Psychotherapy Alphabet Soup: CBT, DBT, ACT, and More

Psychotherapeutic approaches, e.g. ACT, CBT, CPT, ERP, PE, CFT, DBT, EMDR

Some studies have shown that the quality of the therapeutic relationship between client and therapist is a stronger predictor of therapeutic outcomes than the type of therapy used. However, it seems logical that the type of therapy should at least to some extent match up with how you tend to conceptualize the problems you’re experiencing. Here is a brief run-down of some different psychotherapy approaches. This is by no means an exhaustive list, and it doesn’t include things like humanistic approaches or those therapies that do a deep dive into past issues and attachment. GoodTherapy.org has a much more extensive list.

The Resources page has a free downloadable mini-ebook called the Therapy Basics Toolbox, which covers key concepts from acceptance and commitment therapy (ACT) cognitive behavioural therapy (CBT), and dialectical behaviour therapy (DBT).

ACT: Acceptance and Commitment Therapy

Acceptance and commitment therapy metaphors: passengers on a bus, tug of war, leaves on a stream, and the chessboard

Acceptance and commitment therapy (ACT) takes the perspective that resistance to thoughts and feelings is the main cause of distress. It addresses areas such as present moment awareness, acceptance, separating the self from thoughts, and taking committed action consistent with identified values.

There are a lot of great metaphors used to help with conceptualizing various ACT concepts – you can read more about them in Acceptance and Commitment Therapy Metaphors.

I’ve reviewed some great ACT-based books including:

CBT: Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) is perhaps one of the best known counselling approaches. It considers the relationships between thoughts, feelings, and behaviours, and how each of those elements can be changed. Evidence for and against thoughts is examined with the goal of identifying problematic thinking patterns that cause distress and replacing them with more realistic thoughts. As well, new behaviours are practiced to reduce distress and promote more realistic thinking.

Cognitive distortions in CBT, e.g. all-or-nothing thinking, catastrophizing

Some important concepts in CBT include:

I’ve reviewed quite a few CBT-based books; you can find them on the Book Reviews page.

There are a number of different forms of therapy that are based on CBT. Here are just a few examples.

CBT for Chronic Pain

CBT for chronic pain aims to change how the brain responds to pain. Behavioural activation is an important part of this.

CBT-i: CBT for Insomnia

CBT-i has a cognitive component that addresses dysfunctional beliefs related to sleep, but the main elements are behaviour. A key piece is not staying in bed awake for more than 15 minutes at a time, and getting up at the same time every morning regardless of how much sleep you’ve gotten.

CPT: Cognitive Processing Therapy

Cognitive processing therapy (CPT) is a form of CBT for PTSD, and aims to change cognitions about the trauma that are keeping the person stuck and preventing them from fully processing the trauma. The post Creating a Trauma Account talks about how I borrowed a tool from CPT.

ERP: Exposure and Response Prevention

Exposure and response prevention (ERP) is used in the treatment of OCD, and involves exposure without resorting to the use of compulsions.

PE: Prolonged Exposure

Prolonged exposure (PE) is a form of CBT that aims to decrease fear and trauma responses by exposing the person in a controlled way. This can be either in vivo (in person) or imaginal (the client is asked to vividly imagine a particular situation), or a combination of both. It progresses based on an identified hierarchy of feared stimuli.

TF-CBT: Trauma-Focused CBT

Like CPT, trauma-focused CBT (TF-CBT) is a form of CBT for trauma, but it is geared toward children and adolescents.

CFT: Compassion-Focused Therapy

Compassion-focused therapy (CFT), which is influenced by CBT, focuses on compassion towards both others and the self. It can be useful for people struggling with emotions like shame and self-criticism.

CFT describes three systems within the brain: the threat system, the drive system, and the caregiving system. The therapy aims to strengthen the care-giving system while toning down the threat system.

There’s more information about CFT on the Compassionate Mind Foundation.

DBT: Dialectical Behaviour Therapy

Dialectical behaviour therapy (DBT) was developed by Dr. Marsha Linehan to address some of the shortcomings of CBT for treating borderline personality disorder (BPD). The dialectic refers to the idea that the way the individual is doing things now is valid and they are doing the best they can, but they would still benefit from change. DBT is very skill-based, with modules covering areas of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

Wise mind is a really useful DBT concept that involves the overlap of rational mind and emotion mind. There’s nothing wrong with rational mind or emotion mind, but we make our best decisions when we have both engaged.

Wise mind: overlap between reasonable mind and emotion mind

Some of the foundational assumptions on which DBT is built are quite profound, regardless of whether or not you choose to do DBT; I talk more about these in the post Wise Words from DBT Creator Marsha Linehan.

The Dialectical Behavior Therapy Skills Workbook is an excellent DBT resource.

EFT: Emotionally Focused Therapy

Emotionally-focused therapy (EFT) considers emotions to be reflective of underlying needs. It classifies emotions as adaptive, maladaptive, reactive, and instrumental. Therapeutic tasks are identified based on the client’s particular emotional experiences.

The International Center for Excellence in EFT has more information about the therapy.

Note: This isn’t the same thing as Emotional Freedom Techniques, also known as EFT or tapping.

EMDR: Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) is a type of trauma therapy. The client uses horizontal eye movements to track the therapists’ fingers, and while this is being done the client focuses on an identified distressing image and the bodily sensations associated with that distress. A Subjective Units of Distress (SUDS) scale is used to track progress, and as the SUDS score drops the therapist and client work on installing a new positive cognition.

EMDR is based on the idea that trauma memories are stored in an unintegrated manner in the brain, with a strong sensory element that’s disconnected from a narrative element. The goal of therapy is to process these memories so they can be stored in an integrated form like other memories.

The American Psychological Association goes into more detail in this article as part of their PTSD treatment guidelines. Counsellor Johnzelle Anderson has also done a guest post on EMDR for Mental Health @ Home.

IFS: Internal Family Systems Therapy

Internal family systems therapy (IFS) is based on the belief that our minds are naturally multiple, and we all have a collection of parts that make up the Self. It identifies three types of parts: managers, firefighters, and exiles. Exiles are seen as holding the most difficult experiences from the past. IFS is most commonly used for people dealing with the effects of trauma.

IPT: InterPersonal Therapy

Interpersonal therapy (IPT) is a short-term, structured approach that focuses on addressing interpersonal problems that contribute to problems with mental health, as well as building interpersonal communication skills. Research has supported its effectiveness in the treatment of depression.

The IPT Institute site goes into some of the details of IPT.

MBCT: Mindfulness-Based Cognitive Therapy

Mindfulness-based cognitive therapy (MBCT) is focused on the use of mindfulness to address cognitive distress. It covers things like acting on autopilot, being mindful of the breath, allowing and letting be, engaging in self-care, and recognizing that thoughts aren’t facts.

MBCT.com has more information about this form of therapy.

Psychodynamic Psychotherapy

Psychodynamic psychotherapy incorporates Freudian psychoanalytic concepts. It explores conflicts from the past that have influenced the development of current problems. Transference plays an important role in this form of therapy, with the therapeutic relationship providing a safe place for clients to project their feelings towards others onto the therapist so those conflicts can be worked through.

MBT: Mentalization-Based Therapy

Mentalization-based therapy (MBT) is a form of psychodynamic therapy used in the treatment of borderline personality disorder. Mentalization is the ability to capture in our imagination other people’s beliefs, emotions, and motivations. MBT aims to re-establish mentalization when people have gone into prementalistic modes.

REBT: Rational Emotive Behaviour Therapy

Rational emotive behaviour therapy (REBT) was developed by psychologist Albert Ellis. It’s a cognitive behavioural type of therapy, and it was a precursor to Aaron Beck’s CBT. Concepts from REBT are incorporated into the SMART Recovery program.

You can read here about the 12 irrational beliefs that Ellis identified.

SFBT: Solution-Focused Brief Therapy

Solution-focused brief therapy (SFBT) works on identifying and developing the skills to create changes and achieve goals. The therapist asks particular types of questions to guide the client toward envisioning their future and identifying strengths and coping skills.

The Institute for Solution-Focused Therapy has more information.

Schema Therapy

Schema therapy identifies and addresses early maladaptive schemas that are contributing to present difficulties. It’s an evidence-based therapy for borderline personality disorder, and it’s also shown positive results for a number of other disorders.

STAIR Narrative Therapy

STAIR narrative therapy is a form of trauma therapy. The therapy begins with the STAIR, which stands for Skills Training in Affective and Interpersonal Regulation. After working on those skills, the therapy moves on to the narrative component, which involves taking authorship of one’s story and creating new meaning. This also serves as a form of exposure.

What types of psychotherapy have you tried? What was your experience like?

The Psychology Corner: Insights into psychology and psychological tests

The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.

28 thoughts on “Psychotherapy Alphabet Soup: CBT, DBT, ACT, and More”

  1. harotianessentials

    I’ve done CBT and BDT. Both helped me at the time but really not in the long run. Thanks for sharing the other options

  2. This is a great list, I’m confident it will be helpful to those who are looking in to different types of psychotherapy. Thank you! I have done CBT and DBT as well as typical talk therapy. Talk therapy is validating but CBT and DBT offer me the most practical steps for managing my illnesses. I am finding as time goes on I am realizing the impact of my CBT, at first I wasn’t confident I had really learned anything. DBT has been fantastic particularly for distress tolerance skills.

  3. I’ve been reading a lot on various kinds on therapy lately, but still some of those you mentioned were new to me. I’d been doing CBT for a long long time, with varying results, but I found it hugely helpful in the past when I was dealing with a lot of intense emotions and issues and learned a lot of useful coping techniques to regulate feelings or manage them better. I also had a great therapist with whom I was working for years, and apart from CBT, she was also mixing it with some other approaches/techniques, and she was a Christian therapist which I liked, being myself a practicing Christian. Though a few months ago, as you know, I had to change therapists and since then I wasn’t feeling like I was doing much progress, so now I”m starting psychodynamic therapy, with the therapist who is also integrating some other approaches a bit and so far it seems to be OK, although I’ve had just one session. I was a bit scared and thought it might turn out not too good for me as I’ve heard really various things about PD but since my issues are to do with the past that seemed to have the most sense, to choose psychodynamic therapy. If that won’t work though, I may try something humanistic, I know humanistic therapies aren’t to do with the past but as much as I kow about them something kinda speaks to me in them, or just look for another CBT therapist.

  4. I think there’s certainly an element of interpersonal relationships influencing the efficacy of therapy, it would be very difficult to engage fully with a therapist that you dislike.

    I have had CBT – excellent principles but really hard to put into use at the time when distress is greatest. For me, it was useful to look back at the negative distortions I was using and challenge these with fact, but only after the distress had diminished.
    BA (Behavioural Activation) – a subset of CBT, this looks at changing behaviour rather than challenging thoughts and personally I found it easier to use at the time of distress and was at least partially effective.
    EMDR – my therapist used hand tapping rather than eye movement. EMDR is a very tough therapy, it releases trauma memories, and you experience intense emotions and physical reactions as though you are back in the actual trauma. But it works, it’s incredibly hard to go through but for me it feels like magic has been worked on me! Since I finished EMDR, I have continued to benefit from it… like the process instilled little seeds of truth inside me and these have taken time to grow and heal. (stopping writing now before I sound completely away with the fairies!) 😀

  5. I have never used any of these therapies to be honest. I have peaked at DBT and CBT and read A LOT about everything. I think the therapy I used was learning to live and cope the best way for me. Centering yourself around positive people and settings, learning to live in the moment and forgiving myself were key elements for me. The best therapy was God’s love. God saved my life. Much love and hugs, Sue

  6. This is a great synopsis of the various approaches to therapy. I use CBT and DBT in my work with clients. When I went to therapy, I liked the CBT approach best.

  7. Wow, there are several on here that I had never even heard of. The few that I have experienced over time is the ACT, CPT, CBT, MBCT, and EFT. My therapist and I still go over certain areas more so than others over the course of 2&1/2 years.
    A very informative post. Thank you!

    1. I find that with the passage of time and new learning/experiences I’m able to go back and look at things again and get even more out of them than I did originally.

      1. Oh, I know that that is the case with me. When I first went through CBT, I was still in a very scary, unfamiliar territory of being homeless. I was paying more attention to survival skills than anything else.
        When that situation was over with, I revisited that and moved forward from there. It made much more sense to me the second time around. 🙂

  8. This is such an informative post (and I love the title). I have tried EMDR and it was amazing, I was skeptical but it worked really well! I however am a Humanistic Therapist and from my side it seems to be really effective 🙂

  9. Great list! I love psychotherapy alphabet soup – must be the wannabe psychologist in me! ACT is something I’d like to write more about on my blog at some point soon as it’s used quite heavily in my pain management sessions and can be quite a powerful framework. x

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