CBT, DBT & other talk therapies

These therapies look at how thoughts, feelings, body sensations and actions feed each other, and teach skills to break unhelpful cycles. They are usually structured, goal-focused and include practice between sessions. CBT is the best known.

Examples

• ACT
• Behavioural activation
• CBT
• DBT
• Exposure therapy and ERP
• Motivational interviewing
• Solution-focused therapy

These therapies explore how past experiences, relationships and hidden patterns shape how you feel today. Many put the relationship with your therapist at the heart of healing.

Examples

• Compassion-focused therapy
• Interpersonal therapy
• Mentalization-based therapy
• Narrative therapy
• Person-centred therapy
• Psychodynamic therapy
• Schema therapy

Many therapists blend ideas from several approaches, depending on their training and what you need. It’s fine to ask, “Which approaches do you use, and why for me?”

Therapies are not formally approved the way some other treatments are. Instead, researchers test them in studies. Therapies shown in large studies to help are called “evidence-based”. Throughout this guide, each therapy says in plain words how much research supports it.

CBT is a goal-focused talk therapy built on a simple idea: the way we think shapes how we feel and what we do. You learn to catch quick, automatic thoughts, check whether they are accurate, and try new ways of acting.

How a session works

• Sessions usually last about an hour, often weekly or every other week
• You and your therapist set clear goals together
• You look at recent situations, the thoughts that came up, and how you reacted
• You practise a skill in the session, then try it at home between sessions

Common CBT skills

• Calming skills such as slow breathing and mindfulness
• Spotting thinking traps like all-or-nothing thinking or expecting the worst
• Taking small, gradual steps back toward things you’ve been avoiding
• Using routines, rewards and problem-solving
• Weighing up the evidence for and against a worried thought

What it can help with

• Anxiety, panic, phobias and social anxiety
• Eating difficulties and substance use
• Life stress such as divorce, grief, relationship or work problems
• Low mood and depression
• OCD and PTSD
• Sleep problems, chronic pain, IBS and migraines

Evidence: CBT is one of the most researched therapies there is. Many people attend about 8 to 12 visits. In the UK, people usually have 5 to 15 sessions, one-to-one, in a group, online or by phone.

When we feel low, we often stop doing things. That makes life smaller and mood even lower. Behavioural activation breaks this cycle by planning small, meaningful activities, even before motivation comes back. Action often comes first; feeling better follows.

What it looks like

• Noticing what gives you a sense of pleasure, connection or achievement
• Scheduling small, doable steps, like a 10-minute walk or texting a friend
• Spotting avoidance and problem-solving what gets in the way
• Tracking what you do each day and how it affects your mood

Evidence: a 2014 review of 26 trials with 1,524 people found behavioural activation worked better than control conditions for depression. Many studies were small or short. In research it has been delivered well by trained non-specialists, which can help it reach more people.

Behaviour therapy is the older “parent” of CBT. It focuses on what we do rather than what we think. The idea is that behaviours are learned, so they can be unlearned or replaced with healthier ones.

Common tools

• Building new routines and skills, like social or communication skills
• Gradual exposure and systematic desensitization (pairing small steps with relaxation)
• Parent training, where parents learn ways to encourage helpful behaviour in children
• Positive reinforcement: rewarding steps in the right direction
• Tracking behaviours to see patterns and triggers

It is often used for children’s behaviour, habits, fears and phobias, and as part of family work. Many therapists combine behavioural tools with CBT.

• Body sensations: safely bringing on a racing heart to learn it isn’t harmful
• Graded: starting small and working up a “ladder” of fears
• In real life: for example, slowly getting closer to a dog if you fear dogs
• In your imagination: picturing a feared situation or memory in detail
• Virtual reality: when real life isn’t practical, like fear of flying

Exposure and response prevention (ERP) is the version used for OCD. You face the thoughts or situations that trigger obsessions and then choose not to do the compulsion (like checking or washing). Compulsions bring short relief, but they teach the brain that danger was real. Resisting them lets the anxiety rise and then fall on its own.

NIMH says research shows ERP effectively reduces compulsions. The International OCD Foundation calls ERP the most important CBT approach for OCD.

Exposure helps over 90% of people with a specific phobia who commit to and finish it. How long it takes depends on the fear and your commitment. Some people need only a few sessions; others need more.

ACT (said like the word “act”) helps you relate differently to painful thoughts and feelings. Instead of fighting them, you learn to accept them as a normal part of being human, and commit to actions that match your values.

The six core skills

• Acceptance: allowing feelings to be there
• Defusion: seeing thoughts as passing events, not orders
• Being present: focusing on now, not “what ifs”
• Self-as-context: you are more than your thoughts or experiences
• Values: knowing what truly matters to you
• Committed action: small steps toward those values

Sessions include mindfulness, values and behaviour-change exercises, with practice between sessions. There’s no fixed length; most people meet weekly for several weeks.

What it can help with: anxiety, depression, OCD, PTSD, stress, eating difficulties, substance use, and coping with chronic or serious illness. It suits teens and adults because it uses abstract thinking.

DBT grew out of CBT and was developed by American psychologist Marsha Linehan in the 1970s. “Dialectical” means holding two ideas at once: accepting yourself and your life as they are, while also working to change what isn’t helping.

How DBT is delivered

• Weekly one-to-one therapy, often with a diary of feelings and actions
• A weekly skills class (taught like a class, not a sharing group)
• Phone coaching for help using skills in tough moments
• Therapists often meet in a consultation team to support their work

The four skill areas

• Distress tolerance: getting through a crisis without making it worse
• Emotion regulation: understanding and calming strong feelings
• Interpersonal effectiveness: asking for what you need and setting boundaries
• Mindfulness: being aware of the present

Evidence: studies link DBT with less self-harm and anger, fewer hospital days and less substance misuse for people with very intense, unstable emotions. It is also used for PTSD, binge eating, depression and anxiety. It usually lasts at least six months to a year.

Instead of digging deep into problems, SFBT asks about your goals, your strengths and the times when the problem is smaller or absent. It is short, practical and future-focused.

Questions you might hear

• “If you woke up tomorrow and things were better, what would be different?”
• “When is the problem a little less bad? What’s happening then?”
• “On a scale of 0 to 10, where are you now? What would one point higher look like?”
• “How have you coped so far?”

Evidence: a 2024 review of 72 studies found a large helpful effect on psychosocial problems, with bigger effects in non-clinical groups than clinical ones. Older reviews were more mixed, so it may suit everyday struggles more than complex, long-term conditions.

How long: usually a small number of sessions. It is common in schools, counselling services and settings where time is short.

MI is a collaborative conversation style that helps people sort through mixed feelings about change. It was first described by William Miller in 1983 for alcohol problems and is now used for many health behaviours.

The core skills (often called OARS)

• Open questions: “What worries you about how things are?”
• Affirmations: noticing your strengths and efforts
• Reflections: saying back what you heard so you feel understood
• Summaries: pulling the conversation together

Rather than lecturing, the helper draws out your own reasons for change. People are more likely to change when the reasons come from them.

Evidence: most research has been on substance use. It is often brief (one to a few conversations) and is also used by doctors, nurses and coaches.

Psychodynamic therapy explores past thoughts, feelings and memories to understand how they shape your life now. The aim is to bring hidden (unconscious) patterns into awareness so you understand why you act as you do, and can choose differently.

What sessions are like

• Exploring feelings that come up toward the therapist, which often echo other relationships
• Linking childhood experiences to present-day reactions
• Noticing repeated patterns in relationships
• Open-ended conversations: you say whatever comes to mind
• Sometimes talking about dreams

How long: usually once or twice a week for about an hour, for a few months or several years. Studies show it can help many concerns, especially depression and long-standing personality patterns. It can work more slowly than some therapies, but its benefits are known to last after therapy ends.

Related: dynamic interpersonal therapy is a shorter version offered by the NHS, which looks at how childhood experiences affect current relationships.

Psychoanalysis grew from the ideas of Sigmund Freud more than a century ago and is the root of psychodynamic therapy. It explores the unconscious mind through free association: saying whatever comes to mind without filtering.

How it differs from psychodynamic therapy

• Analysts complete long, specialized training
• It usually lasts years rather than months
• Sessions are more frequent, often several times a week
• The person may lie on a couch, which helps thoughts flow freely

Because it is intensive, it is less common and can be costly. Many people get similar insight-focused help from once- or twice-weekly psychodynamic therapy.

Person-centred therapy (also called client-centred or Rogerian therapy) was pioneered by psychologist Carl Rogers in the early 1940s. It rests on the belief that people naturally move toward growth when they feel truly accepted.

What the therapist offers

• Empathy: deeply trying to understand your world
• Genuineness: being real, not hiding behind a role
• Reflective listening, so you hear yourself more clearly
• Unconditional positive regard: accepting you without judgement

You are seen as the expert on your own life, so you set the direction. Few therapists use only this approach today, but its ideas are woven into almost every kind of therapy. Much everyday “counselling” is person-centred.

Narrative therapy sees our lives as stories. When a problem dominates the story, we can start to believe the problem is who we are. This approach separates you from the problem (“externalising”) and helps you notice the strengths and moments the old story leaves out.

What it can look like

• Exploring how the problem affects your life, and how you push back against it
• Finding “exceptions”: times you acted against the problem
• Giving the problem a name, like “the Worry Monster”
• Re-authoring: telling a richer, truer story about yourself
• Sometimes inviting important people to witness your new story

It is popular with children, families and communities, and it fits well with cultural and faith stories. There is less large-scale research on it than on CBT, so ask your therapist how they use it alongside other approaches.

IPT links how you feel with what is happening in your relationships. You talk about problems in your relationships and learn ways to manage them.

Common focus areas

• Disagreements or conflict with people close to you
• Feeling isolated or finding relationships hard
• Grief that hasn’t eased
• Role changes, like becoming a parent, retiring or moving

It is short-term and structured, and it is one of the NHS’s core talking therapies. It was first designed for depression.

“Mentalizing” means making sense of ourselves and others in terms of thoughts, feelings and intentions. Under stress, especially in close relationships, anyone can lose this ability. MBT, developed by Anthony Bateman and Peter Fonagy, helps strengthen it.

How it works

• Calming strong emotion comes first, then exploring how you see yourself and others
• The therapist takes a curious, “not-knowing” stance
• Usually lasts around 18 months, with crisis planning built in
• Weekly individual and group therapy, with the two therapists working together

Evidence: it was first developed for very intense, unstable emotions and relationships. Trials led by its developers found lasting benefits, including fewer suicide attempts and hospital stays at an 8-year follow-up. The authors note independent studies are needed.

Schema therapy was described by Jeffrey Young in 1990 for long-standing difficulties that didn’t respond to standard cognitive therapy. It blends CBT with ideas from psychodynamic, interpersonal and experiential therapies.

“Schemas” are deep beliefs about yourself, others and the world, like “I’ll always be abandoned” or “I’m not good enough”. They often form in childhood. “Modes” are the moment-to-moment states those beliefs can trigger. Therapy aims to strengthen your “healthy adult” side.

How long: often longer than CBT. Group programmes have run about 20 sessions; individual therapy can run up to 60 sessions or more. A 2017 review found schemas and symptoms usually improved, but most studies were small and low quality.

Psychologist Paul Gilbert founded CFT in 2000 for people with high shame and self-criticism who struggled to feel kinder toward themselves in other therapies.

Three emotion systems it works with

• Threat: spots danger and creates anxiety or anger
• Drive: pushes us to achieve and seek rewards
• Soothing: brings calm, safeness and connection. CFT helps strengthen this one

Common exercises

• Answering self-criticism with self-kindness
• Compassionate imagery
• Writing yourself a compassionate letter

Evidence: a 2015 review of 14 studies found mostly positive results, especially for people high in self-criticism, but said larger, better studies are needed. It is often combined with CBT.

• Want practical tools and a clear plan? Skills-based therapies like CBT, ACT or DBT may suit you
• Want to understand why patterns keep repeating? Psychodynamic or schema therapy may suit you
• Want both? Many therapists blend approaches

• Solution-focused and MI: often a handful of sessions
• CBT: many people attend 8–12 visits
• DBT: usually 6 months to a year
• MBT: around 18 months
• Psychodynamic: months to years

NIMH says rapport and trust are essential. If you have been in therapy for a reasonable time and are not getting better, talk with your therapist about another approach or professional.

1. Write down the thought, like “I’ll mess this up”
2. Ask: what’s the evidence for it, and against it?
3. Ask: is this all-or-nothing thinking or expecting the worst?
4. Write a fairer, kinder version of the thought

When a hard thought shows up, say “I’m having the thought that…” before it. This is a small taste of defusion: seeing thoughts as passing events, not orders.

Pick one small, doable activity that brings pleasure, connection or a sense of achievement, like a 10-minute walk or texting a friend. Notice your mood before and after.

Instead of giving advice, ask an open question (“What’s been hardest?”), then say back what you heard. People are more likely to act on reasons that come from them.

Good first steps include your primary care provider, your insurance company’s list, university training clinics, your EAP, or FindTreatment.gov, SAMHSA’s locator for mental health services. The Therapy: the basics guide helps you choose and prepare.

In the UK, you can often refer yourself to NHS talking therapies for anxiety and depression. Elsewhere, Find A Helpline lists free, confidential helplines in many countries.