What's the difference between Cognitive-Behavioral Therapy, Exposure Therapy, and Exposure with Response Prevention?
It can be quite confusing for clients to figure out what kind of therapy they need. They may have been told by one person they need “exposure therapy,” while another said they would benefit most from “CBT.” Let’s examine each of these terms to figure out what they mean and why people are frequently using them interchangeably, even though they aren’t actually the same things.
Cognitive-Behavioral Therapy (often abbreviated CBT) sounds like a single type of therapy, but it isn’t. Cognitive-Behavioral Therapy refers to Cognitive Therapies (CT) and Behavioral Therapies (BT). These two therapies are often lumped together under the term CBT, because they often overlap.
Exposure Therapy is a type of behavioral therapy. It involves changing your behavior: approaching (or exposing yourself to) anxiety-provoking situations, instead of avoiding them. For instance, a person with a fear of public speaking undergoing exposure therapy would have to imagine giving speeches and then actually give several speeches. It’s probably the case that before treatment they believed that they couldn’t handle giving a speech or that they would embarrass themselves, and after treatment they would belief that embarrassment is unlikely or that they could handle it even if they did make a mistake. Exposure Therapy is useful in the treatment of all anxiety disorders.
Exposure with Response Prevention (ERP) is a specific type of Exposure Therapy designed to treat Obsessive Compulsive Disorder. In ERP, people change their behavior in two ways. They approach anxiety-provoking situations instead of avoiding them (which is exposure). They also stop engaging in compulsive behaviors when they do approach anxiety-provoking situations (which is response prevention). So, if a person with Contamination OCD was undergoing ERP, they would have to both touch items that seem contaminated and resist the urge to decontaminate afterwards. So, they might touch the ground in the bathroom and resist the urge to wash their hands, take a shower, or use hand-sanitizer. We know that touching the bathroom and then immediately washing will never reduce the fear of contamination; thus response prevention (RP) was added to exposure (E) for OCD.
So now you know how these various terms are different. CBT is an umbrella term that refers to a large category of both cognitive and behavioral therapies. Exposure Therapy is a behavioral therapy and therefore falls under the larger term of Behavioral Therapy. Exposure with Response Prevention is a specific type of Exposure Therapy that was designed to treat OCD.
Therefore, it is technically correct to say that CBT, Exposure Therapy, and Exposure with Response Prevention are all effective treatments for OCD. But, it’s more accurate to say that Exposure with Response Prevention, which is a specific type of CBT and Exposure Therapy, is effective in treating OCD.
That still leaves the question of why some people use CBT when they really mean ERP. No one can say for sure why this is, but I think in general CBT is far better known that the other terms. This makes some sense because CBT the largest category, and thus encompasses all the other terms. This is analogous to the fact that most Clevelanders are able to name the Browns as our football team, but far fewer are able to name Hue Jackson, the head coach.