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Psychotherapy, also known as “talk therapy,” is when a person speaks with a trained therapist in a safe and confidential environment to explore and understand feelings and behaviors and gain coping skills.
During individual talk therapy sessions, the conversation is often led by the therapist and can touch on topics such as past or current problems, experiences, thoughts, feelings or relationships experienced by the person while the therapist helps make connections and provide insight.
Studies have found individual psychotherapy to be effective at improving symptoms in a wide array of mental illnesses, making it both a popular and versatile treatment. It can also be used for families, couples or groups. Best practice for treating many mental health conditions includes a combination of medication and therapy.
Therapists offer many different types of psychotherapy. Some people respond better to one type of therapy than another, so a psychotherapist will take things like the nature of the problem being treated and the person’s personality into account when determining which treatment will be most effective.
Cognitive behavioral therapy (CBT) focuses on exploring relationships among a person's thoughts, feelings and behaviors. During CBT a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs.
By addressing these patterns, the person and therapist can work together to develop constructive ways of thinking that will produce healthier behaviors and beliefs. For instance, CBT can help someone replace thoughts that lead to low self-esteem ("I can't do anything right") with positive expectations ("I can do this most of the time, based on my prior experiences").
The core principles of CBT are identifying negative or false beliefs and testing or restructuring them. Oftentimes someone being treated with CBT will have homework in between sessions where they practice replacing negative thoughts with with more realistic thoughts based on prior experiences or record their negative thoughts in a journal.
Studies of CBT have shown it to be an effective treatment for a wide variety of mental illnesses, including depression, anxiety disorders, bipolar disorder, eating disorders and schizophrenia. Individuals who undergo CBT show changes in brain activity, suggesting that this therapy actually improves your brain functioning as well.
Cognitive behavioral therapy has a considerable amount of scientific data supporting its use and many mental health care professionals have training in CBT, making it both effective and accessible. More are needed to meet the public health demand, however.
Dialectical behavior therapy (DBT) was originally developed to treat chronically suicidal individuals with borderline personality disorder (BPD). Over time, DBT has been adapted to treat people with multiple different mental illnesses, but most people who are treated with DBT have BPD as a primary diagnosis.
DBT is heavily based on CBT with one big exception: it emphasizes validation, or accepting uncomfortable thoughts, feelings and behaviors instead of struggling with them. By having an individual come to terms with the troubling thoughts, emotions or behaviors that they struggle with, change no longer appears impossible and they can work with their therapist to create a gradual plan for recovery.
The therapist's role in DBT is to help the person find a balance between acceptance and change. They also help the person develop new skills, like coping methods and mindfulness practices, so that the person has the power to improve unhealthy thoughts and behaviors. Similar to CBT, individuals undergoing DBT are usually instructed to practice these new methods of thinking and behaving as homework between sessions. Improving coping strategies is an essential aspect of successful DBT treatment.
Studies have shown DBT to be effective at producing significant and long-lasting improvement for people experiencing a mental illness. It helps decrease the frequency and severity of dangerous behaviors, uses positive reinforcement to motivate change, emphasizes the individual’s strengths and helps translate the things learned in therapy to the person’s everyday life.
Eye movement desensitization and reprocessing therapy (EMDR) is used to treat PTSD. A number of studies have shown it can reduce the emotional distress resulting from traumatic memories.
EMDR replaces negative emotional reactions to difficult memories with less-charged or positive reactions or beliefs. Performing a series of back and forth, repetitive eye movements for 20-30 seconds can help individuals change these emotional reactions.
Therapists refer to this protocol as "dual stimulation." During the therapy, an individual stimulates the brain with back and forth eye movements (or specific sequences of tapping or musical tones). Simultaneously, the individual stimulates memories by recalling a traumatic event. There is controversy about EMDR—and whether the benefit is from the exposure inherent in the treatment or if movement is an essential aspect of the treatment.
Exposure therapy is a type of cognitive behavioral therapy that is most frequently used to treat obsessive-compulsive disorder, posttraumatic stress disorder and phobias. During treatment, a person works with a therapist to identify the triggers of their anxiety and learn techniques to avoid performing rituals or becoming anxious when they are exposed to them. The person then confronts whatever triggers them in a controlled environment where they can safely practice implementing these strategies.
There are two methods of exposure therapy. One presents a large amount of the triggering stimulus all at once (“flooding”) and the other presents small amounts first and escalates over time (“desensitization”). Both help the person learn how to cope with what triggers their anxiety so they can apply it to their everyday life.
Interpersonal therapy focuses on the relationships a person has with others, with a goal of improving the person’s interpersonal skills. In this form of psychotherapy, the therapist helps people evaluate their social interactions and recognize negative patterns, like social isolation or aggression, and ultimately helps them learn strategies for understanding and interacting positively with others.
Interpersonal therapy is most often used to treat depression, but may be recommended with other mental health conditions.
Mentalization-based therapy (MBT) can bring long-term improvement to people with BPD, according to randomized clinical trials. MBT is a kind of psychotherapy that engages and exercises the important skill called mentalizing.
Mentalizing refers to the intuitive process that gives us a sense of self. When people consciously perceive and understand their own inner feelings and thoughts, it’s mentalizing. People also use mentalizing to perceive the behavior of others and to speculate about their feelings and thoughts. Mentalizing thus plays an essential role in helping us connect with other people.
BPD often causes feelings described as "emptiness" or "an unstable self-image." Relationships with others tend to be unstable as well. MBT addresses this emptiness or instability by teaching skills in mentalizing. The theory behind MBT is that people with BPD have a weak ability to mentalize about their own selves, leading to weak feelings of self, over-attachment to others, and difficulty empathizing with the inner lives of other people.
In MBT, a therapist encourages a person with BPD to practice mentalizing, particularly about the current relationship with the therapist. Since people with BPD may grow attached to therapists quickly, MBT takes this attachment into account. By becoming aware of attachment feelings in a safe therapeutic context, a person with BPD can increase their ability to mentalize and learn increased empathy.
Compared to other forms of psychotherapy such as cognitive-behavioral therapy, MBT is less structured and should typically be long-term. The technique can be carried out by non-specialist mental health practitioners in individual and group settings.
The goal of psychodynamic therapy is to recognize negative patterns of behavior and feeling that are rooted in past experiences and resolve them. This type of therapy often uses open-ended questions and free association so that people have the opportunity to discuss whatever is on their minds. The therapist then works with the person to sift through these thoughts and identify unconscious patterns of negative behavior or feelings and how they have been caused or influenced by past experiences and unresolved feelings. By bringing these associations to the person’s attention they can learn to overcome the unhelpful behaviors and feelings which they caused.
Psychodynamic therapy is often useful for treating depression, anxiety disorders, borderline personality disorder, and other mental illnesses.
Spending time with domestic animals can reduce symptoms of anxiety, depression, fatigue and pain for many people. Hospitals, nursing homes and other medical facilities sometimes make use of this effect by offering therapy animals. Trained therapy pets accompanied by a handler can offer structured animal-assisted therapy or simply visit people to provide comfort.
Dogs are the most popular animals to work as therapy pets, though other animals can succeed as well if they are docile and respond to training. Hospitals make use of therapy pets particularly for patients with cancer, heart disease and mental health conditions. The pets that are certified to visit medical facilities meet a high standard of training and are healthy and vaccinated.
For people with a mental health condition, research has shown that time with pets reduces anxiety levels more than other recreational activities. Pets also provide a non-judgmental form of interaction that can motivate and encourage people, especially children. Veterans with PTSD have also found therapy pets helpful.
A session with a therapy pet and its handler may focus on specific goals such as learning a skill through human-animal interaction. Alternatively, simply spending time holding a therapy pet can have benefits such as lower anxiety levels.
Though more research is necessary to establish why animal therapy is effective, one theory is that humans evolved to be highly aware of our natural environment, including the animals around us. The sight of a calm animal reassures us that the environment is safe, thus reducing anxiety and increasing our own feelings of calm.
Therapy animals are not the same as service animals, who receive a higher level of training and learn specific tasks for assisting one person on a long-term basis. Service animals are considered working animals, not pets. They have shown some promise in helping people with mental health conditions, particularly PTSD and panic disorders.