Can You Do DBT and ERP at the Same Time?

Written By

Dr. Azhar Qureshi


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Dialectical Behavior Therapy (DBT) and Exposure and Response Prevention (ERP) are two common therapies used to treat various mental health conditions.

Many wonder if these therapies can be combined or if they should be done separately. Here’s what you need to know.

Overview of DBT and ERP

DBT focuses on regulating emotions, distress tolerance, interpersonal skills, and mindfulness. It helps treat issues like borderline personality disorder, depression, and PTSD.

ERP exposes you to feared thoughts, images, objects, or situations in a gradual and controlled way so you learn they aren’t dangerous and your anxiety decreases over time. It’s often used for OCD.

Key Differences Between the Therapies

Teaches coping skillsExposure-based
Addresses thought and behavior patternsFocuses specifically on OCD obsessions/compulsions
Wide range of applicationsMainly used for anxiety disorders

These differences show DBT takes a broader approach while ERP has a narrower focus.

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Can They Be Combined?

Some key factors determine if DBT and ERP can be combined effectively:

Treating Co-Occurring Disorders

If you suffer from multiple disorders that would benefit from both DBT and ERP, like borderline personality disorder and OCD, doing both together may help treat your full range of symptoms.

Alignment of Treatment Goals

The core goals of lowering emotional reactivity with DBT and decreasing obsessive thoughts via ERP may conflict. But if tailored well, they can complement each other.

Therapist Expertise

A therapist well-versed in both modalities can better integrate them cohesively. Most therapists specialize in one or the other.

So combination can be done successfully but requires skillful integration.

Risks of Combining the Therapies

Concurrent treatment does pose some risks, including:

  • Confusing clients with mixed messages or homework
  • Overwhelming clients with too many components
  • Hampering progress if not properly aligned

Maintaining strong communication among all providers is essential to mitigate these risks.

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How to Combine DBT and ERP

If attempting an integrated approach, some tips include:

  • Match treatment intensity – Ensure similarity in frequency/length of DBT skills training vs ERP exposure sessions
  • Coordinate homework – Make DBT diary cards and ERP exposure exercises complement vs compete
  • Review regularly – Check-in monthly to assess effectiveness and adjust approach accordingly

Key Takeaways: Can You Do Both?

  • Individual factors determine if combination can be effective
  • Beneficial for co-occurring disorders if done carefully
  • Requires coordination between well-trained providers
  • Allow adjustments through consistent review

So with thoughtful integration by an experienced therapist, DBT and ERP can complement each other well. But simple combination without care risks impeding progress.

Discuss options with providers to determine if and how to best incorporate both therapies.
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About the author

Dr. Azhar Qureshi

Dr. Azhar Qureshi

As a physician and cardiologist, my training encompassed a comprehensive range of invasive and noninvasive procedures, providing extensive hands-on experience in echocardiography, cardiac stress testing, diagnostic catheterization, and coronary interventions. In addition, I developed skills in psychological assessments and formulating detailed case reports. This multifaceted training has equipped me with a strong foundation across cardiology, psychological studies, and documentation to support my medical research. I am passionate about medical writing and exchanging knowledge to help the global community. Social

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