CBT, DBT, somatic therapy, exposure therapy: which one fits you

Someone asked me the other day what is different between CBT, DBT, somatic work and exposure therapy. Fair question. These names get thrown around and they sound similar. They are not the same, and each one shines for different problems.

CBT, cognitive behavioral therapy, is about the loop between thoughts, feelings and actions. You learn to notice the thoughts that feed anxiety or low mood, test them against reality, and practice new behaviors. It is structured, usually weekly, and works well for anxiety, panic, depression and OCD. A large review of trials found strong support for CBT across anxiety disorders.

DBT, dialectical behavior therapy, grew out of CBT for people with very intense emotions and urges to harm themselves. It adds skills for distress tolerance, emotion regulation and relationships, plus coaching between sessions. The original trial showed it reduced self harm behavior in borderline patients. If your emotions feel like they go from zero to one hundred fast, DBT is worth a look.

Exposure therapy is a family of approaches where you face feared situations in a planned, step by step way. It is the core of treatment for phobias, panic and PTSD. A meta analysis of prolonged exposure for PTSD found it strongly effective. Expect homework and a therapist who coaches you through it, not around it.

Somatic and body based therapies focus on physical sensations, breath and movement to process stress held in the body. The research base here is newer and smaller than for CBT, so I am honest about that. Many patients like these approaches for trauma when talk alone feels stuck, often alongside a proven therapy like CBT or exposure.

How to choose? Match the therapy to the problem. Anxiety, panic and OCD point to CBT. Intense emotions and self harm point to DBT. Avoidance and trauma point to exposure. Body held tension points to somatic work as a complement. And the relationship matters: the best method with a therapist you trust beats the perfect method with one you do not.

Anthony

Sources: Hofmann SG et al., Cognitive Therapy and Research (2012), review of meta analyses of CBT for anxiety disorders. Linehan MM et al., Archives of General Psychiatry (1991), cognitive behavioral treatment of chronically parasuicidal borderline patients. Powers MB et al., Clinical Psychology Review (2010), meta analytic review of prolonged exposure for PTSD.