15.2 — The Therapies, and What Each Is For

Cognitive behavioural therapy

The most studied and the default recommendation for most common conditions.

The idea: thoughts, feelings and behaviour form a loop. Change the thoughts or the behaviour and the feelings follow.

What happens: identify the automatic thoughts, test them against evidence, and change specific behaviours — with homework between sessions.

Best for: depression, anxiety disorders, panic, social anxiety, OCD, insomnia, and as an addition in psychosis and bipolar disorder.

Length: typically eight to twenty sessions. Structured, time-limited, and it has an end.

Criticisms: can feel mechanical, focuses on the present rather than on origins, and does not suit everybody. Self-applicable, and 15.3 is the method.

Behavioural activation

The stripped-down version, and it is not a lesser one. Scheduling activity regardless of mood.

Best for: depression, where it performs comparably to full CBT and to medication.

Its advantage: it is the simplest thing in this Part and the easiest to do alone (8.8).

Acceptance and commitment therapy

A different premise: the problem is not the presence of difficult thoughts and feelings but the struggle against them.

What it teaches: noticing thoughts as thoughts rather than as truths, allowing uncomfortable feelings without fighting them, clarifying values, and acting on them regardless of how you feel.

Best for: chronic pain, chronic illness, anxiety, depression, and situations that genuinely cannot be changed — where CBT's "test the thought against evidence" has limited purchase because the thought is accurate.

Highly self-applicable, and 15.4 is the method.

Dialectical behaviour therapy

Developed for people with intense, fast, long-lasting emotional reactions and self-harm.

Four skill modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Best for: borderline personality pattern and repeated self-harm, where it has the strongest evidence. The skills themselves are useful to anybody whose emotions run hot, diagnosis or not.

15.5 is the portable part.

Psychodynamic therapy

The descendant of Freud, considerably changed (1.2).

The idea: current difficulties are shaped by patterns formed early and largely outside awareness, particularly patterns in relationships — and these show up in the relationship with the therapist.

What happens: less structured, more exploratory, longer.

Evidence: better than its reputation. Meta-analyses find effects comparable to other therapies for common conditions, with some evidence of benefits that continue growing after treatment ends.

Best for: long-standing relationship patterns, recurrent difficulties, and people who want to understand rather than to manage.

Not self-applicable, because the mechanism is the relationship.

EMDR

Eye movement desensitisation and reprocessing. Structured processing of a traumatic memory while performing bilateral stimulation, usually guided eye movements.

Evidence: good for PTSD, recommended in guidelines.

The mechanism is disputed — the eye movements may not be the active ingredient (14.4).

Not self-applicable, and should not be attempted alone.

Interpersonal therapy

Focused on relationships and roles rather than on thoughts. Works on grief, role transitions, disputes, and social isolation.

Best for: depression, where it has good evidence, particularly where the trigger is relational.

Mindfulness-based cognitive therapy

Eight weeks, group-based, combining attention practice with cognitive therapy.

Best for: preventing relapse in recurrent depression, where it has strong evidence and is recommended in guidelines. Designed for people in remission, not for a current severe episode (7.9).

Family and couples therapy

Treats the system rather than the person.

Best for: family-based treatment for adolescent anorexia, family intervention in psychosis, and relationship difficulties.

Emotionally focused therapy for couples has good evidence, and it works on the attachment pattern in 9.5.

Not appropriate where there is ongoing abuse (13.6).

Choosing

Match to the problem, not to the fashion.

Depression — CBT, behavioural activation, interpersonal therapy, or medication. Combination for moderate to severe. Anxiety, panic, phobia, social anxiety — CBT with exposure. OCD — exposure and response prevention specifically. Ask for it by name.PTSD — trauma-focused CBT or EMDR. Insomnia — CBT-I specifically. Chronic pain or illness — ACT. Intense emotions and self-harm — DBT. Long-standing relationship patterns — psychodynamic or schema-focused work. Recurrent depression, in remission — MBCT. Bipolar disorder or psychosis — medication, with therapy alongside.

And if you do not know: CBT is the reasonable default for most common problems, and a competent therapist will tell you if something else fits better.

Two things to know about the market

Therapy is not regulated equally everywhere. "Counsellor" and "therapist" are loose titles in many countries including India (1.1). Check the qualification (15.8).

And be sceptical of anything promising rapid transformation, proprietary methods, or techniques that cannot be described in plain language. The effective therapies are all describable in a paragraph, which is what this page just did.

What to do

Match your problem to the list, and if you are seeking help, ask for the specific approach by name. "I'm looking for CBT for panic" or "I need exposure and response prevention" gets a different answer from "I need therapy."

If you are doing this yourself, pick one of the three self-applicable methods — CBT for thoughts you can test, ACT for situations you cannot change, DBT for emotions that overwhelm — and use one for a month.

Next: 15.3 is the first of them, in full.