Evidence-Based Treatment

Evidence-Based Therapy

Therapy at VA

Evidence-based therapies (EBTs) have been shown to improve a variety of mental health conditions and overall well-being. These treatments are tailored to each Veteran’s needs, priorities, values, preferences, and goals for therapy. EBTs often work quickly and effectively, sometimes within a few weeks or months, depending on the nature or severity of your symptoms. Work with your VA provider to choose the treatment options that work best for you. To learn more about EBTs offered at VA and the mental health conditions they are used to treat, explore the information below.

Acceptance and Commitment Therapy for Depression (ACT-D)

ACT-D is a therapy that can help transform and improve the lives of people experiencing depression. ACT-D aims to help you live in a way that’s more closely aligned with your values, improving your relationships with yourself, others, and the world.

Through this therapy, you’ll learn to accept your thoughts and emotions, choose and commit to actions that align with your values, and take action to achieve what matters most to you. ACT-D typically requires 10 to 16 individual sessions, but it can be tailored to your treatment preferences and priorities. This therapy can lead to:

• A decrease in negative thoughts and feelings.
• Increased awareness and focus that helps you to fully connect with others and live in the moment.
• The ability to clarify your values and take action to achieve what means the most to you in life.

If you choose ACT-D, you may be asked to:

• Commit to attending sessions regularly.
• Set treatment goals with your provider at the onset of therapy.
• Speak openly about your depression, the challenges you’re facing, and your values.

To determine whether ACT-D may be right for you, speak with your mental health provider about your symptoms so you can work together to create the most effective treatment plan.

Behavioral Activation (BA)

BA is a therapy that has been shown to relieve or resolve symptoms of depression. This therapy will help you become more engaged with activities that can improve your mood.

BA will teach you ways to build personally rewarding daily activities, and ways to identify and achieve the things you value and enjoy in life. Sessions of BA are action-oriented, focused on problem-solving, and typically provided in 20 to 24 individual sessions. After participating in this treatment, you may experience:

• An increase in healthy behaviors and positive experiences, thoughts, and mood.
• The ability to turn overwhelming tasks into attainable achievements.
• Increased participation in hobbies and social events, including some that you may have enjoyed before your depression.

If you choose BA, you may be asked to:

• Develop a personalized plan to help you reconnect with the experiences you find rewarding.
• Engage with activities that may feel uncomfortable at first but will help you become more socially active.

To learn more about this therapy, speak with your mental health provider about your symptoms and treatment goals. Together, you can determine the treatment that best fits your needs.

Behavioral Family Therapy (BFT)

BFT is a family therapy for Veterans who have complex, long-term mental health conditions, such as schizophrenia and bipolar disorder, or frequently experience psychosis.

Typically lasting from 20 to 25 sessions of 50 minutes each, BFT emphasizes the importance of a strong family support system, and it can help motivate your loved ones to participate in this journey with you. BFT has five components: engagement, assessment, illness education, communication skills training, and problem-solving instruction. These components may be presented through:

• Role-playing and skill practice in an out-of-session setting.
• Review of written materials.
• Family education about mental health and your specific condition.
• Development of communication and problem-solving skills to help you and your family cope with mental health stressors together.

If you choose this therapy, you may be asked to:

• Commit to attending regular weekly sessions.
• Practice role-playing and skill development in and out of therapy sessions.

To learn more about this therapy, speak with your mental health provider about your symptoms and treatment goals. Together, you can determine the treatment that best fits your needs.

Cognitive Behavioral Conjoint Therapy (CBCT)

CBCT is a therapy that is shown to help treat PTSD in Veterans. This treatment is delivered together with a Veteran’s family member or another loved one. Some Veterans desire family involvement in their treatment because of the impact that PTSD has had on the quality of their relationships and social life.

CBCT typically consists of a 15-session treatment plan over three phases, which can be tailored to each couple. After engaging with this therapy, you may experience:

• A decrease in PTSD symptoms and their severity.
• Improved relationships with your family members and others in your life.
• A decrease in comorbid symptoms that may be linked to your PTSD and their severity.
• An increase in your partner’s mood and engagement.

If you choose CBCT, you may be asked to:

• Learn about PTSD and its impact on how relationships function.
• Practice new communication skills with your partner, both in and outside of sessions.
• Develop skills to help you and your partner overcome avoidance.
• Change problematic beliefs about trust, power, and emotional and physical intimacy.

To learn more about CBCT, speak with your mental health provider about how you’re feeling and discuss your goals and preferences for treatment.

Cognitive Behavioral Therapy

CBT is a recommended treatment for Veterans struggling with stimulant use disorder. This therapy focuses on relationships between thoughts, feelings, behaviors and situations and helps Veterans build skills to change their unwanted behaviors and achieve their goals.

CBT is considered a short-term therapy and typically involves six to 14 sessions. Through this therapy, you learn to:

• Cope with triggers for using stimulants, such as cravings and social pressures.
• Manage high-risk situations.
• Reinforce behaviors that align with your recovery goals.
• Challenge thoughts that lead to and follow stimulant use.

If you choose CBT, you will be asked to:

• Commit to attending regular sessions.
• Work with your provider to set treatment goals.
• Identify triggers for using stimulants.
• Practice — outside therapy sessions — the skills you learn in therapy.

To learn more about CBT, speak with your mental health provider or ask your primary care provider for a referral to a therapist.

Cognitive Behavioral Therapy for Depression (CBT-D)

CBT-D is a type of therapy that is shown to be an effective treatment for depression. CBT-D treatments often focus on identifying and altering unhelpful thought patterns and behaviors that contribute to or worsen symptoms of depression.

Typically lasting from 12 to 16 sessions, CBT-D can help you reach your treatment goals. Through this therapy, you may:

• Develop more balanced and helpful thoughts about yourself, others, and the future.
• Spend more time engaging in pleasurable or productive activities.
• Learn new skills to help achieve personal goals and solve problems, improving your quality of life and overall level of functioning.

If you choose CBT-D, you will be asked to:

• Commit to attending sessions regularly.
• Work with your provider to set treatment goals.
• Address important personal issues during each session.
• Practice the new skills you learn outside of therapy sessions.

No matter what is causing your mental health condition, proven treatments and resources are available. To learn more about CBT-D, speak openly with your mental health provider about your symptoms so you can work together to determine the best treatment plan for you.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is a talk therapy that research has shown to be the best way to treat insomnia disorder. Veterans with insomnia disorder experience frequent sleep disruption, usually over more than three months, which may include trouble getting to sleep or staying asleep as well as waking up too early.

CBT-I therapy typically involves about four to seven weekly sessions of 30 to 60 minutes each. During CBT-I talk therapy, you may:

• Learn how much sleep you need to feel rested and how to achieve it.
• Spend less time in bed trying to sleep.
• Learn how to turn your bed back into a place for sleep, not wakefulness.
• Learn strategies that help your mind and body relax and prepare for sleep.
• Adjust thoughts that get in the way of sleep.

If you choose CBT-I treatment, you will be asked to:

• Commit to attending weekly sessions.
• Maintain a daily sleep diary so that you and your therapist can track your sleep challenges and improvements.
• Practice new skills, such as relaxation strategies or wind-down routines.

No matter what caused your insomnia or how long you have experienced it, CBT-I is a treatment with the proven ability to help, even if you have other medical or mental health conditions. To learn more about CBT-I, speak with your mental health provider or ask your primary care provider for a screening for insomnia disorder and referral to care.

Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD)

CBT-SUD is being disseminated as part of the ongoing, national VA Evidence-Based Psychotherapy (EBP) Training Initiative. CBT-SUD is an evidence-based, time-limited intervention that teaches Veterans how to make and maintain changes in substance use and improve their quality of life. CBT-SUD encourages Veterans to adopt an active, problem-solving approach to cope with the many challenges associated with substance use conditions.

Contingency Management (CM)

CM is an evidence-based treatment for substance use disorder (SUD); and, it is particularly helpful for those patients who misuse stimulants (like cocaine or methamphetamine) or cannabis. In CM, the patient receives incentives for completing recovery behaviors such as abstinence verified by urine drug screens (UDS). The incentives increase in size with consistent performance of the recovery behavior, i.e. for consecutive negative UDS results. Extensive research on CM has shown that is a very effective treatment for helping a wide array of patients with SUD, including Veterans, achieve and maintain abstinence and retention in treatment.

Cognitive Processing Therapy (CPT)

CPT is a therapy shown to treat PTSD that teaches Veterans to identify, evaluate, and ultimately modify the unpleasant thoughts following a traumatic experience. Trauma can change the way you think about yourself, others, and the world, and it may leave you feeling stuck. Through CPT, you can learn skills that help you recognize more helpful ways to think about your trauma and create a new perspective on the world.

CPT typically lasts from seven to 15 weekly sessions, either in an individual or a group setting, depending on your preference. Through this therapy, you may:

• Develop healthier, balanced beliefs about yourself and others.
• Relieve feelings of distress related to memories of the trauma.
• Return to the activities you enjoy in life.
• Practice new skills that provide more helpful ways to think about your trauma.

If you choose CPT, you will be asked to:

• Speak and write about the impact of the trauma you’ve experienced.
• Learn to identify and challenge unhelpful thoughts.
• Complete take-home practice assignments between sessions to apply the skills you are learning in therapy.

Speak openly with your mental health provider about your symptoms and priorities so you can work together to determine whether this therapy is best for you.

Dialectical Behavioral Therapy (DBT)

DBT teaches skills to help control harmful and impulsive behaviors such as self-harming, substance misuse, and binge eating; reduce suicidal thoughts and behaviors; and improve symptoms of PTSD, depression, and borderline personality disorder. This treatment can also help patients build and maintain healthy relationships and may be particularly well-suited for people who experience a lot of conflict in relationships with frequent ups and downs. DBT uses a combination of acceptance and change strategies to help you learn new problem-solving and coping skills to improve your overall quality of life.

DBT lasts longer than some other EBTs, typically taking at least six months to provide full benefits. There are four main components to this treatment: individual therapy, skills training classes, one-on-one “in-the-moment” telephone consultation, and weekly consultation with a therapist. DBT can be personalized for each individual, depending on the nature and extent of your mental health challenges and their impact on your quality of life. Through this therapy, you may:

• Develop a more balanced view of your experiences and opportunities for experiencing safety and growth.
• Find increased motivation to participate in activities and hobbies.
• Develop new ways to understand and address painful emotions and ask for the support you may need.
• Learn to build and maintain satisfying relationships.
• Practice mindfulness to help you stay in the here and now.
• Develop effective coping skills to reduce impulsive behaviors.

If you choose DBT, you may be asked to:

• Attend weekly sessions with your provider to discuss therapy goals, progress, and any challenges encountered since your last check-in.
• Participate in a weekly skills group to learn and practice ways of coping with problems and emotions, and apply new skills to specific events and challenges in your life.
• Complete homework between sessions to practice new skills, track your progress, and then review your efforts with your providers.

No matter what brings you into care, proven treatments and resources are available. To learn more about DBT, speak openly with your mental health provider about your symptoms so you can work together to determine the best treatment plan for you.

Eye Movement Desensitization Reprocessing for PTSD (EMDR-PTSD)

EMDR has been shown to reduce symptoms of posttraumatic stress disorder (PTSD). This treatment pairs patients’ eye movements with their processing of traumatic memories. A patient pays attention to a back-and-forth movement or sound while they recall a traumatic memory until the distress associated with that memory decreases. Eventually, they focus on a positive belief or feeling while they hold the memory in their mind.

EMDR typically consists of six to 12 sessions. Through this therapy, you:

• Learn emotional management techniques, such as relaxation techniques.
• Follow emotional management with in-depth processing of traumatic memories and the beliefs and physical symptoms attached to those memories.

To determine whether EMDR is right for you, talk with your mental health provider about your symptoms so you can work together to create the most effective treatment plan.

Integrative Behavioral Couples Therapy (IBCT)

IBCT is a therapy for couples that focuses on reducing marital distress and improving relationship satisfaction. This therapy develops increased emotional understanding, effective communication strategies, and improved behavioral responses between loved ones. By accepting your differences and understanding your partner’s sensitivities and stressors, you can work together to overcome the challenges you’re facing.

IBCT typically ranges from 11 to 26 sessions, but your treatment plan will be tailored to your needs and has no fixed number of sessions. The therapy may teach you how to negotiate and set goals together with your partner, friend, or family member in two phases: evaluation and treatment.

• The evaluation phase usually consists of a joint session, an individual session with each partner, and a feedback session for the therapist to explain their understanding of the couple’s problems and outline next steps for treatment.
• The treatment phase consists of the therapist’s work with the couple to alter and improve the way they interact with and understand each other.

Through this therapy, you may:

• Experience increasing relationship satisfaction.
• See an improvement in your communication skills and emotional closeness with your partner.
• Recognize and change problematic patterns of interaction.
• Increase your positive interactions and connection.

To learn more about IBCT, speak with your mental health provider about how you’re feeling and discuss your goals and preferences for treatment.

Interpersonal Therapy (IPT)

IPT is a therapy that focuses on healing relationship problems that may be the cause or result of depression. By understanding the connection between interpersonal issues and your depression, you can create social skills to help deal with these problems and improve the way you feel.

IPT typically involves 12 to 16 weekly sessions of 50 minutes each over three phases:

• Initial sessions provide information about depression and how it may be affecting your daily life.
• Intermediate sessions focus on one or two specific areas that are most concerning to you and that you believe contribute to your depression. In these sessions, you will also begin developing new skills to improve your response to certain life stressors.
• In the termination phase, your mental health provider will review your progress with you, explore your possible stressors, discuss the new skills you’ve learned, and evaluate whether further treatment is needed. After this phase, many Veterans notice an increase in overall life satisfaction.

If you choose IPT, you will be asked to:

• Commit to attending regular weekly sessions.
• Set treatment goals with your therapist.
• Discuss personal issues that you’re experiencing in each session.
• Practice new skills inside and outside of the sessions.

To learn more about this therapy and its treatment phases, speak with your mental health provider about your symptoms and treatment goals.

Motivational Enhancement Therapy (MET)

MET is a therapy that is mainly for Veterans who are thinking about changing their use of alcohol or drugs. This brief intervention focuses on exploring your reasons and motivations for changing your substance use.

Lasting from three to four sessions, MET can be used alone or as a step toward other treatments, depending on your individual needs. Through this therapy, you may:

• Experience an increased awareness of your reasons for and commitment to changing your alcohol or drug use.
• Develop healthier substance use habits and health-related behaviors.
• Reduce your engagement in risky activities, such as having unprotected sex, gambling, or taking drugs with unsafe needles.

If you choose this therapy, you may be asked to:

• Commit to attending weekly sessions for up to four weeks.
• Complete an assessment to explore your reasons for changing substance use.
• Review the assessment results with your therapist to identify your motivations for change and, when it makes sense, to formulate a treatment plan that works for you.

By speaking openly with your mental health provider about your substance use, you can collaborate to find the treatment that is best for you.

Motivational Interviewing (MI)

MI is a therapy that can help you develop healthier habits related to substance use, smoking, nutrition, exercise, chronic health problems, and risky behaviors. An MI therapist will work with you to explore your values and goals for treatment and your reasons for change. This is accomplished in a therapy environment that is based on collaboration, respect for your right to self-determination, and compassion.

Typically lasting from one to four sessions, MI focuses on exploring your reasons for changing a behavior that affects your health. This therapy can work alone or in combination with other treatments. Through this therapy, you may:

• Experience an increased awareness of your reasons for and commitment to changing the target behavior you discuss with your therapist.
• Commit to healthier choices related to substance use, nutrition, exercise, and addressing chronic health problems.
• Choose to engage in follow-up care, if needed, to support your treatment goals.

If you choose MI, you may be asked to:

• Commit to attending weekly sessions lasting one to three weeks.
• Work with your therapist to identify the focus or target of the behavior change.
• Speak about your experiences in changing your behavior and your reasons for making that change.

By speaking openly and honestly with your mental health provider about mixed feelings you may have about a change you are considering, you can work together to explore and use your motivation for change.

Problem-Solving Therapy (PST)

PST is a therapy for Veterans who are experiencing depression or suicidal thoughts. PST can help you recover from the effects of experiencing difficult situations and learn skills for coping with challenging life circumstances and chronic daily stressors.

PST is a goal-oriented treatment that can teach you to identify, understand, and evaluate problems. Then you may learn to find creative solutions to those problems and pursue the best course of action to overcome them. The number of sessions varies depending on your needs. Through this treatment, you may:

• Strengthen your ability to address negative feelings associated with suicide and depression.
• Increase your confidence in confronting situations in a deliberate way.
• Heighten your feelings of optimism and motivation.
• Increase your ability to think things through when you feel overwhelmed.
• Learn to address difficult challenges such as finding a job or working through a serious health issue.

If you choose PST, you may be asked to:

• Complete written assignments in and outside of sessions, sometimes as homework.
• Learn new problem-solving skills to overcome obstacles and address challenges.
• Identify a problem and practice your new skills to find a solution.
• Learn new skills to address negative emotions, brain overload, and low motivation.
• Meet regularly with your therapist to discuss and establish goals for treatment.

Speak openly with your mental health provider about your symptoms and priorities so you can work together to determine whether this therapy is best for you.

Prolonged Exposure Therapy (PE)

PE is a highly effective therapy for PTSD that helps patients gradually address their symptoms and get their lives back. PE works by having you approach and address traumatic memories, feelings, and situations that you may be avoiding because of the traumatic event(s) you experienced. By talking about these difficult moments, you can begin to overcome these challenges and decrease symptoms of PTSD so that you can start living your life more fully again.

PE typically lasts from eight to 15 sessions. Your provider will work with you to ensure that therapy progresses at a rate that works best for you and is tailored to your treatment preferences, values, and priorities. Through this therapy, you may:

• Learn new breathing techniques to help relieve your distress.
• Engage with and feel more comfortable in safe situations that you have been avoiding due to trauma.
• Process and work through the traumatic event, which will ultimately decrease unwanted memories and thoughts.
• Change negative, unwanted beliefs by working through the memory and engaging in activities you have been avoiding.

If you choose this therapy, you may be asked to:

• Commit to attending regular weekly sessions.
• Talk about the details of your trauma.
• Make a list and gradually revisit the people, places, or activities that you’ve avoided since your trauma.
• Complete homework and practice new skills outside of the sessions.

Speak openly with your provider about your mental health symptoms so that you can work together to determine the treatment plan that is best for you.

Safety Planning (SP)

SP is an intervention to help Veterans experiencing suicidal thoughts and behaviors. By working together with your provider, you will create a safety plan that includes a list of prioritized coping strategies and sources of support to use in preventing or responding to a suicidal crisis. The plan can help you discover healthy ways to cope with suicidal thoughts, curb harmful behaviors, and improve your quality of life.

SP can be a single session or incorporated into ongoing treatment with your provider. Creating the SP may take about an hour. After creating a safety plan, you may:

• Experience a heightened sense of self-control.
• Have a more optimistic attitude when it comes to addressing suicidal thoughts and crises.

If you choose SP, you may be asked to:

• Work with your provider to create a list of coping strategies and resources to use during a suicidal episode.
• Identify warning signs that signal when to use your coping strategies.
• Discuss how to use the safety plan and how to overcome barriers or obstacles to using the plan.
• Review the plan periodically with your provider when your circumstances or needs change.

Speak openly with your provider about your feelings and mental health symptoms so that you can work together to develop a safety plan that best meets your needs and situation.

Social Skills Training (SST)

SST is an intervention that was developed to treat individuals with schizophrenia. SST is also commonly effective in helping people diagnosed with schizoaffective disorder, bipolar disorder, or treatment-refractory depression. Typically, SST is provided in a group setting to teach you ways to better express yourself and respond to others’ thoughts, feelings, and needs. SST can help you learn to communicate and get along better with others in group sessions designed to be very supportive (and even fun!).

Before joining the first group session, you will attend an individual session to learn more about the intervention and set a personal goal or goals for the social skills group. The length and frequency of an SST group’s sessions depend on the setting, as well as the needs of the group members. SST groups usually meet once or twice a week for up to six months. A group leader can provide more specific information about SST groups available at your VA.

SST strives to improve your social skills and increase your ability to function in everyday settings. Through this group intervention, you may:

• Improve social skills that help you make progress toward your goals.
• Learn to start and maintain better conversations.
• Become more skillful in asking for help from others.
• More effectively express your feelings, resolve conflicts, make friends, and assert yourself when necessary.
• Learn to improve and maintain social relationships.
• Become more independent.

If you choose SST, you may be asked to:

• Commit to attending sessions regularly.
• Learn about the importance of various social skills.
• Demonstrate your ability to use various social skills in role-plays.
• Accept constructive feedback and notes for improvement from group facilitators and peers.
• Practice new social skills in the community between SST group sessions.

To learn more about SST, speak with your mental health provider about your goals and preferences for treatment.

Written Exposure Therapy

Written exposure therapy can help Veterans relieve symptoms of posttraumatic stress disorder (PTSD). With this therapy, you learn to lessen the distress caused by traumatic memories.

Written exposure therapy typically consists of five sessions. Through the therapy, you learn that:

• Traumatic memories do not have to cause significant distress.
• Any distress you feel is temporary.
• It is possible to develop new ways of thinking about the trauma and its meaning.

If you choose written exposure therapy, you will be asked to:

• Write in detail about the trauma you experienced.
• Reframe the way you think about your trauma.

To learn whether written exposure therapy is right for you, speak with your mental health provider about your mental health symptoms and discuss your goals and preferences for treatment.

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