Nuts & Bolts of Evidence-Based Treatment

Evidence-based treatment is therapy backed by research. This means that protocols have been developed and tested through randomized controlled trials (RCTs) to discover if the treatment works better than a control (i.e. waitlist or another type of therapy). There are several types of evidence-based treatments I practice:

Cognitive Behavioral Therapy (CBT)

CBT is a treatment that helps individuals start to notice automatic thoughts that pop up and begin to understand how these thoughts influence our feelings and behaviors. Through CBT, we can learn to respond differently to our thoughts. For example, we can challenge a negative thought or think about how likely it really is that a worried thought will come to fruition. We can also start to shift our behaviors by approaching situations that we ordinarily may avoid due to fear. CBT is helpful for a variety of conditions, such as anxiety and depression.

Exposure and Response Prevention (ERP)

ERP is a strategy within the CBT framework developed specifically to treat OCD. When we fear something, it makes sense that we want to avoid it. However, the problem with avoidance is that it reinforces the notion that something must really be unsafe, or that we wouldn't be able to tolerate the discomfort if we stayed in that situation. If instead we slowly learn to confront our feared situations, we learn that we are in fact safe and we can tolerate the discomfort better than we may have believed. In addition, ERP also involves decreasing compulsive behaviors, such as hand washing, counting or ritualized behaviors.

Prolonged Exposure (PE) Therapy

PE was developed for individuals with PTSD and is a type of CBT that also involves exposures. Individuals with PTSD are thought to engage in avoidance behaviors that actually maintain their distress. In PE, there are two types of exposures. The first is in session exposures, where we would face the memories of the trauma by sharing our trauma narrative repeatedly with a therapist. The second exposure involves in vivo exposures outside of session, which involves confronting the people, places or situations that remind us of the trauma. Over time, by processing the trauma, both the trauma memory and reminders of the trauma become less scary and interfering.

Acceptance and Commitment Therapy (ACT)

While at times it is useful to challenge unhelpful thoughts, at other times we may get caught in a thought spiral that is counterproductive. In these situations, it can be more helpful to use an acceptance approach. ACT is all about accepting or "acknowledging" our anxious/negative thoughts and in turn giving less power and attention to these thoughts. ACT takes a values-oriented approach, whereby we can ask ourselves "How can I live a life with fear/anxiety/sadness and still move in a direction towards my values?"

Dialectical Behavior Therapy (DBT)

DBT was originally developed for borderline personality disorder and is a very helpful treatment for regulating emotions. DBT skills can be helpful for putting our suffering in the context of everything going on in our lives. DBT emphasizes the balance between acceptance and change and encourages self-validation. We live in a world of hardship and unfortunately pain is inevitable- therefore, how can we be gentle with ourselves while also encouraging ourselves to be open to reflection, change and progress? DBT teaches skills related to mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation, which can be helpful in times of intense emotions.

In later blog posts, I will get more in depth about skills related to each type of therapy. Please feel free to leave any questions or comments about a particular type of therapy you are curious to learn more about. Feel free to also check out the Therapy Resources page for referral options if you are interested in seeking out treatment.