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How to choose a type of therapy: CBT and PDT

Understanding types of therapy is daunting! There are dozens of jargon-y names and little transparency about what it might be like to participate in them.

There are far too many to cover in a blog post, however, below is a brief summary of two common ones. Many types of therapy will fall under the umbrella of cognitive-behavioral therapy (CBT) or psychodynamic therapy.

And check the companion article - How to Choose a Therapist - for information on selecting the best person to meet with.

Cognitive-behavioral therapy (CBT)

CBT is an approach that has a wealth of scientific background for efficacy in just about every mental health disorder, including the common ones of anxiety disorders, depression, and PTSD. It is aimed at reducing symptoms of these disorders, which often include unpleasant moods, maladaptive beliefs and attitudes (e.g., pessimism), health-related symptoms like poor sleep, and impaired functionality in daily life. It accomplishes this change in symptoms by making changes to your thoughts and behaviors. When adherent to the model, CBT is time-limited and directive, meaning that a therapist will have an agenda and will likely recommend in-between session practices like worksheets. Adherent CBT will also include symptom questionnaires to assist in diagnosis and to track improvement over time. CBT is designed to be a short-term treatment (usually about 12 weeks, although 6-20 weeks is also common) and is the most insurance-friendly approach because of its evidence base and efficiency.

There are specific therapies within CBT that might be more recognizable by their name, such as:

  • Behavioral activation (for depression)

  • Exposure therapy (for anxiety disorders and phobias)

  • Exposure and response prevention (for OCD)

  • Cognitive processing therapy and prolonged exposure therapy (for PTSD)

These specified CBT interventions are also time-limited, problem-focused, and highly evidence-based.

Two common therapies related to CBT: Dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT)

Dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT) are also within the CBT family. DBT focuses on helping individuals with strong emotions learn to manage emotions, be more effective interacting with other people, increase mindfulness of thoughts, and cope with moments of distress without doing something you'll regret later. It has particularly good research evidence for people with borderline personality disorder, eating disorders, self-injury or suicidal thoughts, and substance use disorders.

ACT is a behavioral therapy that’s based on acceptance of your emotions, thoughts, and circumstances (rather than resisting or trying to change them), mindfulness, defining your personal values, and taking ‘committed action’ to align your life with those values. It has strong evidence of efficacy for a number of psychological disorders, including anxiety disorders and depression.

What you might like:

  • If your goal is reduction of symptoms of a mental health disorder, there is a ton of evidence behind CBTs for that. You might notice the difference within weeks or even days!

  • You will learn strategies to manage symptoms on your own, so with good maintenance, you can enjoy the benefits of these strategies indefinitely

  • It is practical, efficient, and cost-effective

  • Insurance is more likely to cover it

What you might not like:

  • A CBT therapist’s agenda might mean less time and flexibility to talk about anything other than the identified problem

  • Because it focused on the present moment and symptoms, you might not have much time to process the past, or “the big picture”

  • Can feel like it is surface-level

As a last, important note about CBT, many therapists will blend it with other approaches, like psychodynamic therapy or client-centered therapy, so it might be less rigid than it sounds above. This depends on the individual therapist or clinic setting.

Psychodynamic therapy

Psychodynamic therapy (PDT) is another very common approach. Rather than targeting changes to thoughts and behaviors, PDT focuses on developing insight as a source of change and freedom. There are many specific schools of thought within psychodynamic therapy, but common elements include providing a supportive space to process past and present experiences, identifying and understanding recurring life themes or patterns, dream interpretation, understanding how life experiences have shaped who we are today, and exploring what comes up in the relationship between the therapist and patient.

Psychodynamic therapy has been put to the test in scientific research less often than CBT approaches for psychological disorders. There is evidence that it might be as effective or more for personality disorders, and as equally effective as depression, compared with CBTs. However, for other problems, such as anxiety disorders, OCD, or PTSD, there is little evidence for PDT or evidence it is likely to be inferior to CBT. Keep in mind that in most of this research, levels of disorder-specific symptoms are the outcome, and that might not be your primary goal.

Some of the approaches and theories that are under the umbrella of psychodynamic therapy are:

  • Relationally Focused Psychodynamic Therapy (RFPT)

  • Psychoanalysis

  • Jungian Therapy

  • Object Relations

  • Intensive Short-Term Dynamic Psychotherapy (ISTDP)

What you might like:

  • You will gain lots of self-knowledge broadly, that goes beyond your “presenting problem”

  • There is focus on the whole person, rather than a problem-or symptom-focused treatment

  • You will have a long-term and meaningful relationship with a therapist

  • You will have more time to discuss what you’d like than in CBT

What you might not like:

  • If you have a mental health diagnosis, odds are there is less evidence for PDT, or the research may indicate that is less effective than CBT

  • It is based more on theory than empirical research compared to CBT

  • Many courses of treatment will be longer, meaning more time commitment and expenses

Additional resources:

Psychology Today has a thorough description of many more types of therapy:

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