CBT (cognitive behavioral therapy) is a type of talk therapy that focuses on the connection between your thoughts, feelings, and actions. It teaches you to notice when your thoughts are making you feel worse and to practice thinking in ways that help instead. Research shows CBT works well for depression, anxiety, and trauma, and it typically takes place in weekly sessions over several months.
When people talk about mental health treatment, they usually mean one of three things: talk therapy, medication, or both together. There is no single right answer that fits everyone. The best choice depends on what you are going through, what you prefer, and what you and your provider decide together. This guide explains the main kinds in plain words, so the choices feel less confusing.
- Treatment is usually talk therapy, medication, or both together; there is no single right answer.
- CBT is one of the most-studied talk therapies for depression, anxiety, and trauma.
- Most medications take four to eight weeks to work, so early discouragement is normal.
Talk therapy, the main kinds
Talk therapy, also called psychotherapy, means meeting with a trained provider to work through difficult thoughts, feelings, and behaviors. The National Institute of Mental Health explains the main approaches. You do not need to pick one yourself; your provider will suggest what fits.
- Cognitive behavioral therapy (CBT). Helps you notice thoughts that are unhelpful or untrue and change the patterns tied to them. It is used for depression, anxiety, and many other conditions, and it has some of the strongest research support of any talk therapy (Hofmann et al., 2012).
- Dialectical behavior therapy (DBT). Teaches skills to handle strong emotions, tolerate distress, and improve relationships. It is often used when emotions feel overwhelming, when you have urges to hurt yourself, or when your feelings change fast and feel hard to control. In research studies, DBT has been shown to lower self-harm and help people function better in daily life (Stoffers-Winterling et al., 2022).
- Interpersonal therapy (IPT). Focuses on your relationships and life changes, such as grief, conflict, or a hard transition, and how they connect to your mood. It is one of the best-studied talk therapies for depression and works well both on its own and together with medication (Cuijpers et al., 2011).
- Behavioral activation. A simple, step-by-step therapy that helps you slowly add back activities that bring you a sense of pleasure or accomplishment, because doing less and pulling away can make depression worse. The VA describes it as an evidence-based practice that gets you more active and more involved in rewarding activities.
- Acceptance and commitment therapy (ACT). Helps you make room for painful thoughts and feelings without letting them run your life, get clear on what matters most to you, and take steps toward it. The VA calls ACT an evidence-based talk therapy that is effective for depression.
- Trauma-focused therapy (PE, CPT, and EMDR). For the effects of trauma, providers gently help you approach memories and feelings you have been avoiding, at a safe pace. The VA’s National Center for PTSD lists three trauma-focused talk therapies with the most support: prolonged exposure (PE), cognitive processing therapy (CPT), and EMDR (eye movement desensitization and reprocessing). Each usually takes about three months.
- Psychodynamic therapy. Looks at how past experiences and patterns shape how you feel and act today, to help you understand yourself more deeply.
Here are the main talk therapies side by side:
| Therapy | What it helps with | How it works |
|---|---|---|
| Cognitive behavioral therapy (CBT) | Depression, anxiety, and many other conditions | Notice unhelpful or untrue thoughts and change the patterns tied to them |
| Dialectical behavior therapy (DBT) | Overwhelming emotions and urges to hurt yourself | Teaches skills to handle strong emotions, tolerate distress, and improve relationships |
| Interpersonal therapy (IPT) | Depression tied to relationships and life changes | Focuses on grief, conflict, or a hard transition and how it connects to your mood |
| Behavioral activation | Depression | Step by step, add back activities that bring pleasure or accomplishment |
| Acceptance and commitment therapy (ACT) | Depression | Make room for painful thoughts, get clear on what matters, and take steps toward it |
| Trauma-focused therapy (PE, CPT, EMDR) | The effects of trauma | Gently approach avoided memories and feelings at a safe pace |
| Psychodynamic therapy | Understanding yourself more deeply | Looks at how past experiences and patterns shape how you feel and act today |
How therapy is set up
Therapy also comes in different formats, and you can combine them:
- Individual therapy is one-on-one with your provider. This is the most common.
- Group therapy brings together a few people working on similar things, led by a provider. It can help you feel less alone.
- Family or couples therapy includes the people close to you, which helps when the difficulty involves your relationships or your household.
Medication
Medication is managed by a prescriber, usually a psychiatrist, and sometimes your primary care provider. NIMH explains how mental health medications work. A few things are good to know. Many medications, such as antidepressants, take time to work, often four to eight weeks, so do not give up early. You can and should ask questions: what it is for, what to expect, and how long until it helps. If you notice side effects, report them to your prescriber; the plan can be adjusted. One safety point matters for families: NIMH notes that some children, teenagers, and young adults under 25 may have an increase in suicidal thoughts or behavior when they start an antidepressant, especially in the first few weeks or when the dose is changed, so anyone in this age group should be watched closely early on. Never stop a mental health medication suddenly on your own; work with your prescriber to lower the dose slowly and safely. Nothing is permanent, and changes are normal.
Never stop a mental health medication suddenly on your own. Work with your prescriber to lower the dose slowly and safely.
Therapy and medication together
For many people, talk therapy and medication work well as a team. Some do well with therapy alone, some with medication, and some with both. For certain conditions the two together work better than medication by itself: a large review found that adding talk therapy to antidepressant medication improved results for major depression, panic disorder, and OCD (Cuijpers et al., 2014). This is a decision you make with your provider, based on what helps you.
You choose, in your language
You are part of every decision. Your provider will explain the options and recommend an approach, but nothing is decided without you. You can ask why a treatment is suggested, say what you prefer, and change course later. Therapy works well through a qualified interpreter or with a provider who speaks your language, so language is never a reason to go without care. See Your right to a free interpreter.
What is available near you varies
Which treatments and which providers you can reach, and what your insurance or Medicaid covers, varies by state and by plan. To check, call the number on your insurance card and ask what mental health care is covered, or contact a local community health center, which often offers therapy and medication on a sliding scale. NIMH’s Help for Mental Illnesses page also lists ways to find treatment.
Questions you can ask, and where to start
You are allowed to ask questions about any treatment before you agree to it, and a good provider welcomes them.
"Why are you suggesting this one for me?"
"How long before I should notice a change?"
"What are the common side effects, and what should I do if I have them?"
"What are my other options if this does not help?"
"Can we do this with an interpreter, or with a provider who speaks my language?"
To find care you can afford, community health centers offer therapy and medication on a sliding fee scale no matter your income, insurance, or immigration status; find one at findahealthcenter.hrsa.gov. You can also search findtreatment.gov for mental health and substance use providers near you. In a crisis, call or text 988 any time for free, confidential help in many languages.
What happens in the first session
The first meeting is mostly about getting to know you, so it can feel more like an interview than treatment. Your provider will ask what brought you in, and about your health, your history, and what you hope will get better. This is called an intake, and it can take more than one session. Together you set goals and a rough plan for the work ahead. A first session often lasts about 45 to 50 minutes (American Psychological Association).
What you say in therapy is private. Your provider keeps it confidential as part of their professional rules, with a few limits they should explain to you: they may have to act if you are going to seriously hurt yourself or someone else, or if a child, an older adult, or a person with a disability is being abused or neglected (American Psychological Association). It is fair to ask at the start, “What I tell you, do you keep private, and when might you have to share it?” Your immigration status is not part of treatment and does not need to come up.
How long does therapy take?
There is no single answer. Some people feel better after just a few sessions, and some stay in therapy for a year or more. Research suggests that about half of people improve after around eight sessions, and about three out of four improve within six months (American Psychological Association). Many structured therapies, like CBT, run for a set number of weekly sessions and then end. Trauma-focused therapies such as prolonged exposure, cognitive processing therapy, and EMDR often take about three months (VA National Center for PTSD). Other therapies are more open-ended and continue as long as they help. You can ask at the start how many sessions to expect.
A closer look at medication types
Mental health medications come in a few main groups, and your prescriber will explain which one fits you and why. According to NIMH:
- Antidepressants, including a common type called SSRIs, treat depression and also many anxiety disorders. They usually take about four to eight weeks to reach full effect.
- Anti-anxiety medicines ease strong fear, worry, and panic. Some are meant only for short-term use because they can become habit-forming, so your prescriber will guide how long to take them.
- Mood stabilizers help even out the highs and lows of bipolar disorder and are sometimes added to an antidepressant.
- Antipsychotics treat symptoms such as hearing or seeing things that are not there or losing touch with reality, and are also used for bipolar disorder and some severe depression.
Many medications, such as antidepressants, take about four to eight weeks to reach full effect, so do not give up early. Ask what a medicine is for and how long until it helps, and report any side effects so the plan can be adjusted.
If a treatment is not helping
Treatment is not one and done, and it is normal to adjust it. If you have given a therapy or medication a fair amount of time and still do not feel better, tell your provider (NIMH). You are not being difficult; this is useful information. Your provider can change the dose, switch to a different medication or therapy, or add the other kind so you have both. It helps to keep a simple note of how you feel from week to week, and some clinics track your symptoms with a short questionnaire at each visit, which makes it easier to see whether things are moving. Give changes time, keep your provider informed, and keep going until you find what works.
Sources
- American Psychological Association. Understanding psychotherapy and how it works. https://www.apa.org/topics/psychotherapy/understanding
- Cuijpers, P., Geraedts, A. S., van Oppen, P., Andersson, G., Markowitz, J. C., & van Straten, A. (2011). Interpersonal psychotherapy for depression: A meta-analysis. American Journal of Psychiatry, 168(6), 581-592. https://doi.org/10.1176/appi.ajp.2010.10101411
- Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: A meta-analysis. World Psychiatry, 13(1), 56-67. https://doi.org/10.1002/wps.20089
- Hofmann, S. G., Asnaani, A., Vonk, I. J. 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. https://doi.org/10.1007/s10608-012-9476-1
- MedlinePlus (National Library of Medicine). Mental health. https://medlineplus.gov/mentalhealth.html
- National Institute of Mental Health. Help for mental illnesses. https://www.nimh.nih.gov/health/find-help
- National Institute of Mental Health. Mental health medications. https://www.nimh.nih.gov/health/topics/mental-health-medications
- National Institute of Mental Health. Psychotherapies. https://www.nimh.nih.gov/health/topics/psychotherapies
- Stoffers-Winterling, J. M., Storebø, O. J., Kongerslev, M. T., Faltinsen, E., Todorovac, A., Sedoc Jørgensen, M., Sales, C. P., Edemann Callesen, H., Pereira Ribeiro, J., Völlm, B. A., Lieb, K., & Simonsen, E. (2022). Psychotherapies for borderline personality disorder: A focused systematic review and meta-analysis. British Journal of Psychiatry, 221(3), 538-552. https://doi.org/10.1192/bjp.2021.204
- U.S. Department of Veterans Affairs, National Center for PTSD. Talk therapy. https://www.ptsd.va.gov/understand_tx/talk_therapy.asp
- U.S. Department of Veterans Affairs, VISN 16 South Central MIRECC. Living with purpose: A guide for getting more out of each day. https://www.mirecc.va.gov/visn16/living-with-purpose-manual.asp
- U.S. Department of Veterans Affairs, VISN 19 MIRECC. Learn about ACT for depression. https://www.mirecc.va.gov/visn19/treatmentworksforvets/depression/act/index.asp
LINC is a research prototype, not a medical or legal service. Translation can be wrong; you have the right to a free, qualified interpreter. For anything high-stakes, do it with a community health worker or someone you trust. In a crisis, call or text 988, or 911 for immediate danger.