Popular Therapy and Counselling Approaches

CBT (Cognitive Behavioural Therapy) is a structured form of psychotherapy that helps a person understand and change the connection between thoughts, feelings, and behaviours.

The basic idea is:

What we think influences how we feel, and how we feel influences how we behave. Changing unhelpful patterns of thinking and behaviour can improve how we feel and function.

A simple example

Suppose someone thinks:

Event: A friend doesn't return a phone call.

Thought: “He doesn't want to talk to me. Everyone is avoiding me.”

Feeling: Rejection, sadness, anxiety.

Behaviour: Withdraws from the friend and stops calling.

In CBT, the therapist might help the person examine the thought:

• What evidence supports it?

• What evidence doesn't support it?

• Are there other possible explanations?

• What would you say to a friend who had this thought?

The person may arrive at a more balanced interpretation:

“He hasn't called back, but I don't actually know why. He could simply be busy.”

This can reduce the emotional distress and lead to a more useful response.

CBT isn't simply "positive thinking"

It is not about forcing yourself to think positively or denying difficult experiences. It is about examining thoughts more objectively and testing whether they are accurate, helpful and supported by evidence.

CBT also works on behaviour, not just thoughts. Techniques can include:

• Behavioural experiments

• Gradual exposure to feared situations

• Activity scheduling

• Problem-solving

• Developing coping strategies

• Identifying triggers and patterns

• Learning skills to manage difficult emotions

CBT and psychosis

CBT can also be used as part of treatment for psychosis and schizophrenia, usually called CBTp (CBT for psychosis).

Here the approach is somewhat different. The therapist generally doesn't confront or ridicule a person's hallucinations or delusions. Instead, they may help the person:

• explore different explanations for unusual experiences;

• identify situations that make voices or suspicious thoughts stronger;

• reduce distress caused by hallucinations;

• examine beliefs gradually and collaboratively;

• develop ways of responding to voices;

• improve functioning and quality of life;

• recognise early warning signs of relapse.

For example, rather than saying “That voice isn't real,” a therapist might explore:

“When you hear the voice, what does it say? When does it become stronger? How do you feel afterward? Are there circumstances in which it becomes quieter? What ways of responding make it less distressing?”

This makes CBTp particularly interesting for understanding a character experiencing schizophrenia: the therapy can become a gradual process of helping someone question their interpretation of reality without simply telling them that their experiences are imaginary.

CBT is generally most effective when delivered by a trained mental-health professional, and for schizophrenia it is usually an adjunct to, rather than a replacement for, appropriate medical treatment.

Journaling in mental health means regularly writing down your thoughts, emotions, experiences, perceptions, and reactions in order to understand them better and notice patterns over time.

It is more than simply keeping a diary. In a therapeutic context, journaling can become a tool for self-observation and emotional processing.

What might someone journal?

A person might write:

• What happened: “My brother didn't answer my call.”

• What I thought: “He's angry with me.”

• What I felt: “I felt rejected and anxious.”

• What I did: “I stopped speaking to him.”

• What I later realised: “I don't actually know whether he was angry.”

• What I could do differently: “I'll ask him rather than assume.”

This overlaps considerably with CBT, where identifying the relationship between situation → thought → emotion → behaviour is important.

Different kinds of mental-health journaling

1. Free-form journaling

Writing whatever comes to mind without structure. This can help someone externalise thoughts and emotions.

2. Thought journal

Recording troubling thoughts and examining the evidence for and against them. This is commonly used in CBT.

3. Mood journal

Tracking mood, anxiety, irritability, sleep, energy, and significant events to identify patterns.

4. Gratitude or positive-event journal

Recording things that went well or moments of pleasure, connection, or achievement.

5. Symptom journal

Recording unusual experiences—such as voices, suspicious thoughts, changes in sleep, or periods of intense energy—to help identify triggers and patterns.

Journaling and psychosis

For someone experiencing psychosis, journaling can have an additional benefit: creating a record of experiences that can later be examined when the person is in a more stable state.

For example:

Monday: I heard a voice telling me that my neighbour was watching me. I felt frightened and stayed indoors.

Tuesday: I still believe he is watching me, but I'm beginning to wonder whether the voice might be related to my illness.

Friday: I discussed it with my therapist. We identified that the voice becomes stronger when I haven't slept well.

That doesn't mean the journal should be used to tell the person “what you experienced wasn't real.” Instead, it can help create distance between the experience and the interpretation of the experience.

Recovery International (RI) is a structured, peer-led mental-health self-help method founded in the United States in the 1930s by psychiatrist Dr. Abraham Low. Despite its name, it is not the same thing as psychiatric rehabilitation or a treatment programme for recovery from psychosis.

The method is based on the idea that people can learn to manage distressing thoughts, emotions, impulses and reactions by practising specific mental-health skills.

The central idea

RI teaches a distinction between:

• Feelings and sensations — which can be intense but are temporary.

• Thoughts and interpretations — which can amplify those feelings.

• Actions and responses — which a person can learn to control even when feelings are difficult.

A commonly emphasised RI principle is essentially:

Feelings are not facts, and you don't have to act on every feeling or impulse.

How the method works

RI uses a collection of structured techniques and phrases, rather than open-ended psychotherapy.

For example, a person might learn to:

1. Identify an upsetting situation

“I received criticism from my colleague.”

2. Recognise the emotional reaction

“I immediately felt humiliated and angry.”

3. Separate the feeling from the action

“I can feel angry without responding aggressively.”

4. Use a prepared coping statement

The person reminds themselves that the feeling is temporary and that they can choose a constructive response.

5. Practise repeatedly

The techniques become easier with repetition.

RI also places considerable emphasis on gradual exposure to situations that have become difficult or frightening, while learning to manage the resulting emotional reactions.

Recovery International meetings

RI traditionally operates through peer-led meetings, where participants learn the method, discuss examples from their lives and practise its principles.

The emphasis is generally on self-management rather than analysing one's childhood, unconscious motivations, or the causes of one's illness.

This makes it quite different from traditional forms of psychotherapy.

In the context of mental health, meditation is a set of practices designed to train attention, awareness, and the way a person relates to thoughts, emotions, and bodily sensations.

It is not necessarily about “emptying the mind.” In many forms of meditation, the person learns to notice what is happening without immediately reacting to it.

A simple example

Someone becomes anxious and thinks:

“Something terrible is going to happen.”

Instead of immediately following that thought, meditation may teach them to notice:

“I am having a frightening thought. My heart is beating faster. I notice fear.”

Then they gently return their attention to their breathing, body, or another chosen focus.

The goal isn't necessarily to make the thought disappear. It is to create some distance between the person and the thought.

Common forms

Mindfulness meditation

Paying deliberate attention to present-moment experiences—breathing, sounds, sensations, thoughts—without immediately judging or reacting to them.

Focused-attention meditation

Keeping attention on one object, such as the breath, and returning to it whenever the mind wanders.

Open-monitoring meditation

Allowing thoughts, feelings and sensations to arise and observing them without becoming absorbed in them.

Loving-kindness meditation

Cultivating feelings of compassion and goodwill toward oneself and others.

How can meditation help mental health

Regular practice may help some people with:

• stress and anxiety

• emotional regulation

• rumination

• attention and concentration

• sleep

• coping with difficult emotions

• general psychological well-being

One of its important psychological skills is decentering—recognising that a thought is something the mind is producing, rather than necessarily a fact that must be believed or acted upon.

Meditation and psychosis

This requires some caution.

For someone experiencing active psychosis, particularly hallucinations, paranoia, or severe disorganisation, certain meditation practices can sometimes be uncomfortable or destabilising. Sitting quietly and directing intense attention inward can potentially make unusual perceptions or thoughts more prominent.

Therefore, meditation shouldn't automatically be assumed to be beneficial for everyone with psychosis. A gentle, structured approach under the guidance of an appropriately trained mental-health professional may be preferable, particularly during periods of instability.

Chanting—the rhythmic repetition of a word, phrase, prayer, mantra, or sound—can support mental wellbeing for some people through a combination of attention, breathing, rhythm, relaxation, emotional regulation, and social connection.

It is useful to distinguish the psychological mechanisms from any spiritual or religious meaning a person may attach to chanting.

How chanting may help

1. It gives the mind a simple focus

Repeating the same sound or phrase gives attention something relatively stable to return to.

Instead of:

thought → worry → another thought → memory → worry

the person repeatedly returns to:

chant → listen → breathe → chant → listen

This can reduce rumination and mental distraction for some people.

2. It naturally regulates breathing

Many forms of chanting involve relatively slow, rhythmic breathing. Prolonged vocalisation also tends to lengthen the exhalation.

This can encourage a more relaxed physiological state, particularly when the chanting is gentle rather than forceful.

3. Rhythm can be regulating

Repetition and rhythm provide predictability. Predictable sensory patterns can sometimes help reduce feelings of mental chaos or agitation.

This is one reason rhythmic activities more generally—music, drumming, walking, singing—can have calming effects.

4. It can create psychological distance from thoughts

Similar to mindfulness, chanting can give a person an alternative focus when thoughts become intrusive.

For example:

“I'm having an anxious thought.”

rather than:

“I must solve this thought right now.”

The person returns attention to the sound and rhythm.

5. It can provide emotional comfort

If the chant has personal, cultural or spiritual significance, it may evoke:

• safety

• hope

• belonging

• faith

• gratitude

• acceptance

• connection with others

Those effects aren't necessarily produced by the sound alone; the meaning attached to the chant can be important.

6. Group chanting adds social connection

Chanting in a group introduces synchrony—people breathe, vocalise and listen together.

That can create a feeling of:

“I am part of something larger than myself.”

For someone experiencing loneliness or social withdrawal, that communal aspect may be particularly valuable.

Chanting and the brain

Research on chanting and mantra-based practices suggests that repetitive vocalisation may influence attention, autonomic arousal and stress-related processes, although the evidence is still developing and shouldn't be interpreted as proof that chanting treats psychiatric illness.

The effects probably arise from several factors working together:

repetition + attention + breathing + rhythm + meaning + social connection

rather than from a single special property of a particular word or mantra.

Chanting and schizophrenia/psychosis

This requires a little more caution.

Chanting shouldn't be regarded as a treatment for schizophrenia or a substitute for antipsychotic medication or psychological care.

For someone who is relatively stable, a gentle, familiar form of chanting might be incorporated as a relaxation or mindfulness practice if they find it helpful.

However, during active psychosis, highly intensive spiritual practices or prolonged inward-focused meditation/chanting may not be appropriate for everyone. If chanting starts to intensify voices, unusual beliefs, agitation, sleep disruption or preoccupation, it would be sensible to stop and discuss it with the treating clinician.

Art therapy in mental health is a form of psychotherapy in which a person uses drawing, painting, sculpture, collage, or other creative activities as a way of exploring emotions, experiences, and psychological difficulties.

The important point is that art therapy isn't simply making art to relax. It is a therapeutic process facilitated by a trained art therapist.

How it works

A person may be unable—or unwilling—to put an experience into words. Creating an image can provide another way of expressing it.

For example, a therapist might invite someone to:

• Draw what anxiety feels like.

• Paint a memory that is difficult to describe.

• Create an image representing their family.

• Draw their experience of hearing voices.

• Make a collage representing how they see themselves.

• Create two images: “How I see myself now” and “How I would like to see myself.”

The therapist then helps the person talk about what they created and what it means to them.

Importantly, the therapist shouldn't simply look at an image and declare, “This symbol means you are depressed.” The person who created the artwork is the primary authority on its meaning.

Why can it help?

Art-making can provide several therapeutic functions:

Expression

Some emotions are easier to depict than explain.

Externalisation

A troubling thought or emotion can be represented outside oneself—for example, putting an image of “fear” onto paper can make it something the person can examine rather than something they are completely immersed in.

Exploration

The artwork can open conversations about experiences that might otherwise be difficult to discuss.

Emotional regulation

The creative process itself can sometimes help with calming and organising emotions.

Communication

It can provide a channel of communication when verbal communication is difficult.

Art therapy and schizophrenia/psychosis

Art therapy can be used as a complementary intervention for people with schizophrenia and other serious mental-health conditions. It may help with emotional expression, social interaction, engagement and aspects of psychological functioning.

It is important, however, not to present it as a treatment that cures schizophrenia or replaces appropriate psychiatric treatment.

For someone experiencing hallucinations or delusions, the therapist also needs to be careful about how artwork is interpreted. An image depicting a frightening hallucination, for instance, shouldn't automatically be treated as evidence that the underlying belief is true—or dismissed as meaningless.

Instead, the therapist might ask:

“Can you tell me what this image represents to you?”

That opens the door to understanding the person's subjective experience without necessarily validating the psychotic interpretation.

In the context of mental health, yoga refers to using a combination of physical postures, controlled breathing, relaxation, and sometimes meditation/mindfulness as a complementary approach to psychological well-being.

It is broader than exercise, but it is also important not to present yoga as a standalone treatment for psychiatric disorders.

How yoga may affect mental health

Yoga can work through several interconnected components:

1. Physical movement

Postures and gentle movement can reduce physical tension and improve flexibility, strength and body awareness.

2. Breathing practices (pranayama)

Controlled breathing can help a person regulate arousal and develop greater awareness of their physiological state.

3. Attention and mindfulness

Focusing on bodily sensations, breathing and movement can interrupt rumination and bring attention back to the present moment.

4. Relaxation

Practices such as shavasana can deliberately activate a state of rest and relaxation.

5. Mind–body awareness

A person may become better at recognising early physical signs of stress—for example, muscle tension, rapid breathing or a racing heart.

What might it help with?

Research suggests that yoga can be useful as a complementary intervention for some people experiencing:

• Stress

• Anxiety symptoms

• Depressive symptoms

• Sleep difficulties

• Psychological distress

• Problems with emotional regulation

The evidence is generally stronger for yoga as an adjunct than as a replacement for established treatments.

Yoga and psychosis

Yoga has also been studied as an adjunctive intervention in schizophrenia. Some studies suggest potential benefits in areas such as negative symptoms, quality of life, social functioning and general well-being.

But yoga does not replace antipsychotic medication or psychological and psychosocial interventions when these are clinically indicated.

There is also an important consideration with active psychosis. Some intensive practices—particularly prolonged meditation, sensory deprivation, extreme breathing exercises or highly inward-focused practices—may not be appropriate for everyone. A gentle, supervised approach is generally more sensible when someone is psychologically unstable.