When you first enter the world of therapy, you might not know exactly where to start. That might have something to do with a feeling that you don’t know the lingo and can’t make sense of the alphabet soup. Every therapist will have a slew of letters behind their name – LCSW, PsyD, CST, LMFT, etc – and possibly an equally mystifying list of areas of expertise: DBT, ACT, EMDR, CBT. If you aren’t feeling up for the challenge, decoding this puzzle could be enough of a barrier to stop you from getting the help that you are searching for. We are here to break it down for you and explain what these acronyms mean, why your therapist at Wildflower uses them, and which ones might be best for you.
What are EBPs?
DBT, ACT, EMDR, CBT are examples of what is called evidence-based treatment or evidence-based practice. Evidence-based practices (EBPs) are clinical approaches that are backed by scientific evidence. Studies have been conducted and extensive research has been documented on a particular treatment, and it has proven to be successful. The goal of EBPs is to encourage the use of safe and effective treatments likely to achieve results and to lessen the use of unproven, potentially unsafe treatments.
EBPs in psychotherapy evolved from Evidence-Based Medicine (developed in 1992). EBM was designed to encourage the use of safe, effective, and proven to work treatments vs “throwing spaghetti at the wall.” There is wide organizational support for the use of EBPs. Psychological organizations like American Psychological Association (APA) and Substance Use and Mental Health Services Administration (SAMHSA) support the use of EBPs. SAMHSA also approves the list of all EBPs (Nathan, 2004). While there is an argument that all forms of psychotherapy offer some benefit, EBPs originated to ensure psychotherapists were guided by research and using proven and effective methods with their clients.
At Wildflower, we believe that EBPs guide ethical and effective treatment. And we also respect the art of therapy in addition to the science: Just as the goodness of fit between therapist and client has intangible qualities, so too does the type of approach that will resonate for each person. A manual might guide the way, but each therapist carries their own lantern to illuminate the path. We hope understanding the options empowers you to find a therapist and a method that works for you.
Common EBPs you will encounter in psychotherapy include:
Acceptance and Commitment Therapy (ACT)
Cognitive Behavior Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Eye Movement Desensitization and Reprocessing (EMDR)
Exposure and Response Prevention (ERP)
What is ACT?
Acceptance and Commitment Therapy, or ACT (pronounced like the word “act”), is a mindful approach to accepting the hardships in life to improve one’s overall quality of living. Developed by Dr. Steven Hayes, ACT is a third wave behavioral therapy approach. This means it was preceded by two other waves of behavioral therapies. It evolved into an approach that focused more on processes related to acceptance in addition to change.
ACT helps people focus on the present and move forward from overwhelming, difficult emotions. It is designed to empower individuals to diffuse the impact of difficult emotions and change your relationship to your thoughts to treat depression, anxiety, and other similar concerns.
Using 6 core processes, ACT addresses the pain that comes with avoidance, fusion with unhelpful thoughts, fixation on the past or future, overidentifying with the stories we tell ourselves, lack of direction, and stuckness. These 6 core processes are: acceptance, cognitive defusion, mindfulness, self as context, values, and committed actions (Harris, 2021). An ACT therapist will help you connect with what matters to you (your core values) and without judgment begin to address what is getting in the way of leading that value-based life. By setting committed actions in line with these values, an individual will begin to mindfully move toward a life that they want to be present in.
Who benefits from ACT?
ACT is helpful for anyone interested in living a more mindful and values driven life. It has been proven to be especially effective with those struggling with depression and long standing mood disorders, intrusive thoughts, anxiety disorders, trauma, recent significant loss and/ or sense of failure, self doubt, low self worth, social phobias, and maladaptive substance use.
What is CBT?
Cognitive Behavior Therapy (CBT) was a groundbreaking second wave behavioral therapy in the 1960’s. Dr. Aaron Beck was a researcher and clinician who is recognized as the pioneer of CBT. Not only is CBT evidence-based, it has been found to be effective in over 2000 clinical trials for a wide range of concerns.
CBT is a bit of a mental makeover; it’s rooted in the idea that the way people perceive a situation or circumstance is more relevant to their emotional state than the situation itself. CBT helps people identify and change negative thought patterns and behaviors. With a focus on understanding how thoughts, feelings, and behaviors are all connected, CBT aims to develop healthier coping mechanisms and improve overall wellbeing. It is time sensitive, structured, and solution focused. (Beck Institute, 2023)
The CBT triangle (below), also known as the cognitive triangle, illustrates this connection. The primary goal of CBT is to recognize and alter negative thought patterns and thereby change both feelings and behaviors.
In addition to identifying cognitive distortions, or unhelpful thought patterns, and restructuring them, a CBT therapist will use interventions including (but not limited to) journaling, relaxation techniques, exposure to activating thoughts and feelings, and playing the script till the end to explore worst case scenarios. (https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/)
Who benefits from CBT?
CBT is proven to be particularly helpful for those coming to therapy for depression, phobias, eating disorders, substance use disorders, anxiety, sleep disorders, obsessive-compulsive disorder (OCD), and bipolar disorder. The present focused nature and time limited treatment approach makes CBT attractive to people who are hoping to make progress on specific goals and might not be interested in pursuing therapy long-term.
What is DBT?
Dialectical Behavior Therapy (DBT) is a third wave mindfulness-based therapy developed by Marsha Linehan to treat emotional dysregulation and life threatening behaviors. The first randomized control trial was published in 1991 and has since continued to be proven to offer significant improvements for individuals suffering with problems in regulating emotions, coping with stressors, and difficult interpersonal relationships. While DBT was originally developed to treat Borderline Personality Disorder, it is now widely known as an effective approach to treat a variety of people and presenting concerns.
DBT balances acceptance and change strategies with a focus on validation. Where other therapeutic approaches might give you skills to “fix” what’s wrong, DBT takes time to validate and accept things as they are and also provides skills to help people cope effectively and create a meaningful life they want to present in. This is what the “D” in DBT is about. Dialectics, a philosophy that means two seemingly opposite things can be true at the same time. For example, instead of approaching your depressed mood by telling yourself “I feel terrible, but I’ll get out of bed and go to work,” dialectics allow both statements to be true and valid. “I feel terrible, and I’m going to get out of bed and go to work. And I can be gentle with myself.” Your feelings are valid and how you respond to them is your choice.
The “B” in DBT is the behavioral part of the therapy. DBT teaches skills based in four categories:
- Mindfulness: the practice of being fully aware and present in this one moment
- Distress Tolerance: how to tolerate pain in difficult situations, not change it
- Interpersonal Effectiveness: how to ask for what you want and say “no” while maintaining self-respect and relationships with others
- Emotion Regulation: how to change emotions that you want to change
DBT therapists believe we are all doing the best we can with the skills that we have, and you can learn skills to cope more effectively. As Maya Angelou says, “Do the best you can until you know better. Then when you know better, do better.”
Who benefits from DBT?
As mentioned, DBT was originally developed for individuals diagnosed with Borderline Personality Disorder and is now considered a highly researched and validated approach to treat a variety of diagnoses and concerns. DBT is commonly used to treat emotional dysregulation and subsequent behaviors. It can be helpful for those struggling with depression, thoughts of harming oneself, engaging in self-destructive or harming behaviors, anxiety disorder, Post Traumatic Stress Disorder, eating disorders, and substance use disorders. DBT allows people to reflect without judgment on what is and isn’t working in their lives and make changes based on what they hope for themselves. It is not about right or wrong or good or bad, it is and isn’t working for a person in their life.
What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a highly structured therapy. It encourages the patient to focus briefly on the trauma memory while simultaneously experiencing something called bilateral stimulation (typically side-to-side eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories. EMDR therapy is an extensively researched, effective psychotherapy method proven to help people recover from trauma and PTSD symptoms. The first clinical trial occurred in 1989 and dozens of studies have continued to prove its efficacy.
During EMDR therapy, individuals are guided by a trained therapist and the goal is to help the person reprocess traumatic memories, reducing their emotional intensity and promoting psychological healing.
Who benefits from EMDR?
EMDR is recognized for its effectiveness in alleviating symptoms related to trauma, anxiety, and other stress-related disorders.
What is ERP?
ERP stands for Exposure and Response Prevention. During ERP therapy, individuals deliberately expose themselves to whatever triggers their anxious thoughts or reactions by participating in a real life experience under controlled conditions. Over time, as we experience anxiety, we often become more sensitive to the experience of anxiety for a number of reasons. As a result, we may find ourselves limiting our activities in order to avoid that feeling of distress. This can lead us to engaging in a life that is limited, and not in alignment with our values. ERP engages you in facing your anxiety and challenging that process, which is known as experiential avoidance.
Through ERP you learn to accept and sit with the distress as it naturally reduces over time, rather than engaging in avoidant behaviors that you might typically would use to avoid the distress. With repeated practice, this helps decrease the urges to engage in avoidance following an activating event, and ultimately increase your confidence that you can “survive” the distress and anxiety. This might sound scary and overwhelming, and this is where your therapist can help you learn coping skills and strategies to manage this most effectively.
Like many of the evidence-based practices we’ve discussed, ERP is guided by values and what works for you. If you have a fear of spiders that doesn’t interfere with your value-based life, there’s no need to approach that fear! If you are a park ranger though, and that fear disrupts your ability to do what you love and support your family, ERP helps you increase your ability to tolerate the anxiety and fear that comes from being in close contact with spiders. You might always be afraid, but your relationship to that fear changes so that you can approach versus avoid and do what matters.
Who benefits from ERP?
ERP is helpful in decreasing the urges to engage in avoidance or self-destructive behaviors following a stimulus (thought or situation) and increasing one’s confidence that they can “survive” the distress and anxiety. Therefore ERP is helpful for those who experience anxiety, phobias, and avoidant behaviors. It is most widely used for the treatment of Obsessive Compulsive Disorder (OCD) and is also helpful for Post Traumatic Stress Disorder (PTSD), particularly when avoidance of trauma related stimuli is life interfering.
Evidence-based Practices Summed Up
No one has a crystal ball, therefore no one will be able to tell you which type of therapy will work for you. With the help of your therapist, you can first define what it means for an approach to “work for you” and then identify which evidence-based practice might be the best option to use. Just like you are more than your story, EBPs are more than the acronyms that name them. They are designed to guide therapy versus define it. We hope these explanations help decode some of the mystery so that you can make informed choices in your care. If you would like to learn more about how evidence-based approaches are utilized at Wildflower, reach out for your free initial consultation!
References
Ackerman, Courtney E. (2022, September 10). CBT techniques: 25 cognitive behavioral therapy worksheets. PositivePsychology.com. Retrieved November 5, 2022, from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/
Core Evidence & Research – Behavioral Tech Institute. Behavioral Tech Institute. (2023, July 26). https://behavioraltech.org/evidence/
Evidence-based treatment (EBT). GoodTherapy.org Therapy Blog. (n.d.). Retrieved November 5, 2022, from https://www.goodtherapy.org/blog/psychpedia/evidence-based-treatment
Harris, R. (2021). Act made simple: An easy-to-read primer on acceptance and commitment therapy. Echo Point Books & Media, LLC.
Nathan, P. (2004). The evidence base for evidence-based mental health treatments: four continuing controversies. Brief Treatment and Crisis Intervention, Vol. 4, No. 3. doi: 10.1093/brief-treatment/mhh021. Retrieved from http://btci.stanford.clockss.org/cgi/reprint/4/3/243.pdf
Understanding CBT. Beck Institute. (2023, September 15). https://beckinstitute.org/about/understanding-cbt/
What is EMDR?. EMDR Institute – EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY. (2024, January 3). https://www.emdr.com/what-is-emdr/
