciding what crisis resources are "right" at the worst possible moment is a harm vector not worth the personalization benefit.

7. References

1. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy. 2014;58:10-23. PubMed
2. Aardema F, et al. Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial. Psychotherapy and Psychosomatics. 2022. PubMed 35584639
3. Foa EB, Yadin E, Lichner TK. Exposure and Response (Ritual) Prevention for OCD: Therapist Guide. Treatments That Work series, Oxford University Press, 2012.
4. O'Connor K, Aardema F. Clinician's Handbook for Obsessive Compulsive Disorder: Inference-Based Therapy. Wiley-Blackwell, 2012.
5. Abramowitz JS. Getting Over OCD: A 10-Step Workbook for Taking Back Your Life. Guilford, 2018.
6. Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. Guilford, 2011.
7. Golden RL, Aboujaoude E. A transdiagnostic model for how general purpose AI chatbots can perpetuate OCD and anxiety disorders. npj Digital Medicine. 2026.
8. International OCD Foundation, treatment guide. iocdf.org.