Talk therapy is a powerful weapon to guard against and work through depression and anxiety. From CBT to DBT to ACT to teletherapy, find your best fit here!
By Donna Jackel & Jade Zora Scibilia
Walking into a therapist’s office or attending a virtual teletherapy appointment for the first time is a leap of faith. You are about to share your most intimate thoughts and experiences with a stranger. Yet, when the counselor is a good fit, the work you do together can be transformative.
Skillful therapists offer you a fresh
perspective and help you to identify triggers, process past trauma, and
overcome long-held fears and insecurities. They also provide objective support and
teach you different strategies to manage the stressors in your life.
“Psychotherapy can serve as a safe space to work through problems you may be experiencing and can help with areas in which you feel stuck or at an impasse,” says Sarah Selden, PhD, who has a private practice in New York City and is a cofounder of Greenwich Mental Health Group in Greenwich, CT.
As for the more-immediate
results, effective talk therapy “can also improve your relationships and
provide relief when you are suffering,” Selden says.
Especially if you are feeling a
bit unsure after scheduling your initial appointment—or even after a few
sessions—familiarizing yourself with different types of talk therapy, such as
cognitive behavioral therapy and acceptance commitment therapy, can go a long
way toward bolstering your confidence. When you know what to expect and what
your other options are, you can make better-informed decisions about your
HOW DO YOU THINK?
“A lot of depression is, in large part,
influenced by how we think about our lives and the contents of our
experiences,” says Steven C. Hayes, PhD, a
professor of psychology at the University of Nevada and author of A Liberated Mind.
He explains, “Talk therapy focuses on how to think about the
challenges we face.”
It’s when we are at our lowest, in the fog of
depression, that we tell ourselves, “I’m worthless,” or “I can’t do anything
right.” Such thoughts are called negative core beliefs or negative automatic thoughts. They only drive us
deeper into depression, anxiety, and hopelessness, making it all the more
tempting to self-isolate.
That’s when talk therapy can be most helpful.
“Therapists are able to create space between
feelings and thoughts—for example, ‘This is the depression talking,’” says
Selden, the Connecticut– and New York–based therapist.
Once that space is established, counselors
can help their clients “challenge these thoughts and develop critical coping
skills,” she says.
These might include staying in the present
moment (mindfulness), reducing your emotional reactivity, and committing to
some type of regular exercise. Each particular form of talk therapy emphasizes
different approaches and strategies.
BARRIERS TO BOOKING AN APPOINTMENT FOR PSYCHOTHERAPY
According to the National Comorbidity Survey (NCS), approximately 80 percent of Americans who have a mental health condition eventually seek care. However, the average delay between the onset of symptoms and initial treatment is nearly a decade.
The proven effectiveness of many psychiatric medications and therapy have helped to reduce the social stigma of going to therapy, yet financial constraints, shame, fear of disclosure, and scarcity of adequate local services remain common challenges.
Another complicating factor is that when clinical depression lasts for months or years, people may not even realize that they are living with a treatable condition. As Selden, cofounder of Greenwich Mental Health Group, explains, “People may have felt depressed for so long that they may perceive it to be their baseline and not remember feeling otherwise.”
The good news? Over the past 30 years,
researchers have conducted thousands of controlled, randomized clinical studies to determine precisely which
types of talk therapy are most effective for depression,
anxiety, and other conditions.
The approaches detailed below are
evidenced-based, meaning they have undergone vigorous study; and short-term, lasting
anywhere from two months to several years. Plus, each form of talk therapy
offers skills that can be put to use in everyday life and further developed
even after the conclusion of treatment.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy,
which was created in the 1960s, is based on a deceptively simple premise: how we
perceive situations influences our emotions. It focuses on recognizing unhelpful thoughts
and emotions and replacing
them with more accurate, positive ones.
Psychiatrist Aaron T. Beck, founder
of CBT, observed that when we are in distress, our perspective and our
ideas about ourselves, the world, or our future
tend to be negative and unrealistic. Yet once we identify the factors compelling
these thought patterns, we can challenge our false perceptions, modify our mistaken beliefs, and better relate to others.
CBT skills can be put to use
to address a variety of concerns—from anxiety to grief to managing a chronic
physical condition. This practicality is part of what makes it
Emily S.’s first forays into therapy were unsuccessful—she didn’t like the process of sitting down to discuss at length how her previous week had gone.
“Some people want space to talk for an hour,”
says the 25-year-old. “I needed more concrete skills and ways of thinking.”
Then she found a therapist trained in CBT.
“The biggest thing she helped me do is set little weekly goals,” says Emily, who lives in the Washington, DC, area.
Emily also began to realize that for her depression to improve, she would have to actively change her behaviors instead of waiting to try things until she felt better. Determined to overcome this challenge, she committed to taking actions that were in direct opposition to her current psychological state. When Emily wanted to stay under the covers all day, she forced herself to get up and make her bed. If she felt too depressed to leave home but wanted to socialize, she worked up the willpower to send a brief message to a friend.
“I would just send a text saying ‘hi.’ That’s
it,” she says. “And that tiny action was still draining and hard, but doing it
changed my thinking from ‘I have no friends’ to ‘I have friends.’”
Challenging her negative thoughts motivated
her to make different decisions, ones that allowed her to make progress with
her depression: “Once I flipped that mind-set—doing those tiny things you don’t
want to do—I began disrupting the depression cycle.”
Acceptance & Commitment Therapy (ACT)
As its name suggests, acceptance and
commitment therapy, unlike CBT, focuses on accepting unhelpful thoughts rather
than changing them. Psychologist Steven C. Hayes drew from personal pain when he
developed ACT in the 1980s.
Early in his academic career,
Hayes began experiencing panic attacks. The harder he tried to ignore them
or make them go away, the more powerful and frequent they became.
One evening, his emotional distress reached a
peak, and Hayes became convinced he was having a heart attack; as time passed, he
realized it was panic yet again. That night, Hayes decided he would no longer run
from his emotions.
In developing ACT, Hayes drew on principles
from CBT, but with one key difference: instead of asking individuals to change their negative or irrational
thoughts, he encouraged them to observe the ideas without becoming overwhelmed or engaging in them.
“You develop a little healthy distance,” Hayes
explains. “You see it, remember it, but don’t struggle with it. You open up to the
feelings in an incremental way.”
Hayes coined the term “psychological flexibility”
to describe the learned ability to “hold our own thoughts and emotions a bit
more lightly and act on longer-term values,” bringing more love and positive
change to our world.
Through mindfulness and behavioral exercises, ACT allows us to recognize and work with difficult thoughts and emotions, says Megan Call, PhD, a counseling psychologist who teaches ACT skills to physicians and nurses within University of Utah Health.
“ACT is very experiential,” says Call. “As
you work on things, you become more motivated and excited about where your life
is headed. It might not make your life completely better, but it makes your
experience with life better.”
of the strategies she teaches is grounding yourself when overstressed or overwhelmed
by challenging emotions. For example, if you’re sitting, you push your feet onto
the surface of the floor and—while taking note of what that feels like—you also
push your back into the chair. Then you take a deep breath to slow things down.
Check in with yourself. Look around the room, registering what you see and hear.
in more of your senses can make the situation more workable,” says Call.
Another technique to decrease the impact of
unhelpful thoughts is by learning how to look at them instead of from them. For
example, if the thought, “No one likes me,” flits across your mind, you can tell
yourself, “I’m having the thought that no one likes me.”
Call explains that “this creates enough space
between yourself and the thought for you to pause and think, ‘Do I want to keep
buying into that?’”
“These are very practical strategies you can apply
immediately,” she says, “to allow you to feel more connected to yourself.”
Though she was initially trained in CBT, Call
considers ACT “a game changer.”
Dialectical Behavior Therapy (DBT)
Similar to ACT, dialectical behavior therapy
encourages mindfulness and working with difficult emotions (rather than trying
to alter them). However, DBT is more complex and typically takes a year to
A type of cognitive
behavioral therapy that teaches us how to live in the moment, DBT helps us to cope
with stress, regulate emotions, and improve our connection to others. It was developed
in the 1980s by University of Washington psychologist Marsha Linehan, PhD, and
has since been adapted for a broad range of
mental health conditions.
“You can have all the insight in the world
and, at the same time, still struggle with change,” says psychologist Sarah Selden.
“Understanding past patterns, while helpful,
doesn’t necessarily translate to coping with very painful emotions in the
present,” she says. In fact, “many struggle to even name how they are feeling.
That’s where DBT fits in.”
DBT’s overarching aim is better understanding the source of our
feelings and reducing our emotional distress. We achieve this by learning how to accept where we are in the present and building
skills to both decrease negative behaviors and add/increase positive habits.
There are four DBT skills modules: (1)
mindfulness, (2) interpersonal effectiveness, (3) emotion regulation, and (4)
distress tolerance. And it can be delivered in individual or group therapy,
both of which involve identifying problems, setting goals, learning new skills,
and filling out daily DBT cards to indicate which skills worked effectively the
preceding week, which didn’t work as well, and how it could go better in the
By identifying our triggers, recognizing our emotions as they arise, and understanding how thoughts and behaviors can influence our feelings; DBT skills increase how effectively we respond to a specific situation—not just emotionally but cognitively and behaviorally as well.
Twenty-eight-year-old David R. of Minneapolis saw tangible benefits to learning these skills in his teens. David, who is a speaker with Active Minds, a nonprofit dedicated to raising mental health awareness among college students, says that he was in middle school when he first recognized that he was experiencing symptoms of depression. They intensified during high school, and he was diagnosed with depression while in tenth grade.
“I had perfectionist thinking—that I wasn’t good enough,” David says.
The popular athlete assured himself that everyone
else felt similarly and he would get over it. He also saw a psychotherapist but
stopped after a few months when they failed to connect well.
Looking back, he says, “What I needed to be
told was, ‘It’s okay to not be okay.’”
When David began skipping school and dropped out of his numerous extracurricular activities, his guidance counselor reached out. Encouraged to try talk therapy again, he found success with a therapist who practiced CBT “with a little DBT thrown in.”
This therapist helped him consider his
emotions from a different perspective, specifically that they needed to be
“respected, looked at, and acknowledged.”
“I learned to treat myself with more kindness and to communicate in an effective way, instead of lashing out,” says David, who is now a speaker with Active Minds, a nonprofit organization that seeks to spread mental health awareness among college students.
He still experiences symptoms of depression and continues with therapy, but he navigates it differently as an adult. David, who is now a DBT therapist, explains, “Emotion is just emotion; a thought, just a thought—it’s important to first acknowledge and respect it in a compassionate way, and then move forward appropriately.”
Interpersonal Psychotherapy (IPT)
Interpersonal psychotherapy was developed by Drs. Gerald Kerman and Myrna Weissman in the 1970s to treat major depressive disorder (MDD). Rather than examining the cause or source of depression, IPT helps us to identify problematic tendencies in how we relate to others—family, friends, coworkers, or partners—and provides skills to interact more effectively.
Specifically, IPT addresses five main topics:
- Social troubles, such as isolating or forming
- Unresolved grief, such as over a divorce or
the death of a loved one.
- Significant life transitions, such as retirement
- Conflict, such as with partners, family members,
close friends, or coworkers.
- Current (rather than past) relationships
while recognizing, but not focusing on, internal conflicts.
Depending on the situation, IPT works for individual
or group sessions, and treatment typically lasts 12 to 16 weeks.
TRYING DIFFERENT TYPES OF TALK THERAPY FOR DEPRESSION
It is common to benefit from one type of talk therapy, then seek out another type to further your recovery. Lisa B. of Liberty, South Carolina, was diagnosed with major depressive disorder 15 years ago. During a two-week hospitalization, she was introduced to DBT as a means of coping with stress and intense emotions.
After she left the hospital, Lisa continued with DBT for eight years.
“I learned to notice the distress, accept it,
and develop techniques to self-soothe,” she says.
Lisa’s therapist introduced her to different techniques for reducing negative impulses and adding positive coping skills. Then, she says, “I picked the ones I liked.”
“When I get distressed, I squish an orange,”
The smell and the texture of the fruit temporarily
distract her from her current internal pain and draw her attention to the
If she is having a rough day, the mother of two
uses creative expression as an outlet, keeping a box stocked with coloring books,
word searches, and markers.
Last year, when Lisa’s DBT therapist retired, she sought care from a CBT specialist who helped her recognize how her negative thinking was disrupting her life.
“For example,” she says, “if someone asks, ’How
is your family?’ I take it like they’re asking what’s wrong with my family. I get
defensive when they are asking a general question.”
In learning to identify those unhelpful thoughts and emotions and reframe them as neutral or positive, Lisa recognizes that she is “coming around to a more realistic way” of viewing the world and her experiences.
She has no doubt that talk therapy has changed
her life for the better: “DBT really helped me with eliminating extreme or harmful
behaviors, and CBT has helped me look at what I’m thinking in my head all the time.”
With the combination of two different talk therapies, the 44-year-old has gained a clearer, healthier, and more positive perspective on life.
• • • • •
TELETHERAPY IN THE SPOTLIGHT
easy to book a teletherapy appointment and sign up with a
counselor in advance—just hop on your favorite device to connect. This
flexibility provides invaluable benefits—and not just to those who live in
remote areas, have restricted access to transportation, have unpredictable
schedules, or are homebound. Teletherapy opens the door for everyone.
called telemedicine or virtual therapy, allows clients to communicate with therapists
remotely—by phone, webcam, or text-based services like email, private chats,
text messages, and other messaging platforms.
Nicole Mosey, LMHC, founder and owner of Core Mental Health Counseling in Buffalo, New York, is excited by the new technology and the opportunities it affords.
“Overall,” she says, “the benefits of
teletherapy far outweigh any challenges.”
According to Mosey, the two main advantages
are “convenience and consistency.”
The teletherapy offered at Core, whether via
phone or video chat, has grown organically. Initially offered as a solution for
existing clients who needed an option for continuing care while out of town or
otherwise unable to attend in-person appointments, this service is now
available to all potential clients beginning treatment.
“It allows us to meet people where they’re
at,” Mosey says, “and it enables greater access to care.”
Confidentiality Concerns with Telehealth
Increased access, however, doesn’t
necessarily translate to equal quality of care.
One of the main concerns with teletherapy has
to do with maintaining privacy and confidentiality.
Previously, these worries were addressed simply
by following the same measures as in-office visits: using HIPPA-compliant
electronic medical records and ensuring that therapy sessions are held in a
In a move long requested by telemedical professionals, the US Department of Health and Human Services relaxed regulations on telemedicine in March 2020, amidst the COVID-19 pandemic.
While the long-term effects of these changes
have yet to be determined, the decision allowed providers to more immediately
communicate with clients in crisis and enabled access to mental health services
across the board, at a time when it was needed most.
Pat Spencer, LCSW, who serves as secretary of the National Association of Social Workers, New Jersey (NASW-NJ), spoke about the concerns she had to address when rapidly switching to a virtual-only practice, in a May 2020 interview on the podcast Social Work Talks.
that it was an adjustment for both client and therapist, she says the sessions
did improve: “As we got more comfortable with it, the clients also got more
comfortable with it…. We seem to have developed some level of a flow, some
level of a new normal for these not-normal times…. We’re actually starting to
talk deeper to maybe delve into some deeper clinical underpinnings than what we
were [discussing] early in the pandemic.”
Access & Effectiveness of Teletherapy
Mosey, of Core Mental Health Counseling, has
found that her counselors are able to cultivate a trusting relationship with
their off-site clients. Virtual sessions can be as effective as in-person
care—even in some cases of trauma resolution.
And the research bears this out. A meta-analysis of 64 studies published in April 2018 in the Journal of Anxiety Disorders found that study participants believed that CBT via teletherapy was as effective as face-to-face talk therapy.
Sometimes, Mosey says, it can actually shorten
the course of treatment and prevent recurrent episodes of care. Because of its scheduling
flexibility, teletherapy allows clients to book more frequent sessions at the
start, freeing them to dig down to the root problem, then learn and implement
coping skills in real time.
This is more advantageous and preferable to spending
an hour each month catching up and possibly running out of time to address concerns
or learn new strategies. Mosey says that the regular, consistent support made available
with this new technology leaves clients better prepared to face the next trigger
or trauma that life throws their way.
Nowadays, those triggers and traumas are
widespread. And here is where teletherapy’s greatest asset steps in. As Mosey
puts it, teletherapy “lets us break down barriers.”
“If people are unable to come into the office,” she says, “that no longer means they’re unable to access needed services.” Undoubtedly, these services are now—and will continue to be—essential.
* * * * *
Donna Jackel is a freelance journalist from New York State who writes about mental health, social justice, and animal welfare. Her work has appeared in the Chicago Tribune, the Progressive, the Chronicle of Higher Education, CityLab, and elsewhere.
Jade Zora Scibilia is an editor at bp Magazine and esperanza. She was formerly the managing editor at Prometheus Books and the senior editor of Seventh Street Books and Pyr.
Published as “Talk the Talk,” Spring/Summer2020
The post Talk the Talk: The Power of Psychotherapy appeared first on hopetocope.com | Hope To Cope With Anxiety & Depression.