CBT? DBT? Psychodynamic? What type of therapy is right for me? | Health
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Working with a therapist can help you manage or improve your mental health. elenabs/iStock via Getty Images Plus
Since ancient times, cultures across the world have understood that human suffering can have psychological causes. At its core, psychotherapy is working with another person to help identify and address emotional challenges that matter to you. It involves trying to understand the source of those problems and coming up with ways to tackle them head on.
Some therapists may take a particular approach to psychotherapy, like cognitive-behavioral or psychodynamic. As a child and adolescent psychiatrist who trains and consults with many other clinicians, I often find myself fielding questions about what type of therapy would be the best fit for a particular person.
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It can be difficult to understand what therapists mean when they refer to these different techniques, and which is best for you. Learning about how each of the most common approaches to psychotherapy works may help clarify what you might expect from a particular session.
Cognitive behavioral therapy
Cognitive behavioral therapy is considered the gold standard in psychotherapy. Numerous clinical trials have found CBT to be effective for a spectrum of emotional health challenges, from anxiety and depression to addiction and schizophrenia.
CBT involves identifying, assessing and finding ways to push back on the negative thoughts that often underlie many negative feelings. For example, if I’m stuck thinking that I will definitely be unable to give a good presentation to my colleagues tomorrow, this can lead to feelings of anxiety and dread that fuel unhelpful behaviors like avoiding finishing up my preparation. A therapist might help me examine these thoughts by asking questions like, “Is this thought really accurate? Is this helpful right now in reaching my goals?”
Cognitive behavioral therapy focuses on the connection between thoughts, feelings, beliefs and behaviors.
Exploring the thoughts underlying negative feelings and behaviors doesn’t always feel like a very natural process. But with practice, usually in the form of “homework” to help you practice identifying and “talking back” to these negative thoughts, it can become second nature. Over time, CBT can help you to transition from the skewed lens of depression and anxiety to a more nuanced and balanced perspective on your daily life.
CBT can be brief (four to eight sessions) or intermediate (12 to 20 sessions) in length, but is not designed to be long term. The idea is to learn these adaptive skills in a quick, practical, “minds-on” way, then go out and use these strategies in daily life. Sometimes a refresher can help if you find yourself stuck in negative thought patterns again. But CBT has a great track record for long-term effectiveness over months and years.
Behavioral therapies
Behavioral therapies encompass a number of treatments that focus on helping your body and brain build new connections through healthier behaviors. These connections are both psychological (developing healthier cognitive and emotional habits) and neurobiological (improved connectivity between brain regions involved in strong emotional responses).
For example, one form of treatment called behavioral activation seeks to lift mood by slowly increasing and reintegrating activities that are fun, physical, social or give a sense of achievement back into your daily life. It is often used as a component of CBT.
Physically, anything from taking a walk to incorporating the stairs in your daily routine is a great way to get your body and mind moving again. Socially, calling or texting an old friend may also help you gradually feel more connected and engaged with others. Simultaneously addressing both the psychological and behavioral sides of mental health can often synergistically kick-start progress toward feeling better overall.
Mental health has both behavioral and psychological components. Kobus Louw/E+ via Getty Images
If you have a particular phobia, a therapist might use graduated exposure to help you relearn how to tolerate the normal distress that can accompany uncomfortable experiences. The goal is not to eliminate all feelings of distress, but rather to relearn that your body and brain can withstand normal distress without shutting down. Eventually, you may be able to participate in an activity you’ve been avoiding, or directly engage with what you fear.
For example, if I’m struggling with a fear of needles, I would spend some time understanding the full range of the fearful responses I have to them. Thinking about needles makes me feel uncomfortable, seeing needles makes my heart race, and preparing to have my blood drawn makes me sweat and intensely want to avoid my appointment. Graduated exposure therapy would slowly but steadily introduce minimally distressing experiences (looking at pictures of needles) until my body and brain become accustomed to the fear response and return increasingly quickly to a normal state. This process, called habituation, can be practiced with increasingly distressing versions of your fear until you’re ready to tackle the full experience (getting blood drawn).
For children and families, behavioral modification is a generally brief (four to eight sessions) and problem-focused way to introduce more structure to parent-child interactions. This might involve creating a plan that establishes rewards to encourage positive behaviors, and consequences to discourage challenging behaviors.
If a family is working on improving respectful language in the home, for example, a parent might offer specific praise each time a child uses respectful language, strategically ignore minor disrespectful language, and establish predictable and consistent consequences for major disrespectful language.
Behavioral modification can also be useful for adults working to change specific challenging behaviors of their own. A typical example may be getting to watch an episode of a favorite TV show only if you’ve exercised that day.
Dialectical behavioral therapy
Often considered a type of CBT, dialectical behavioral therapy is ideal for those who chronically struggle with managing their emotions. DBT focuses on learning skills to help you tolerate distress and navigate challenging interpersonal relationships.
One core skill of DBT is mindfulness. Mindfulness entails finding ways to “declutter” your mind from past emotional challenges and focus on what is happening in the moment. A common mindfulness strategy utilized in DBT is guided imagery. This involves repeatedly imagining a beautiful and relaxing physical environment, such as a beach, mountain meadow or cozy family kitchen, both to prevent and improve feelings of stress.
Dialectical behavioral therapy focuses on managing emotions and behaviors.
A common DBT strategy to tolerate emotional distress is sensory grounding. When you’re feeling overwhelmed, sensory grounding involves taking a step back and finding five objects you see in the physical environment, four objects you can touch, three sounds you can hear, two things you can smell and one thing you can taste. This gradual experience helps take the mind’s focus off an emotionally distressing experience to calm both body and mind.
DBT usually involves both individual and group sessions. While group sessions are often time limited (usually about six months), individual sessions sometimes can be longer term.
Psychodynamic psychotherapy
Psychodynamic psychotherapy starts with the framework that unconscious mental processes, such as denial or repression, regularly influence your thoughts, feelings and behaviors.
It utilizes the strong relationship built between you and your therapist to uncover these processes. The goal is to find functional ways of navigating interpersonal difficulties, trouble achieving personal goals or broader life dissatisfaction. Your therapist will likely help you explore your past experiences and relationships, looking for thought and behavior patterns influencing the challenges you’re facing in the here and now.
Psychodynamic therapy is generally longer term, with weekly or more frequent meetings. While some patients can continue to have sessions indefinitely, most work with their therapists for several months to a year or more.
Gestalt and person-centered therapies
Gestalt and person-centered therapies are often referred to as humanistic psychotherapy. This model is generally centered on individual experiences and challenges, emphasizing that each person has a unique point of view.
Sessions are usually less structured and directive compared to other types of therapy. Rather than learning specific cognitive or behavioral skills, gestalt and person-centered therapies focus on exploring your current emotional state and identifying and working through your own identified goals with gentle guidance from your therapist.
For example, if I am struggling with depression related to a problematic relationship with my parents, a session might focus on better understanding the dynamics of this particular relationship and devising practical steps for possible ways to improve it.
Therapy can be held in both individual and group sessions. SDI Productions/E+ via Getty Images
Choosing the right therapy for you
In thinking about what kind of therapy you might benefit from most, consider how you tend to approach and solve problems in your daily life.
Are you someone who tends to be problem-focused and open to learning new skills? CBT may be a good fit for you. Do you like to understand why you respond the way you do to certain situations and enjoy finding root causes of the challenges you face? Psychodynamic therapy may be a better fit. Have you been avoiding a major challenge in your life and need some concrete way to feel better? A behavioral or DBT approach may better suit you.
Just as important as the type of therapy is how well you connect with your therapist. Finding a good match can be a challenge. A recommendation from people you know and trust, such as your friends or primary care provider, can help point you in the right direction. Your insurance company may also have a list of therapists who are covered in your plan. If you’re looking online, your local community may have a regional association of therapists, and some websites like Psychology Today have a searchable database of therapists. A number of telehealth platforms offer remote therapy as well.
Think about who you’d feel comfortable with, what you want to work on and what kind of work you want to do together. Communicate your needs and goals upfront in your first session with your prospective therapist. If you don’t feel like you have a good connection after the first few meetings, tell them your concerns and don’t be afraid to seek another therapist.
Ultimately, your therapist wants you to better understand yourself and grow in your ability to help yourself navigate all that lies ahead.
Sourav Sengupta does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Understanding the connections between mental health conditions and substance use disorders
Understanding the connections between mental health conditions and substance use disorders

The stigma surrounding substance use disorders and mental health conditions has long dominated how both issues are discussed, and how those who experience these issues are seen. Because substance use disorders and mental illness frequently co-occur, meaning individuals experience both at the same time, increased stigma and stereotypical associations of one condition with the other have colored people’s views of both.
Substance use disorders are a type of mental health condition, a disorder affecting the brain that impacts an individual’s ability to moderate their use of substances. Some of the substances commonly associated with this include alcohol, tobacco and nicotine products, opioids like heroin and oxycodone, stimulants such as methamphetamine and cocaine, and tranquilizers, including Xanax and Valium.
Though they manifest in many different ways, mental illnesses are disorders that disrupt the brain, mood, and behavior, and impact daily life. In 2020, 6.7% (or 17 million) of U.S. adults had both a substance use disorder and at least one other diagnosed mental illness. Those with serious mental illness, or mental illness that significantly impacted daily activities, had particularly high rates of co-occurring substance use disorder with certain substances. Misuse of opioids and tranquilizers, for instance, was roughly 6 percentage points higher among those with serious mental illness than those without a diagnosed mental illness.
Understanding why the two conditions often co-occur relates to recognizing that substance use disorder is a mental health condition, influenced by many of the same factors as other mental illnesses like depression and schizophrenia. Genetics, experiences with trauma or violence, environmental conditions, and many other factors impact how and why substance use disorders and other mental health conditions occur. Decreasing the stigma around both conditions will, according to research, likely make receiving treatment easier.
To explore the factors that influence these conditions, Zinnia Health looked at the connection between mental illness and substance use disorder, citing early 2020 data from the Substance Abuse and Mental Health Services Administration (released in October 2021) and academic studies.
21% of US adults suffer from mental health disorders

More than half of all U.S. adults will receive a mental illness diagnosis in their lifetime, according to the U.S. Centers for Disease Control and Prevention. Many mental health conditions occur together, including depression, anxiety, attention deficit hyperactivity disorder, bipolar disorder, and post-traumatic stress disorder.
Substance use disorder also commonly co-occurs alongside other mental health conditions. Despite the common co-occurrence of substance use disorder and other mental illnesses, one condition does not always cause the other, and experiencing one condition does not always mean a person will develop the other.
Family history can influence mental health risk factors

Over the last couple of decades, scientists have increasingly come to recognize the influence of genetics on mental illness. Most research indicates that while there is no one specific gene responsible for mental health conditions, thousands of gene variants can have small impacts on mental health.
Similarly, family history and genetics account for between 40% and 60% of an individual’s susceptibility to substance use disorder. Certain genetic factors can predispose people to dependence on certain substances. Genes can also interact to alter one’s behaviors toward risk-taking or reward-seeking, increasing or decreasing the likelihood of trying substances in the first place.
Research has also shown that similar genes are responsible for the risk of mental illness, as well as for substance use disorder, illuminating new ways of understanding the high rates of both issues occurring simultaneously.
Stress and trauma can be contributing factors for developing mental health disorders

Traumatic experiences, as well as acute stress, have been shown to have the capacity to alter the brain, particularly the amygdala, hippocampus, and prefrontal cortex (which deal with emotion, memory, and decision-making, respectively). But environmental factors like trauma and stress also have the potential to change genetic expression, bringing out some genetic material that may have previously been dormant. The idea that environmental circumstances can trigger changes in our bodily systems, called epigenetics, also means that mental illness or substance use disorder can sometimes be brought on by traumatic or stressful situations.
Apart from the biological changes stress and trauma can inflict on the body and brain, experiencing traumatic events can cause some to self-medicate in order to deal with psychological distress. Using psychoactive substances to self-medicate can create the risk of developing future mental health conditions, as well as a substance use disorder.
Substance use can increase risk for developing other mental health conditions

Substance use can change the brain in many of the same areas altered by mental health conditions such as anxiety, depression, impulse-control disorders, and schizophrenia. Psychoactive substances can also bring on symptoms similar to those caused by mental illness, including psychosis, paranoia, hallucinations, altered sleep patterns, mood swings, and increased risk-taking behavior. And if substance use begins before the onset of mental illness, it can increase the risk of developing a mental health condition in predisposed individuals.
There are many effective drug therapies for treating mental health conditions

Medication-based therapy has proven to be effective for many with both mental health conditions and substance use disorder. With medical supervision, antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers, among others, can help mediate mental illness symptoms by reducing irregular brain activity, managing physical symptoms like increased heart rate, and changing how compounds like serotonin are used in the brain.
Medication-assisted therapy can also be successful in treating substance use disorder and addiction—particularly when used in conjunction with counseling and behavioral therapy. Medications like methadone can help safely prevent recovering individuals from using substances and can reduce uncomfortable or dangerous withdrawal symptoms.
Targeted behavioral therapies can also help patients with co-occuring mental health conditions

Behavioral therapies, along with medication-based treatments, can help those coping with substance use disorder and or a mental health condition. Integrated treatments, which involve treating both the substance use disorder and the mental illness simultaneously, are seen as the most effective since they acknowledge the often-intermingled causes and symptoms of the co-occurring conditions.
There are, however, many barriers that keep over half of those experiencing a mental health condition from receiving treatment. Stigma around both mental illness and substance use disorder can make seeking help feel shameful and can inspire fear and real-world consequences for wanting treatment.
Many individuals suffering from a mental health condition or a substance use disorder fear losing a job or being ostracized from their community or family. Another major barrier to receiving treatment is its often-prohibitive financial cost. Stark disparities have emerged in who has access to quality treatment, falling along class and racial lines. While 37.6% of white adults with a diagnosis-based need for mental health or substance use disorder treatment received care, only 22.4% of Latinos and 25% of Black Americans did.
This story originally appeared on Zinnia Health and was produced and distributed in partnership with Stacker Studio.
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