Behavior therapy

Behavior therapy is an umbrella term for many techniques based on behaviorist theories such as classical conditioning, operant conditioning, and social learning theory.

This therapy seeks to identify and help change potentially self-destructive or unhealthy behaviors, adjusting them to more helpful or positive ones.

Behavior therapy functions on the idea that all behaviors are learned, and thus unhealthy behaviors can be changed.

Exposure therapy is a type of behavior therapy that is used to help people overcome their fears of situations or objects. This therapy incorporates techniques that expose people to the source of their fears while practicing relaxation strategies.

Another type of behavior therapy, called systematic desensitization, involves learning ways to relax (e.g., through visualization or progressive muscle relaxation), then making a list of fears and ranking them based on intensity.

After this, the therapist encourages the individual to start exposing themselves to these fears in stages so that they get increasingly more comfortable dealing with them.

The people who commonly seek behavior therapy are those wanting to treat depression, anxiety, panic disorder, and anger issues.

Cognitive behavioral therapy (CBT)

CBT is a very popular type of therapy known for producing effective results in a few required sessions.

CBT helps people to identify their unhelpful thinking patterns and behaviors with the therapist, then work together to challenge and restructure these into more healthy and positive thoughts and behaviors.

In CBT, individuals can set goals that they want to work on, problem-solve, and practice new skills with the therapist.

Rational emotive behavior therapy (REBT) is a type of CBT that focuses on identifying negative or destructive thoughts and feelings. The individual can then actively challenge those thoughts and replace them with more rational, realistic ones.

Another type of CBT is mindfulness-based cognitive therapy which combines CBT with meditation. This type of therapy helps cultivate a non-judgemental, present-orientated attitude referred to as mindfulness.

People commonly seek CBT to help treat anxiety disorders and depression, but it can be helpful for other mental disorders or any mental distress.

Dialectical behavior therapy (DBT)

DBT is a type of CBT that was originally intended to treat borderline personality disorder but has since been adapted to treat other conditions.

This therapy is used to help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors such as eating disorders or substance-use disorders.

DBT helps to address thoughts and behaviors while incorporating strategies such as emotional regulation and mindfulness.

DBT aims to teach people how to develop healthy ways to cope with stress, regulate their emotions, and improve relationships with others.

DBT teaches core mindfulness, distress tolerance, and interpersonal effectiveness. This therapy can help people who may lack useful coping skills and find that they move from one crisis to another.

Humanistic therapy

This approach to therapy emphasizes the importance of being your true self in order to lead the most fulfilling life. Humanistic therapy is based on the principle that everyone has their own unique way of looking at the world, and this view can impact choices and actions.

The core belief is that people are good at heart and can make the right choices for themselves. Likewise, the belief is that if people do not hold themselves in high regard, it’s harder to develop their full potential.

The humanist psychologist Carl Rogers developed an approach known as client-centered therapy, which is the main type of humanistic therapy.

This is based on the idea that absorbing criticism or disapproval from others can distort how someone sees themselves, blocking personal growth, which can lead to mental distress.

This therapy involves the therapist unconditionally accepting the client, even if they disagree, which helps to avoid the client holding back out of fear of disapproval.

The client is encouraged to guide the direction of the therapy while the therapist listens without judgment.

This approach focuses on helping people maximize their potential and stresses the importance of self-exploration, free will, and self-actualization.

Psychodynamic therapy

Based on Sigmund Freud’s theory of psychoanalysis, this approach explores how the unconscious mind influences thoughts, feelings, and behaviors.

Psychoanalytic therapy examines how a person’s experiences, often from childhood, may be contributing to their current experiences and actions.

Freud believed that there were unconscious influences that could lead to psychological distress and disturbances, and therapy can help to uncover these unconscious thoughts, desires, and memories to heal.

Some techniques of psychoanalysts include:

Dream interpretation – believed to be the most important technique according to Freud, this provides insight into the workings of the unconscious mind.

Free association – this is an exercise during which the psychoanalyst encourages individuals to freely share their thoughts. This can lead to the emergence of unexpected connections and memories.

Transference – this occurs when the client projects their feelings about another person onto the psychoanalyst. The client can then communicate with the psychoanalyst as if they were that other person.

Psychoanalytic approaches to emotional distress have advanced a great deal since Freud’s time but still, use the main techniques. Psychoanalysis focuses on emotions, explores avoidance, identifies recurring themes, and explores interpersonal relationships.

It is also more free-flowing compared to other therapies, which can be more structured.

How effective is psychotherapy?

Each person’s experience with psychotherapy will be different, and the time it takes to see an improvement will vary.

Some people will notice a difference after around 6-12 sessions, while others may require ongoing treatment for longer, sometimes for years.

The effectiveness of psychotherapy can depend on some of the following factors:

• The reason for seeking therapy, such as the mental health conditions or emotional distress being experienced.

• The skill of the therapist.

• The relationships between the therapist and the individual.

• Any support the person may have outside the therapy sessions.

• The person’s willingness to help themselves – they have to take accountability and not expect the therapist to fix everything for them.

Psychotherapy has been shown to be very helpful for a variety of different issues. Some of the notable benefits include:

• Improved communication skills.

• Healthier thinking patterns and a greater awareness of negative thoughts.

• Improved ability to make healthier choices.

• Greater insights into one’s own life.

• Improved coping strategies to manage distress.

• Stronger family bonds.

• Providing someone to explore their problems within a confidential environment.

• Enabling people to see things from a different perspective.

• Helping people to move towards a solution.

• Learning more about one’s goals and values.

• Developing skills for facing challenges in the present and in the future.

• Being able to overcome specific problems such as phobias.

Psychotherapy has been found to be effective in helping individuals with a variety of mental health conditions, specifically those who have depression (Munder et al., 2018).

Therapists can help depressed individuals build new ways of thinking and reacting, attempting to examine the causes and potential solutions to their concerns.

Psychotherapy has also been helpful for those with anxiety disorders, such as generalized anxiety and social anxiety, helping these individuals become less avoidant, understand their emotions, and progress toward their goals.

Research shows that most people who receive psychotherapy experience symptom relief and are better able to function in their lives. According to the American Psychological Association, about 75% of people who have psychotherapy show to benefit from it.

Numerous studies have identified brain changes in people with mental health disorders (including depression, panic disorder, PTSD, etc.) due to undergoing psychotherapy.

In most cases, the brain changes were similar to changes observed in those who take medication for their condition (Karlsson, 2011).

Specifically for CBT, meta-analyses have found this therapy to be strongly effective, especially in improving the symptoms in people with anxiety-related disorders, including OCD and PTSD, as well as in anger problems, drug abuse, and general stress (Hofmann et al., 2012; NIDA, 2018).

CBT has also been used in children and adolescents, with findings suggesting that this therapy can be effective in treating symptoms of depression and anxiety in these age groups (Oud et al., 2019).

A review of 86 studies investigating humanistic therapies found that this approach was effective at helping people make lasting changes over time, with people in this therapy showing more change than people who were not in therapy (Elliott, 2002).

A 2016 review of existing research suggested that client-centered approaches to therapy, as seen in humanistic therapy, can be helpful for trauma, relationship difficulties, psychosis, and coping with chronic health issues (Elliott, 2016).

Regarding psychoanalytic therapies, a review of the effectiveness of long-term psychoanalytic therapy found moderate to large success rates for reducing symptoms of a variety of psychopathologies (De Maat et al., 2009).

A 2021 review of studies found that short-term psychoanalytic therapy led to lasting improvements in somatic symptoms, depressive symptoms, and anxiety symptoms (Abbass et al., 2021).

Overall, psychotherapies have a vast amount of support for their effectiveness. It is thought that people in all types of psychotherapy show some significant amount of positive change.

This suggests that it is more about finding a type of therapy that a person will enjoy and commit to, suited to their specific problem.

How to get the most out of psychotherapy

To obtain all the benefits of psychotherapy, a person will need to:

Find the right therapist – it’s important to ensure you feel comfortable with your therapist. If you feel as if you are not ‘clicking’ with your current therapist or you would like to try someone else’s approach, there is no shame in finding someone new.

Approach therapy as a partnership – the therapist is there to work with you, and it is helpful to build a strong interpersonal relationship for effective treatment.

Therapy is also more effective when you actively participate and share in decision-making. Ensure that both yourself and your therapist agree on the way that problems are solved and the decisions that are made. Together you can set goals and assess progress over time.

Be honest – the effectiveness of psychotherapy often depends on your ability to be open and honest with the therapist. You should be willing to share thoughts and feelings and consider new insights, ideas, and ways of doing things.

Being closed up and unwilling to change your thoughts may indicate that you are not ready for therapy. However, it is fine to have boundaries with the therapist.

If there are certain topics that you do not want to discuss as they are painful or embarrassing, then let the therapist know, so they know not to bring them up during sessions.

Attend all appointments – while it can be tempting to skip sessions if you are feeling down or lack motivation, feeling this way may indicate that you need the session that day more than usual.

A high proportion of people quit therapy before the sessions are over as it may get too hard for them, or they cannot commit to the sessions. Skipping or quitting therapy can disrupt the progress that has already been made.

Try to stick to the recommended treatment plan, and if something is not working for you, such as the times of the sessions, discuss this with the therapist, who may be able to come up with a solution.

It’s also useful to come to the therapy sessions with some ideas on what you want to discuss so there is a reason in mind for attending the session that day.

Don’t expect instant results – the number of sessions needed to see noticeable results can differ depending on the severity of your symptoms.

Working on emotional issues can be painful and require a lot of patience and hard work. Some people may feel somewhat better after one session, but others may require 6-12 sessions, while others may take longer.

The therapist will usually discuss your goals and progress regularly throughout therapy and assess whether you require more sessions.

Complete assignments between sessions – depending on the type of therapy, such as with CBT, you may be asked to complete some homework between sessions. This may involve using a journal or completing worksheets.

It may feel like a lot of effort, and you may feel unmotivated to do so, but try to follow through on these tasks set by the therapist.

If you find these assignments hard to complete or to fit into your schedule, discuss this with the therapist, as they may decide to make some adjustments or try a different approach with you.

How to get started

As therapy can be effective for a range of issues, you do not necessarily have to have a mental health disorder or have to wait until life becomes overwhelming to seek help. The sooner you reach out, the sooner you can get help.

It may be useful to consider the following steps when looking to get started on psychotherapy:

Consult with your primary physician – they might want to rule out any physical conditions in the first instance. If no conditions are found, the doctor may then refer you to a mental health professional who is qualified to diagnose and treat mental illnesses.

Look for a qualified individual to provide psychotherapy – people who provide therapy can hold many different titles or degrees.

Choose the right therapist – consider whether you feel comfortable divulging personal information to the therapist.

Don’t be afraid to seek a different therapist if the one you have does not quite suit your needs. When choosing a therapist, consider your deal breakers, important qualities, and any other characteristics you value.

Consider whether you need medication – if your treatment requires medication and psychotherapy, a psychiatrist may benefit you.

If you would benefit from some form of therapy without medication, you might be referred to a clinical psychologist or counselor.

Be prepared to fill out paperwork-when things get started, the therapist will likely collect health history and personal contact information. They may also need some consent forms signed by you.

When you are ready to select a therapist, think about the following:

• What type of therapy do you want to do- individual therapy, group therapy, or another type?

• What are your main goals for therapy?

• Whether you can commit the time each week – what days and times are most convenient for you?

Below are some things you may want to ask the therapist:

• What are your areas of expertise?

• Whether they work with your demographic.

• Whether they have experience helping people with symptoms like yours

• What their approach to treatment is, and whether this has proved effective in the past.

• What they expect from you during therapy.

References

Ansell Elfer, E. (n.d.). Understanding the Difference Between Social Anxiety Disorder and Autism. The Autism Site. Retrieved 2022, March 24 from:

Bank, S., Burgess, M., Sng, A., Summers, M., Campbell, B., & McEvoy, P. (2020). Stepping Out of Social Anxiety. Perth, Western Australia: Centre for Clinical Interventions.

Abbass, A., Lumley, M. A., Town, J., Holmes, H., Luyten, P., Cooper, A., Russell, L., Schubiner, H., De Meulemeester, C. & Kisely, S. (2021). Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects. Journal of Psychosomatic Research, 145, 110473.

American Psychological Association. (2020, July 31). Understanding psychotherapy and how it works. https://www.apa.org/topics/psychotherapy/understanding

de Maat, S., De Jonghe, F., Schoevers, R., & Dekker, J. (2009). The effectiveness of long-term psychoanalytic therapy: A systematic review of empirical studies. Harvard Review of Psychiatry, 17(1), 1-23.

Elliott, R. (2002). The effectiveness of humanistic therapies: A meta-analysis.

Elliott, R. (2016). Research on person-centred/experiential psychotherapy and counselling: summary of the main findings.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.

Munder, T., Flückiger, C., Leichsenring, F., Abbass, A. A., Hilsenroth, M. J., Luyten, P., Rabung, S., Steinert, C. & Wampold, B. E. (2019). Is psychotherapy effective? A re-analysis of treatments for depression. Epidemiology and Psychiatric Sciences, 28(3), 268-274.

NIDA. (2020, June 1). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine). From https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy

Oud, M., De Winter, L., Vermeulen-Smit, E., Bodden, D., Nauta, M., Stone, L., van den Heuvel, M., Al Taher, R., de Graaf, I., Kendall, T., Engels, R. & Stikkelbroek, Y. (2019). Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. European psychiatry, 57, 33-45.