Choosing the right therapeutic approach is one of the most important clinical decisions a mental health professional makes. This guide provides an overview of the major evidence-based psychotherapies, the conditions they're most effective for, and the research supporting their use.

Cognitive Behavioural Therapy (CBT)

CBT is one of the most extensively researched psychotherapies, with strong evidence for a wide range of conditions. It focuses on identifying and modifying unhelpful thought patterns and behaviours that contribute to psychological distress.1

Best suited for:

  • Depression and anxiety disorders
  • Panic disorder and phobias
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Insomnia

Meta-analyses consistently demonstrate CBT's efficacy, with effect sizes comparable to or exceeding medication for many conditions.2

Dialectical Behaviour Therapy (DBT)

Originally developed for borderline personality disorder, DBT combines cognitive-behavioural techniques with mindfulness and acceptance strategies. It teaches skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.3

Best suited for:

  • Borderline personality disorder
  • Chronic suicidality and self-harm
  • Emotion dysregulation
  • Eating disorders
  • Substance use disorders

Research shows DBT significantly reduces suicidal behaviour, self-harm, and hospitalisations compared to treatment as usual.3

Acceptance and Commitment Therapy (ACT)

ACT uses acceptance and mindfulness strategies alongside commitment and behaviour change processes to increase psychological flexibility. Rather than trying to eliminate difficult thoughts and feelings, ACT helps clients change their relationship with them.4

Best suited for:

  • Anxiety and depression
  • Chronic pain
  • Substance use disorders
  • Stress-related conditions
  • When traditional CBT hasn't been effective

ACT has demonstrated efficacy across a broad range of conditions, with meta-analyses supporting its use for anxiety, depression, and chronic pain.4

Schema Therapy

Schema therapy integrates elements from cognitive, behavioural, attachment, and psychodynamic approaches. It addresses deep-rooted patterns (schemas) that develop in childhood and continue to cause problems throughout life.5

Best suited for:

  • Personality disorders
  • Chronic depression
  • Long-standing relationship difficulties
  • Treatment-resistant cases
  • Complex trauma

Research shows schema therapy is particularly effective for borderline personality disorder, with higher recovery rates than other treatments in some studies.5

EMDR (Eye Movement Desensitisation and Reprocessing)

EMDR uses bilateral stimulation (typically eye movements) while clients process traumatic memories. It helps the brain reprocess traumatic experiences so they become less distressing.6

Best suited for:

  • Post-traumatic stress disorder
  • Single-incident trauma
  • Complex trauma
  • Phobias
  • Anxiety related to past experiences

EMDR is recognised as an effective PTSD treatment by the WHO and multiple clinical guidelines, with research showing it can produce rapid symptom reduction.6

Exposure and Response Prevention (ERP)

ERP is the gold-standard treatment for OCD. It involves gradually exposing clients to feared situations while preventing the compulsive behaviours they would typically use to reduce anxiety.7

Best suited for:

  • Obsessive-compulsive disorder
  • Specific phobias
  • Body dysmorphic disorder
  • Health anxiety

ERP has the strongest evidence base for OCD treatment, with response rates of 60-80% in clinical trials.7

Psychodynamic Therapy

Psychodynamic therapy explores how unconscious processes and past experiences influence current behaviour and relationships. It focuses on gaining insight into emotional patterns and resolving internal conflicts.8

Best suited for:

  • Depression
  • Personality difficulties
  • Relationship problems
  • Complex or chronic presentations
  • Clients seeking deeper self-understanding

Meta-analyses show psychodynamic therapy is effective for depression, anxiety, and personality disorders, with effects that may continue to grow after treatment ends.8

Interpersonal Therapy (IPT)

IPT focuses on improving interpersonal relationships and communication patterns. It addresses four key areas: grief, role disputes, role transitions, and interpersonal deficits.9

Best suited for:

  • Depression
  • Eating disorders (particularly bulimia)
  • Adjustment to life changes
  • Relationship difficulties

IPT has strong evidence for depression treatment, with efficacy comparable to CBT and antidepressant medication.9

Compassion-Focused Therapy (CFT)

CFT helps people who struggle with shame and self-criticism develop self-compassion. It draws on evolutionary psychology, attachment theory, and neuroscience to understand the threat, drive, and soothing systems.10

Best suited for:

  • High self-criticism and shame
  • Depression and anxiety
  • Trauma
  • Eating disorders
  • When other approaches haven't addressed core shame

Research shows CFT effectively reduces self-criticism, shame, and depression symptoms.10

Mindfulness-Based Cognitive Therapy (MBCT)

MBCT combines cognitive therapy with mindfulness meditation practices. It was developed specifically to prevent relapse in recurrent depression by teaching participants to relate differently to their thoughts.11

Best suited for:

  • Recurrent depression (relapse prevention)
  • Anxiety disorders
  • Chronic pain
  • Stress reduction

MBCT is recommended by NICE guidelines for preventing depression relapse in people who have had three or more episodes.11

Choosing the Right Approach

The most effective therapy depends on multiple factors:

  • The presenting problem: Some therapies have stronger evidence for specific conditions
  • Client preference: Treatment works better when clients believe in the approach
  • Previous treatment history: What has or hasn't worked before
  • Complexity: Long-standing or complex presentations may need integrative approaches
  • Therapeutic relationship: The alliance between therapist and client consistently predicts outcomes across all approaches
"The best predictor of therapy outcome is not the specific technique used, but the quality of the therapeutic relationship."

References

  1. Beck, A. T., & Dozois, D. J. A. (2011). Cognitive therapy: Current status and future directions. Annual Review of Medicine, 62, 397-409.
  2. 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.
  3. Linehan, M. M., Korslund, K. E., Harned, M. S., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder. JAMA Psychiatry, 72(5), 475-482.
  4. A-Tjak, J. G., Davis, M. L., Morina, N., et al. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36.
  5. Giesen-Bloo, J., van Dyck, R., Spinhoven, P., et al. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649-658.
  6. Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma. Journal of Clinical Psychology, 58(8), 933-946.
  7. Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive-compulsive disorder: A systematic review and meta-analysis of studies published 1993-2014. Clinical Psychology Review, 40, 156-169.
  8. Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109.
  9. Cuijpers, P., Geraedts, A. S., van Oppen, P., et al. (2011). Interpersonal psychotherapy for depression: A meta-analysis. American Journal of Psychiatry, 168(6), 581-592.
  10. Leaviss, J., & Uttley, L. (2015). Psychotherapeutic benefits of compassion-focused therapy: An early systematic review. Psychological Medicine, 45(5), 927-945.
  11. Kuyken, W., Warren, F. C., Taylor, R. S., et al. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse. JAMA Psychiatry, 73(6), 565-574.