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

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

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

• Escaping the Emotional Roller Coaster
• Get Out Of Your Mind and Into Your Life
• Book Review: Stop Avoiding Stuff
• The ACT Workbook for Anger
• The ACT Workbook for Depression & Shame
• The ACT Workbook for Perfectionism
• The Anxious Perfectionist
• When Life Hits Hard

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.

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.

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?