CBT — Cognitive Behavioural Therapy

The idea: thoughts, feelings, and behaviour drive each other. Change the thought or the behaviour and the feeling follows.

What a session looks like: structured, with an agenda and homework. You identify a thought (“I’ll humiliate myself”), examine the evidence, and then test it in the real world. Behavioural activation — scheduling meaningful activity and doing it regardless of motivation — is the depression-specific component and works by acting first and letting motivation catch up.

Used for: depression, generalized anxiety, panic disorder, social anxiety, insomnia (as CBT-I), and health anxiety. It has the largest evidence base of any psychotherapy.

Length: typically 8 to 20 sessions. Time-limited by design.

Suits you if you want structure, homework, and a defined endpoint. Less good if you want open-ended exploration.

DBT — Dialectical Behaviour Therapy

The idea: some people feel emotion more intensely and take longer to return to baseline. The work is accepting that and changing it at once — the “dialectic” in the name.

What it involves: full DBT is a programme rather than a weekly chat — individual therapy, a skills group, and phone coaching between sessions. Four skill modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Distress tolerance is the one people find most immediately useful, because it addresses getting through an unbearable hour without doing something you will regret.

Used for: developed for borderline personality disorder and self-harm, where its evidence is strongest. Also used for chronic suicidality, eating disorders, and severe emotion dysregulation.

Length: commonly six months to a year for a full programme.

Suits you if emotions arrive at full intensity with no warning, relationships are turbulent, and you have a history of impulsive responses to distress.

ACT — Acceptance and Commitment Therapy

The idea: trying to eliminate unwanted thoughts tends to amplify them. So stop arguing with them, change your relationship to them, and get on with what matters.

What it involves: defusion techniques that create distance from a thought without disputing its content — noticing “I’m having the thought that I’m a failure” rather than debating whether you are. Then clarifying values and committing to action consistent with them, discomfort included.

Used for: anxiety, depression, chronic pain, OCD, and situations where the difficulty is genuinely not going away and the task is living well alongside it.

Length: typically 8 to 16 sessions.

Suits you if you have tried CBT and found the thought-challenging felt like arguing with yourself, or if your difficulty is a real circumstance rather than a distortion.

The other ones worth knowing

Exposure and Response Prevention (ERP) — the specific treatment for OCD, and distinct from general CBT. You face the trigger and deliberately do not perform the compulsion. Uncomfortable, highly effective, and worth seeking someone who does it specifically, since general therapists sometimes inadvertently reinforce compulsions by providing reassurance.

EMDR — used for PTSD and single-incident trauma. Involves recalling the memory while following bilateral stimulation, usually eye movements. The mechanism is debated; the outcome evidence for PTSD is solid.

Interpersonal Therapy (IPT) — time-limited, focused on relationships, role transitions, and grief. Strong evidence for depression, particularly where onset followed a life change.

Psychodynamic therapy — explores how earlier patterns shape present ones. Longer, less structured, and the right fit for people who want understanding rather than a protocol.

Matching problem to approach

• Depression — CBT with behavioural activation, or IPT
• Generalized anxiety — CBT, or ACT
• Panic disorder — CBT with interoceptive exposure
• Social anxiety — CBT with exposure
• OCD — ERP specifically
• PTSD — EMDR, or trauma-focused CBT
• Insomnia — CBT-I
• Emotion dysregulation, self-harm — DBT
• Chronic pain or illness — ACT

Treat this as a starting point for a conversation rather than a prescription. Presentations overlap, and most therapists work across more than one framework.

Therapy, medication, or both

For mild to moderate depression and anxiety, therapy alone is a legitimate first choice with good evidence. For moderate to severe presentations, combined treatment generally outperforms either alone.

They also do different things. Medication can lift symptoms enough that therapy becomes possible — it is difficult to do behavioural activation when you cannot get out of bed. Therapy builds skills that persist after treatment stops, which medication does not.

In practice these are frequently two providers: a prescriber managing medication and a therapist doing weekly work. Samz Mental Health provides the prescribing side — evaluation, diagnosis, and medication management — and coordinates with your therapist where you have one.

Finding a therapist

Ask directly which modalities they are trained in and how much of their work is with your specific presentation. “I do a bit of everything” is less useful than “most of my caseload is OCD and I do ERP.”

Ask about structure — whether sessions have an agenda, whether there is homework, and roughly how long they expect treatment to run. Ask about fees and insurance before the first session.

Then give it three or four sessions before judging. The first one is largely history-taking and is not representative.

Frequently asked questions

Which therapy has the best evidence?

CBT has the broadest base across the most conditions. For specific problems, others are better — ERP for OCD, DBT for self-harm, EMDR for PTSD. “Best overall” is the wrong question.

How long before therapy works?

Many people notice change within six to eight sessions of a structured approach. Longer-standing or complex difficulties take longer.

Can I do therapy online?

Yes. Remote delivery has good evidence for CBT-based approaches in particular.

Do I need a diagnosis first?

Not to begin therapy. It helps in choosing the approach, which is one reason an evaluation early on is useful even if you do not want medication.

What if I have tried therapy and it did not help?

Worth asking which type, for how long, and whether it matched the problem. Generic supportive counselling for OCD, for instance, is not a failed trial of ERP.

Does a psychiatric provider do therapy?

Some do; many focus on diagnosis and medication and refer therapy out. Ask what a practice actually provides rather than assuming.

Not sure what you need?

A psychiatric evaluation clarifies the diagnosis, which is what determines whether therapy, medication, or both makes sense — and which kind of therapy to look for.

Book an Evaluation