Various Therapy Modalities
What are the different types of psychological therapies?
When it comes to the types of therapies a psychologist may use to best help a client, there are a few that are widely used and numerous therapies in total. So, what are they and how do they differ? In this article, we look at a few of the most popular psychotherapies, the theories that underpin each of them, and their associated interventions.
Cognitive Behavioural Therapy (CBT)
Perhaps the most recognisable and one of the most delivered psychological therapies is Cognitive Behavioural Therapy, or CBT for short. Cognitive Behavioural Therapy (CBT; Beck, 1964) targets an individual’s beliefs about a situation and their behaviour in response to those beliefs. The therapy aims to identify distorted thought patterns, challenge their accuracy and substitute with more appropriate and logical thinking (Beck, 2020). This is known as cognitive restructuring, and but is essentially rooted in changing the way we think. This change in cognitions has shown significant efficacy in positively changing our emotional responses and resulting behaviours (Beck, 2020). A psychologist can implement this intervention using several different techniques depending on the client’s needs, including for example: Socratic questioning or exposure therapy (Beck, 2020). Cognitive behavioural therapy has been thoroughly researched and is consistently shown to be very effective in the treatment of psychological disorders such as: depression, anxiety disorders, anger control problems, post-trauma stress disorder, etc. (Hofmann et al., 2012).
Acceptance and Commitment Therapy (ACT)
Another commonly recognised psychotherapy is Acceptance and Commitment Therapy (ACT). Acceptance and Commitment Therapy (ACT; Hayes et al., 1999) has six distinct components, which can be implemented to enhance psychological flexibility. These include acceptance of that which cannot be controlled or changed; contact with the present moment; establishing values; creating emotional distance and perspective around thoughts; observing thoughts and their effect; committed action toward goals (Hayes et al., 1999; Hayes et al., 2006; Twohig et al., 2020). Research has shown that ACT is effective for a wide variety of mental health issues, including but not limited to depression, anxiety and chronic pain or illness related concerns (Powers et al., 2009). Numerous studies accredit this treatment success to the underpinning theory of psychological flexibility and its relationship with enhanced overall well-being (Gaudiano & Herbert, 2006; Hayes et al., 2006).
Dialectical Behaviour Therapy (DBT)
Though it shares much of its philosophy and foundational elements with CBT and ACT, Dialectical Behaviour Therapy (DBT; Linehan et al., 1991) has some unique elements required for this unique treatment. There are four functions associated with DBT – behavioural skill training, contingency management, cognitive modification, and exposure to emotional cues. Therapists typically balance the implementation of both acceptance strategies and behavioural change in a way that best serves the client. Inventions and practices include mindfulness techniques, emotional regulation, interpersonal skill development, self-management and distress tolerance. In particular, emotional regulation is a primary focus of DBT and targets control and management of intense emotions to positively influence our emotional responses and subsequent behaviours. DBT is largely used to help with the treatment of Borderline Personality Disorder (BPD) and related conditions. Studies have confirmed DBT’s efficacy in the treatment of BPD (Feigenbaum, 2007) and it has specifically been linked to reduced self-harming behaviours, suicidality, and related hospitalisations (Linehan et al., 2015; Swales, 2009).
Compassion-Focused Therapy (CFT)
A less known and yet significantly effective therapy is Compassion-Focused Therapy (CFT; Gilbert, 2009). Underpinned by evolutionary psychology theories and neurological understanding, CFT concentrates on targeting self-criticism and shame, working on the notion that evolved brains are predisposed to negative self-evaluation and destructive behaviours. Negative self-view leads to significant emotional distress and mental health issues, and so, CFT works to develop empathy and compassion towards oneself and others. Using a mix CBT and mindfulness strategies with special attention on easing difficult emotions, and education relating to the evolutionary drives behind our emotions and cognitions, CFT is able to have a consistent and significant positive impact. Research emphasises improvements in symptom of eating disorders, depression, and psychosis (Craig et al., 2020).
Positive Psychology (Seligman & Csikszentmihalyi, 2000) is exactly what it sounds like! It is an approach to psychology practicing that aims to change focus from exclusively addressing disorders or mental health ‘issues’, to instead facilitate the development certain skills or attributes such as: personal strengths, fulfilling relationships, healthy well-being, positive emotions, etc. Positive psychology is a holistic style of therapy that has been supported by studies showing a significant reduction of symptoms of anxiety, low self-esteem and depression as well as improving overall well-being (Duckworth et al., 2005). Gratitude journalling, goal setting and mindfulness techniques are commonly associated with this type of therapy (Duckworth et al., 2005; Seligman & Csikszentmihalyi, 2000; Snyder & Lopez, 2005).
Mindfulness Therapy is often incorporated into many of the therapies already mentioned. It involves bringing awareness to the present-moment and to the thoughts, emotions and sensations being experienced (Baer, 2003; Mace, 2008). It is a non-judgemental observation rooted in compassion and acceptance and is aimed at reducing stress and improve the way in which we regulate our emotions. Mindfulness techniques can be as simple as a one-minute body scan or mediation exercise to do when you have a moment during the day or can be therapist guided mindfulness practices supported by cognitive-behavioural techniques. Regular practice can facilitate the enrichment of mindfulness skills. Mindfulness alone has been shown to be an effective therapy in supporting general well-being as well as the reduction of anxiety, depression, personality Disorders, Grief, PTSD and general stress (Baer, 2003; Hofmann et al., 2010; Khoury et al., 2013).
Yet another therapy style commonly used is that of Schema Therapy (Young et al., 2003). In psychology, schemas refer to a system or organisation of thoughts designed to help digest new information fast. Schemas in of themselves are actually incredibly helpful in our day-to-day life, however, it is when we have maladaptive schemas that they become more harmful than helpful. For example, the Failure schema is a belief or expectation that one is destined to fail or simply not good enough to succeed which in turn may be accompanied by coping mechanisms such as avoidance of trying new or difficult tasks, a pessimistic outlook on life, or a high tolerance of bad treatment to name a few. Schema therapy works by identifying these schemas and when they are presented, understanding the origins of these thinking patterns, recognising the coping styles that have been employed, breaking these patterns of thoughts, and forming new, healthier patterns to replace them. Schema therapy has been shown to be especially helpful in the treatment of chronic depression, anxiety and relationship difficulties and can help to address a wide range of adverse behaviours from substance abuse relapses and self-destructive behaviours to staying in unsatisfactory careers and attraction to inappropriate partners. Working together toward a happy and healthier way of thinking, the therapist and client can see great success in even very stubborn mental health issues while creating meaningful and lasting changes in a person’s life.
Eye Movement Desensitisation and Reprocessing (EMDR)
Eye Movement Desensitisation and Reprocessing (EMDR; Shapiro, 1989) therapy is certainly a mouthful, but the acronym has become a well-known and prominent one in the world of psychology. So, what is EMDR? In short, EMDR therapy instructs the client to focus on a traumatic memory and any negative beliefs and emotions they have in related to the traumatic event. The client will continue to focus on the memory while simultaneously attending to a specific type of stimuli – usually following a back-and-forth movement of the therapist finger with their eyes. Though eye movement is the most commonly used method, as the name suggests, there are actually a number of alternatives that can be used to the same effect, such as taping a body part while alternating between left and right or listening to a pattern of sounds through headphones. Of course, there is preparation involved and the process is guided by a EMDR trained psychologist, but the process is relatively straightforward and importantly, very effective. That said, the process does often needs to be repeated and is considering complete once the target memory no longer triggers negative feelings or distress, but as with all therapies this can take time and may be conducted over a number of sessions. If you’re a bit unsure about this style of therapy, that’s totally understandable – it’s certainly unique. If you’re interested in EMDR, we’re here and want to help. The team at Plenish are experienced in a vast range of therapies including EMDR and will be able to provide you with any extra information and advice that you seek.
These are just some of the many therapies that may be utilised by a therapist during the treatment of a client, and often treatment will involve a combination of many different therapies to ensure the best possible care and support. Having access to the wide range of techniques used in psychology allows for a targeted approach utilising specific techniques. This results in a reduction of symptoms for mental health disorders, as well as improved well-being and enhanced outlook on life.
Our therapists are trained in all of these therapies, along with a whole host of others. If you or someone you know is seeking counselling for whatever reason you can rest assured that the team at Plenish Mind Health can cater to your needs. We offer in-person and virtual therapy sessions as well as retreats to help give you a kick start to living a better life. Click here to find out more about our services or if you’d like to read the book that underpins the ideas and practices for healthy relationships simply click here.
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143. https://doi.org/10.1093/clipsy.bpg015
Beck, A. T. (1964). Thinking and Depression: II. Theory and Therapy. Archives of General Psychiatry, 10(6), 561–571. https://doi.org/10.1001/archpsyc.1964.01720240015003
Beck, J. S. (2020). Cognitive behavior therapy : Basics and beyond. Guilford Publications.
Craig, C., Hiskey, S., & Spector, A. (2020). Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Review of Neurotherapeutics, 20(4), 385–400. https://doi.org/10.1080/14737175.2020.1746184
Feigenbaum, J. (2007). Dialectical behaviour therapy: An increasing evidence base. Journal of Mental Health (Abingdon, England), 16(1), 51–68. https://doi.org/10.1080/09638230601182094
Gaudiano, B., & Herbert, J. (2006). Believability of Hallucinations as a Potential Mediator of Their Frequency and Associated Distress in Psychotic Inpatients. Behavioural and Cognitive Psychotherapy, 34(4), 497-502. https://doi.org/10.1017/S1352465806003080
Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment : the Royal College of Psychiatrists’ Journal of Continuing Professional Development, 15(3), 199–208. https://doi.org/10.1192/apt.bp.107.005264
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043
Hayes, S. C. (1999). Acceptance and commitment therapy : An experiential approach to behavior change. Guilford Publications.
Hofmann, S. G., Asnaani, A., Vonk, I. J., J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. https://doi.org/10.1007/s10608-012-9476-1
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183. https://doi.org/10.1037/a0018555
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M.-A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771. https://doi.org/10.1016/j.cpr.2013.05.005
Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., Evans, A., Radford, S., Teasdale, J. D., & Dalgleish, T. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112. https://doi.org/10.1016/j.brat.2010.08.003
Leaviss, J., & Uttley, L. (2015). Psychotherapeutic benefits of compassion-focused therapy: An early systematic review. Psychological Medicine, 45(5), 927-945. https://doi.org/10.1017/S0033291714002141
Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder. The Guilford Press.
Mace, C. (2008). Mindfulness and mental health therapy, theory, and science. Routledge.
Powers, M. B., Vörding, M. B. Z. V. S., & Emmelkamp, P. M. G. (2009). Acceptance and Commitment Therapy. Psychotherapy and Psychosomatics, 78(2), 73–80. https://doi.org/10.1159/000190790
Schmuck, P., & Sheldon, K. M. (Eds.). (2001). Life goals and well-being: Towards a positive psychology of human striving. Hogrefe & Huber Publishers.
Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5–14. https://doi.org/10.1037/0003-066X.55.1.5
Snyder, C. R., & Lopez, S. J. (2005). Handbook of positive psychology. Oxford University Press.
Swales, M. A. (2009). Dialectical Behaviour Therapy: Description, research and future directions. International Journal of Behavioral Consultation and Therapy, 5(2), 164–177. https://doi.org/10.1037/h0100878
Twohig, M. P., Levin, M. E., & Ong, C. W. (2020). ACT in Steps. Oxford University Press, Incorporated.
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199-223. https://doi.org/10.1002/jts.2490020207
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy. New York: Guilford, 254, 653-658.