Cognitive Behavior Therapy, Exposure Response Prevention, Systems Approach, and Mindfullness

Cognitive Behavior Therapy (DBT)

Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing people’s attitudes and their behavior by focusing on the thoughts, images, beliefs and attitudes that are held (a person’s cognitive processes) and how these processes relate to the way a person behaves, as a way of dealing with emotional problems.

Exposure Response Prevention

Exposure response prevention therapy (ERP) is a gradual and systematic way of helping a person face their fears.  A metaphor for ERP is getting a flu shot; which is like getting a small dose of the virus so your body knows how to fight it so when it actually happens your body knows what to do.

ERP begins by establishing a hierarchy of triggering situations, with exercises addressing the easiest first and then working up to more challenging exposures during the course of treatment. Many exposures can be “in vivo,” meaning they involve literally being in the presence of a fear.   When in vivo exposures are not feasible, imaginal exposures can be employed, which involve writing exercises that elicit the feared state of mind combined with resisting reassuring or neutralizing mental compulsions.

ERP is a collaborative process wherein the therapist and client work together to establish a treatment plan that runs at a pace that will be challenging, but tolerable and effective. An OCD therapist will never ask a client to engage in a behavior that is dangerous, that they themselves will not engage in, or that violates religious or moral beliefs. However, exposures are designed to be challenging and induce discomfort, so part of ERP treatment involves the therapist and client working on motivational issues as well. Exposures are typically practiced first in the therapy session and then assigned as daily homework.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) treatment is a type of psychotherapy that utilizes a cognitive-behavioral approach. DBT emphasizes the psychosocial aspects of treatment.  DBT has four components: Mindfullness, Interpersonal Effectiveness, Distress Tolerance, and Emotional Regulation.

The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations.  DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.

People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Family Systems Approach

Family therapy views a person’s symptoms as taking place in the larger context of the family.

Just as a particular department in a business organization may suffer because of the problems in another department, a person with OCD may be affect the larger family interactions.  If a therapist only treated the person suffering from OCD, they may not share the approaches and tools to get past the thoughts or handle the secondary issues associated with seeing a family member struggle.

Family therapy can be especially effective with children, as often the problems are inter-related with what is going on in the family.  A child’s problems rarely exist in a vacuum, so how the family reacts to the child is important.


The term is used to signify many different things, but in treating OCD, it simply means paying attention to the present moment without judgment or analysis. This includes the presence of thoughts, feelings, and sensations, whether wanted or unwanted.

At the core of mindfulness for OCD is identifying thoughts as simply being thoughts, not threats, meaning the content of the thought itself holds no intrinsic value. Similarly, if you suffer from OCD, you may have come to believe that feelings are facts, signs that your obsessions hold some important truths. Mindfulness challenges this by simply identifying feeling as feelings, experiences that can be observed as they pass through.

All of our providers are out of network and do not participate with any insurance programs.  Please contact your insurance provider – click here for a guide for How to Check Your Health Insurance. Some clients have success advocating for out of network benefits – here is some information that you might find helpful about advocating for out of network benefits.


To make an appointment with any of our providers, please call the office line at 410-979-2326. You can also email or