Comprehensive overview of major psychotherapy modalities including cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), psychodynamic therapy, interpersonal therapy (IPT), EMDR, and humanistic/emotion-focused approaches, with evidence base for each disorder.
This content is for informational purposes only. Always consult a healthcare professional.
Cognitive-Behavioral Therapy (CBT)
CBT is a structured, time-limited, evidence-based psychotherapy that targets the relationship between thoughts, emotions, and behaviors. Developed by Aaron T. Beck in the 1960s, it is among the most extensively researched psychotherapies.
Cognitive Triad
Beck proposed that depression is maintained by negative automatic thoughts across three domains:
Domain
Description
Example
Self
Negative view of oneself
“I am worthless,” “I am a failure”
World/Experience
Negative interpretation of ongoing experiences
“Everyone dislikes me,” “Nothing goes my way”
Future
Negative view of the future
“Things will never improve,” “I am hopeless”
Levels of Cognition
Level
Definition
Example
Intervention
Automatic thoughts
Spontaneous, involuntary cognitions in response to situations
“I’m going to mess this up”
Thought records, cognitive restructuring
Intermediate beliefs
Rules, attitudes, and assumptions
“If I make a mistake, others will reject me”
Socratic questioning, behavioral experiments
Core beliefs
Deeply held, global beliefs about self, others, and world
“I am unlovable”
Core belief worksheets, positive data logs, historical testing
Behavioral Activation
A core component of CBT for depression that targets the avoidance and withdrawal cycle.
Principle
Description
Technique
Activity monitoring
Track daily activities and mood to identify patterns
Activity log with mood ratings (0–10)
Activity scheduling
Plan structured activities, starting with low-effort tasks
Weekly schedule; start with 15-minute increments
Mastery and pleasure
Rate activities on mastery and pleasure to identify reinforcing behaviors
Rating scale (0–10); increase pleasurable and mastery-based activities
Gradual task assignment
Break overwhelming tasks into manageable steps
“Eat one meal,” not “clean the whole house”
Addressing avoidance
Identify and reduce safety behaviors and avoidance patterns
Exposure to avoided situations; stop reassurance-seeking
Exposure-Based Interventions
Type
Description
Disorder
Mechanism
In vivo exposure
Direct confrontation with feared situations
Phobias, OCD, PTSD
Habituation; inhibitory learning
Imaginal exposure
Repeated, detailed imagining of feared events
PTSD (trauma narrative)
Emotional processing; extinction
Interoceptive exposure
Deliberate induction of feared physical sensations
Panic disorder
Fear extinction of somatic cues
Exposure and response prevention (ERP)
Expose to obsessions; prevent compulsive rituals
OCD
Breaks negative reinforcement cycle
The Socratic Method in CBT
The Socratic method (or guided discovery) is a collaborative questioning approach that helps patients examine their thinking rather than being told it is distorted.
Question Type
Example
Clarifying
“What evidence supports that thought?”
Examining evidence
“Is there any evidence that contradicts this belief?”
Exploring alternatives
“What is another way to look at this situation?”
Decatastrophizing
“What is the worst that could happen? How likely is that?”
Reattribution
“What factors outside yourself might have contributed?”
Perspective-taking
“What would you tell a friend in this situation?”
Dialectical Behavior Therapy (DBT)
DBT, developed by Marsha Linehan, is a modified form of CBT designed for borderline personality disorder (BPD) and chronic emotion dysregulation. The term “dialectical” refers to the synthesis of opposing strategies: acceptance and change.
Core Dialectical Tension
Pole
Description
Acceptance
Validating the patient’s experience as understandable given their history
Change
Pushing for behavioral change using problem-solving strategies
Synthesis
Combining validation with change: “You are doing the best you can, and you need to do better”
The Four Skill Modules
Module
Goal
Sample Skills
Mindfulness
Increase awareness of the present moment without judgment
Wise mind (balance of emotion and logic); “what” skills (observe, describe, participate) and “how” skills (nonjudgmentally, one-mindfully, effectively)
Distress Tolerance
Tolerate painful emotions without making the situation worse
Crisis survival skills: TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation), STOP skill, ACCEPTS; pros and cons
Emotion Regulation
Reduce emotional vulnerability and decrease suffering
Identify and label emotions; reduce vulnerability (PLEASE MASTER); opposite action to emotional urges
Interpersonal Effectiveness
Maintain relationships while getting needs met and maintaining self-respect
DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate); GIVE (Gentle, Interested, Validate, Easy manner); FAST (Fair, no Apologies, Stick to values, Truthful)
ACT, developed by Steven Hayes, is a third-wave behavioral therapy that uses acceptance and mindfulness strategies to increase psychological flexibility.
Core Processes (The ACT Hexaflex)
Process
Definition
Goal
Intervention
Acceptance
Openness to internal experiences without attempting to control them
Allow unwanted thoughts/feelings to be present
Welcoming exercises; urge surfing
Cognitive Defusion
Creating distance from thoughts; seeing them as words/events rather than literal truths
Reduce fusion with unhelpful cognitions
“I notice I’m having the thought that…”
Contact with Present Moment
Flexible, nonjudgmental awareness of the here-and-now
Increase mindful engagement
Grounding exercises; present-moment awareness
Self-as-Context
Experiencing self as the ongoing perspective in which experiences occur
Connect with observer self; reduce attachment to stories
Observing self exercises; “sky and weather” metaphor
Values
Chosen life directions that give meaning and purpose
Clarify what matters
Values card sort; committed action planning
Committed Action
Building patterns of values-based action
Move toward valued life
Goal setting; behavioral shaping
The ACT Matrix
Quadrant
Content
Therapeutic Focus
Away moves (external)
Behaviors that avoid discomfort
Identify experiential avoidance patterns
Away moves (internal)
Unwanted thoughts, feelings, sensations
Acceptance, defusion work
Toward moves (external)
Values-consistent behaviors
Committed action, behavioral activation
Toward moves (internal)
Valued qualities, goals, meaning
Values clarification, self-as-context
Psychodynamic Psychotherapy
Psychodynamic therapy focuses on unconscious processes, early relationships, and patterns that manifest in current relationships, including the therapeutic relationship.
Key Concepts
Concept
Definition
Clinical Example
Unconscious
Mental content outside conscious awareness that influences behavior
Patient repeatedly enters relationships with unavailable partners without awareness of the pattern
Transference
Patient projects feelings/expectations from past relationships onto the therapist
Patient feels the therapist is judging them, like their critical parent
Countertransference
Therapist’s emotional reactions to the patient informed by the therapist’s own history
Therapist feels protective of a patient who evokes feelings about their own sibling
Defense mechanisms
Automatic psychological processes that protect the self from anxiety
Any behavior that protects the patient from unconscious material
Coming late to sessions, avoiding topics
Working through
Repeated examination of conflicts across multiple contexts
Applying insight from transference to relationships outside therapy
Defense Mechanism Maturity Continuum
Level
Defense
Description
Mature
Sublimation
Channeling impulses into socially acceptable outlets
Mature
Humor
Using comedy to cope without avoidance
Mature
Altruism
Helping others as a way of managing distress
Neurotic
Repression
Unconsciously blocking threatening thoughts
Neurotic
Intellectualization
Excessive use of abstract thinking to avoid feelings
Neurotic
Reaction formation
Behaving opposite to unacceptable impulses
Immature
Projection
Attributing one’s own unacceptable feelings to others
Immature
Acting out
Behavioral expression of unconscious impulses without insight
Immature
Dissociation
Temporary disruption of identity, memory, or consciousness
Interpersonal Therapy (IPT)
IPT is a time-limited therapy (typically 12–16 sessions) that focuses on the relationship between mood symptoms and interpersonal problems. It was originally developed by Klerman and Weissman for depression.
The Four IPT Problem Areas
Problem Area
Description
Goal
Strategy
Grief (complicated bereavement)
Abnormal or prolonged grief reaction following the death of a significant person
Facilitate mourning; help patient find new relationships/activities
Reconstruct relationship; explore feelings about loss
Role disputes
Conflicts with significant others (partner, family, work)
Identify dispute stage; negotiate resolution
Communication analysis; role-playing; clarify expectations
Role transitions
Changes in life status (divorce, job loss, retirement, illness)
Mourn loss of old role; develop new skills
Validate feelings about change; help patient build new social roles
Interpersonal deficits
Chronic difficulties forming or maintaining relationships
Reduce social isolation; improve communication
Build social skills; explore past significant relationships
IPT Phases
Phase
Sessions
Tasks
Initial (1–4)
1–4
Diagnose depression; complete interpersonal inventory; identify problem area; give the “sick role”
Middle (5–12)
5–12
Work on the identified problem area using IPT strategies; link mood to interpersonal events
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR, developed by Francine Shapiro, is a structured therapy for trauma that uses bilateral stimulation (typically eye movements) while the patient recalls traumatic memories.
Adaptive Information Processing (AIP) Model
Concept
Description
Memory networks
Traumatic experiences are stored in state-dependent form with maladaptive associations
Dysfunctional storage
Trauma is stored with the original emotions, sensations, and beliefs (e.g., “I am in danger,” “I am powerless”)
Adaptive resolution
EMDR facilitates processing to update memories with current adaptive information
Bilateral stimulation
Alternating left-right stimulation (eye movements, taps, tones) is hypothesized to facilitate interhemispheric communication and working memory taxation
EMDR Phases (8-Phase Protocol)
Phase
Name
Description
1
History taking
Assess trauma history; identify targets for processing
Activate the target memory: image, negative cognition, positive cognition, emotion, body sensation, validity of cognition (VoC) 1–7, subjective units of distress (SUD) 0–10
4
Desensitization
Bilateral sets while patient processes; continue until SUD = 0
5
Installation
Strengthen positive cognition; install until VoC = 7
6
Body scan
Check for residual physical tension related to the memory
7
Closure
Debrief; ensure stability between sessions
8
Reevaluation
At next session, check processing and identify new targets
Humanistic and Emotion-Focused Therapies
Person-Centered Therapy (Rogers)
Core Condition
Description
Therapeutic Behavior
Unconditional positive regard
Complete acceptance of the client without judgment
Non-evaluative warmth; absence of conditions of worth
Empathic understanding
Accurate understanding of the client’s internal frame of reference
Reflective listening; checking understanding
Congruence (genuineness)
Therapist is authentic and transparent
No professional facade; sharing reactions appropriately
Emotion-Focused Therapy (EFT)
EFT, developed by Leslie Greenberg, integrates humanistic and experiential approaches with emotion theory.
Principle
Description
Emotion as information
Emotions signal needs and guide adaptive action
Emotion scheme
A learned structure of emotional experience that organizes perception and behavior
Maladaptive emotion
A learned emotional response that is no longer adaptive and blocks healthy functioning
Transformation
Accessing adaptive emotions to transform maladaptive emotions (emotion changes emotion)
EFT Task
Description
Indicator
Two-chair dialogue
Patient moves between chairs to enact internal conflict (self-critical vs. experiencing self)
Self-critical split
Empty chair work
Patient addresses significant other in an empty chair to resolve unfinished business
Unresolved feelings toward another
Focusing
Attending to a vague bodily felt sense to bring implicit meaning to awareness
Unclear felt sense
Systematic evocative unfolding
Re-experiencing a puzzling emotional response to uncover the underlying emotion scheme