CBT — Cognitive Behavioural Therapy
Targets the cognition ↔ emotion ↔ behaviour loop. Core techniques: cognitive restructuring (identify automatic thoughts/cognitive distortions → test evidence → generate balanced appraisals) and behavioural methods (activation, exposure, experiments). Breaks self‑fulfilling cycles (catastrophic prediction → avoidance → confirmation). First‑line across depression and anxiety disorders.
DBT — Dialectical Behaviour Therapy
Developed for borderline PD/chronic self‑harm. Structure: individual therapy + skills group + phone coaching + consultation team. Four skill modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness. The dialectic = acceptance ↔ change ("your suffering is valid AND these behaviours must change"). Strong evidence for reducing self‑harm and admissions.
ERP — Exposure and Response Prevention
The specific, evidence‑based CBT variant for OCD. Graded exposure to the feared trigger while preventing the compulsion, so the anxiety habituates and the negative‑reinforcement cycle is broken. The therapeutic learning: the feared outcome doesn't occur and anxiety subsides without the ritual. Reassurance is a covert compulsion — ERP withholds it.
Pitfalls
- Doing "exposure" while permitting subtle reassurance/safety behaviours (undermines ERP).
- Fragmentary DBT (skills group alone) for high‑risk borderline PD.
Pearls
- 🎯 CBT → cognition/behaviour; DBT → emotion regulation (acceptance + change); ERP → the OCD cycle.
- 🩺 In OCD, stop giving reassurance — it maintains the disorder.
Next → The most misunderstood biological treatment (Concept 49).