Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Therapists work with an individual or families to devise an appropriate treatment plan.What are the different types of psychotherapy?
Many kinds of psychotherapy exist. There is no "one-size-fits-all" approach. In addition, some therapies have been scientifically tested more than others. Some people may have a treatment plan that includes only one type of psychotherapy. Others receive treatment that includes elements of several different types. The kind of psychotherapy a person receives depends on his or her needs.
This section explains several of the most commonly used psychotherapies. However, it does not cover every detail about psychotherapy. Patients should talk to their doctor or a psychotherapist about planning treatment that meets their needs.Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a blend of two therapies: cognitive therapy (CT) and behavioral therapy. CT was developed by psychotherapist Aaron Beck, M.D., in the 1960's. CT focuses on a person's thoughts and beliefs, and how they influence a person's mood and actions, and aims to change a person's thinking to be more adaptive and healthy. Behavioral therapy focuses on a person's actions and aims to change unhealthy behavior patterns.
CBT helps a person focus on his or her current problems and how to solve them. Both patient and therapist need to be actively involved in this process. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.
CBT can be applied and adapted to treat many specific mental disorders.CBT for Depression
Many studies have shown that CBT is a particularly effective treatment for depression, especially minor or moderate depression. Some people with depression may be successfully treated with CBT only. Others may need both CBT and medication. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help a person recognize things that may be contributing to the depression and help him or her change behaviors that may be making the depression worse.CBT for anxiety disorders
CBT for anxiety disorders aims to help a person develop a more adaptive response to a fear. A CBT therapist may use "exposure" therapy to treat certain anxiety disorders, such as a specific phobia, post traumatic stress disorder, or obsessive compulsive disorder. Exposure therapy has been found to be effective in treating anxiety-related disorders. It works by helping a person confront a specific fear or memory while in a safe and supportive environment. The main goals of exposure therapy are to help the patient learn that anxiety can lessen over time and give him or her the tools to cope with fear or traumatic memories.
A recent study sponsored by the Centers for Disease Control and Prevention concluded that CBT is effective in treating trauma-related disorders in children and teens.CBT for bipolar Disorder
People with bipolar disorder usually need to take medication, such as a mood stabilizer. But CBT is often used as an added treatment. The medication can help stabilize a person's mood so that he or she is receptive to psychotherapy and can get the most out of it. CBT can help a person cope with bipolar symptoms and learn to recognize when a mood shift is about to occur. CBT also helps a person with bipolar disorder stick with a treatment plan to reduce the chances of relapse (e.g., when symptoms return).CBT for eating disorders
Eating disorders can be very difficult to treat. However, some small studies have found that CBT can help reduce the risk of relapse in adults with anorexia who have restored their weight.3 CBT may also reduce some symptoms of bulimia, and it may also help some people reduce binge-eating behavior.
Treating schizophrenia with CBT is challenging. The disorder usually requires medication first. But research has shown that CBT, as an add-on to medication, can help a patient cope with schizophrenia. CBT helps patients learn more adaptive and realistic interpretations of events. Patients are also taught various coping techniques for dealing with "voices" or other hallucinations. They learn how to identify what triggers episodes of the illness, which can prevent or reduce the chances of relapse.
CBT for schizophrenia also stresses skill-oriented therapies. Patients learn skills to cope with life's challenges. The therapist teaches social, daily functioning, and problem-solving skills. This can help patients with schizophrenia minimize the types of stress that can lead to outbursts and hospitalizations.Dialectical Behavior Therapy
Dialectical behavior therapy (DBT), a form of CBT, was developed by Marsha Linehan, Ph.D. At first, it was developed to treat people with suicidal thoughts and actions. It is now also used to treat people with Bipolar disorder (BPD). BPD is an illness in which suicidal thinking and actions are more common.
The term "dialectical" refers to a philosophic exercise in which two opposing views are discussed until a logical blending or balance of the two extremes—the middle way—is found. In keeping with that philosophy, the therapist assures the patient that the patient's behavior and feelings are valid and understandable. At the same time, the therapist coaches the patient to understand that it is his or her personal responsibility to change unhealthy or disruptive behavior.
DBT emphasizes the value of a strong and equal relationship between patient and therapist. The therapist consistently reminds the patient when his or her behavior is unhealthy or disruptive—when boundaries are overstepped—and then teaches the skills needed to better deal with future similar situations. DBT involves both individual and group therapy. Individual sessions are used to teach new skills, while group sessions provide the opportunity to practice these skills.
Research suggests that DBT is an effective treatment for people with BPD. A recent NIMH-funded study found that DBT reduced suicide attempts by half compared to other types of treatment for patients with BPD.Interpersonal Therapy
Interpersonal therapy (IPT) is most often used on a one-on-one basis to treat depression or dysthymia (a more persistent but less severe form of depression).
IPT is based on the idea that improving communication patterns and the ways people relate to others will effectively treat depression. IPT helps identify how a person interacts with other people. When a behavior is causing problems, IPT guides the person to change the behavior. IPT explores major issues that may add to a person's depression, such as grief, or times of upheaval or transition. Sometimes IPT is used along with antidepressant medications.
IPT varies depending on the needs of the patient and the relationship between the therapist and patient. Basically, a therapist using IPT helps the patient identify troubling emotions and their triggers. The therapist helps the patient learn to express appropriate emotions in a healthy way. The patient may also examine relationships in his or her past that may have been affected by distorted mood and behavior. Doing so can help the patient learn to be more objective about current relationships.
Studies vary as to the effectiveness of IPT. It may depend on the patient, the disorder, the severity of the disorder, and other variables. In general, however, IPT is found to be effective in treating depression.
A variation of IPT called interpersonal and social rhythm therapy (IPSRT) was developed to treat bipolar disorder. IPSRT combines the basic principles of IPT with behavioral psychoeducation designed to help patients adopt regular daily routines and sleep/wake cycles, stick with medication treatment, and improve relationships. Research has found that when IPSRT is combined with medication, it is an effective treatment for bipolar disorder. IPSRT is as effective as other types of psychotherapy combined with medication in helping to prevent a relapse of bipolar symptoms.8Family-focused Therapy
Family-focused therapy (FFT) was developed by David Miklowitz, Ph.D., and Michael Goldstein, Ph.D., for treating bipolar disorder. It was designed with the assumption that a patient's relationship with his or her family is vital to the success of managing the illness. FFT includes family members in therapy sessions to improve family relationships, which may support better treatment results.
Therapists trained in FFT work to identify difficulties and conflicts among family members that may be worsening the patient's illness. Therapy is meant to help members find more effective ways to resolve those difficulties. The therapist educates family members about their loved one's disorder, its symptoms and course, and how to help their relative manage it more effectively. When families learn about the disorder, they may be able to spot early signs of a relapse and create an action plan that involves all family members. During therapy, the therapist will help family members recognize when they express unhelpful criticism or hostility toward their relative with bipolar disorder. The therapist will teach family members how to communicate negative emotions in a better way. Several studies have found FFT to be effective in helping a patient become stabilized and preventing relapses. 9,10,11
FFT also focuses on the stress family members feel when they care for a relative with bipolar disorder. The therapy aims to prevent family members from "burning out" or disengaging from the effort. The therapist helps the family accept how bipolar disorder can limit their relative. At the same time, the therapist holds the patient responsible for his or her own well being and actions to a level that is appropriate for the person's age.
Generally, the family and patient attend sessions together. The needs of each patient and family are different, and those needs determine the exact course of treatment. However, the main components of a structured FFT usually include:
- Family education on bipolar disorder
- Building communication skills to better deal with stress, and
- Solving problems together as a family.
Psychotherapies can be adapted to the needs of children and adolescents, depending on the mental disorder. For example, an NIMH-funded study found that CBT, when combined with antidepressant medication, was the most effective treatment over the short term for teens with major depression. CBT by itself was also an effective treatment, especially over the long term. Studies have found that individual and group-based CBT are effective treatments for child and adolescent anxiety disorders. Other studies have found that IPT is an effective treatment for child and adolescent depression.
Psychosocial treatments that involve a child's parents and family also have been shown to be effective, especially for disruptive disorders such as conduct disorder or oppositional defiant disorder. Some effective treatments are designed to reduce the child's problem behaviors and improve parent-child interactions. Focusing on behavioral parent management training, parents are taught the skills they need to encourage and reward positive behaviors in their children. Similar training helps parents manage their child's attention deficit/hyperactivity disorder (ADHD). This approach, which has been shown to be effective, can be combined with approaches directed at children to help them learn problem-solving, anger management and social interaction skills