The Therapy Acronym Dictionary: Your Guide to Therapy-Speak

"The Therapy Acronym Dictionary: Your Guide to Therapy-Speak," By Dan Mortenson, PhD

One of the most common phrases I often tell my clients in the first session is, “Your brain is the most advanced supercomputer you will ever possess that puts any smartphone to shame…but it never comes with a user’s manual.”  Much of therapy is essentially learning how to navigate with the awesome power and quirks that your unique brain comes with. But unfortunately, to complicate matters even more, there can be a veritable sea of acronyms and jargon that come with the territory that can feel pretty intimidating to understand.  It can almost feel like it needs a special dictionary to translate. This article serves as a brief introduction to some of the most common terminology that comes up in cognitive behavioral therapy.

“What exactly are Cognitive Behavioral Therapies (CBT)?”

This is what’s known as an ‘umbrella term’ that refers to therapeutic approaches that seek to help understand the patterns and connections in thoughts and behaviors, how we can get stuck in maladaptive cycles, and how we can identify and try out new behaviors and approaches that are more fulfilling.  To give you a crash course in the history of CBT, it started with behavioral therapy in the mid 20th century which was aimed at understanding how certain behaviors could be reinforced or extinguished in various ways and then grew to include more of a cognitive component to understand the role that our thoughts and attitudes play with behaviors based on emerging research in the last quarter of the 20th century.  These were based on reducing symptoms and distress but, as we entered the 21st century, newer versions of CBT started to emerge that were more focused on increasing overall flexibility and changing the relationship we have with distress to allow for more meaningful behaviors to take shape.

That’s a lot to take in, but the basic gist is that CBT allows for there to be more of a common, practical language to help understand our thoughts, behaviors, and emotions and for more concrete skill building to take place in therapy to address what change can realistically look like.  It can break down the “nuts and bolts” of what a better life can resemble and although there are a few different ways to do this they all can have this similar goal in mind depending on the context of the situation.

“My therapist mentioned ERP to address what I’m avoiding. What is that?”

ERP stands for Exposure with Response Prevention and, although it originates from research in the realm of Obsessive Compulsive Disorder, it can be applied to a number of areas in which avoidance is a primary issue.  The central goal with ERP is to help prevent avoidance patterns from taking hold by exposing ourselves to what we’re afraid of incrementally to show that we can handle it better than expected.  The “response prevention” aspect is working to reduce certain behaviors we engage in that often reinforce the avoidance so that we can better move on from the core distress and uncertainty.

“I keep hearing the term BA, where does that fit in?”

BA stands for Behavioral Activation, which is often used as a behavioral technique to help increase basic behaviors when there is a lack of motivation or a high level of depression interfering with progress.  A central aspect of BA is that motivation always follows action and never before.  When we’re stuck, we spend a lot of time trying to conjure up motivation when the trick is to find basic behaviors to get us going to build momentum which ultimately can generate motivation to keep us going in a better direction.

“What about ACT, how does that fit in here?”

ACT stands for Acceptance Commitment Therapy and is a more recent offshoot from the CBT world that takes a unique approach to understanding mental distress compared to the traditional medical model of symptom reduction.  Often, when the main focus is to eliminate symptoms – especially in the case of anxiety – this can ironically make symptoms stronger. So, instead of adding to this vicious cycle, ACT proposes a different approach.  It advocates for a more acceptance-based view of anxiety that allows for there to be a different relationship with the symptoms while encouraging a shift toward committing to valued behavioral choices associated with a more meaningful life.  Essentially, when it can be difficult to eliminate the issue at hand, ACT proposes that we can instead see what we can grow out of the situation instead to help enhance our lives even with the distress still being present. 

“I heard about a program nearby that does DBT, is that similar to what we’ve been talking about?”

DBT or Dialectical Behavioral Therapy is another more recent permutation of CBT that also focuses on reworking our relationship with distress by embracing the paradoxes involved in our more complicated emotions.  It advocates for a “wise mind” approach that incorporates what both the logical and emotional parts of our brains say. This way, we’re able to understand how these two halves of our brains can coexist and we can develop more practical skills within this framework to better regulate ourselves and build meaningful relationships with others.

“How do I know what’s right for me?”

This is something to continuously discuss with your therapist, but I’ve always been a fan of a more modular approach to therapy that allows for there to be a core of working to better understand the basic patterns in our thoughts and behaviors while then integrating more specific techniques that target key distressing areas according to each person’s needs.  In order to be effective, therapy should have a strong element of flexibility that allows it to adapt to the needs of the individual. Therapy does best when there is collaboration between the client and therapist around what techniques match up best with their unique context.