We can all agree therapy is good and everyone deserves access to it. If you’ve gone through the laborious process of finding a therapist you like, and you’re really working on talking things out now, great job! Also…remember how your therapist told you there are no simple answers in life?
Psychotherapy, or what most of us call talk therapy, is (alongside medication) about the most common mental health service people seek out. And it is very solidly backed by research as a helpful treatment for lots of people, including those with depression and anxiety. Of course, lots doesn’t mean all. Not everyone has the insurance or financial means for it (though group therapy and therapist-in-training programs offer free or low-cost alternatives.) And everyone benefits in different ways from talking things out. For some people it really doesn’t work, and for others it’s not good enough on its own.
The good news is that there are lots of other types of therapy out there, which traditional therapists generally approve of—they may even be able to recommend what could work for you. These programs, practices, and treatments all fall under the broad category Complementary and Alternative Medicine (CAM)—that means anything that still needs more well-designed studies to determine safety, exactly what it can treat, and how it should be applied.
How to navigate the options? It’s right there in the name: sometimes it’s alternative if you prefer, say, collaging with a professional to just talking to them; other times it’s a complement, for those who may want to pair a CAM therapy with counseling. Other practices that fall under CAM, like yoga, are simply good practices that can have therapeutic effect or complement therapy.
“Some of these more alternative treatments just don’t have as much research behind them as talk therapy does,” says Vaile Wright, director of research and special projects in the Practice Directorate at the American Psychological Association. But, she says, a lot of behavioral health professionals look beyond talk therapy as a way to further bump up people’s quality of life. “If talk therapy can get people 50 percent better, how do you get to 75 percent?”
A lot of alternative therapies you might have heard of tap into what talk therapy usually doesn’t: physicality. Think art, music, dance and other movement, gardening, or animal-assisted therapy (dogs, usually!). These can be fun and can fit with different people’s interests and values (which can make a huge difference in therapy), but they’re not yet evidence-supported as mental health treatments. Unbiased studies that do exist often test their promise in treating specific things: post-traumatic stress disorder, chronic pain.
The good news is that they may still offer some mental health benefits for the obvious reason: creative, soothing activities can soothe you. Studies about art therapy, for example, do support the idea that it can have an immediate stress-reducing effect—it’s just not clear yet how, say, people with anxiety would benefit from a specifically administered program.
Similar conclusions have been reached for therapeutic interventions involving dog- and music-assisted therapy, basically for the reasons you’d guess: dogs and music generally make us feel good. The bad news is that, as formal therapy programs, these are going to cost you just as much as talk therapy, and they’re even less likely to be covered by insurance.
Three other alternative therapies have shown promise, with varying degrees of supporting research. Bibliotherapy involves getting a syllabus of either self-help or fiction books with the former showing promise for people with depression and the latter showing slightly more ambiguous promise, therapeutically speaking. But again, being given a therapeutic list of novels may be soothing because—who wouldn’t want that?
Biofeedback involves tracking bodily changes you may take for granted—heart rate, breathing, sweat gland activity—that are known to change with, say, anxiety. Training to control those reactions while hooked up to sensors in a therapist’s office has shown promise in helping with stress and anxiety. Perhaps the most evidence-based alternative therapies are mindfulness programs, like mindfulness-based stress reduction (MBSR), which usually involves eight weeks of training in specific meditation techniques.
“Psychologists talk about decentering, getting away from your thoughts and looking at them more objectively, and meditative practice allows that,” says David Shutleff, deputy director of the National Center for Complementary and Integrative Health at the National Institutes of Health. There’s also evidence they’re actually changing your brain. “New circuits are developing that give you more emotional control, understanding, and self reflection.”
Relatedly: according to therapists, self-care absolutely counts as a complementary mental health treatment, as long as you practice the kind that focuses on mental or physical wellbeing—exercise, meditation, and working to build strong social connections are pretty universally recommended. (As in, not the kind of “self care” that involves late-night online shopping.)
“The function of a professional therapist is that they are able to see outside of your situation, to help you identify your thoughts, feelings, and behaviors that are either helpful or unhelpful,” says Wright. “And that’s great, but that’s not the function of yoga. But they work really well together. I think that’s where the field is going is this holistic notion.”
Of course, don’t assume that self-care on its own is enough, especially if you might be dealing with specific mental health challenges. No matter what kind of therapy you’re considering, it may help to start with a talk therapist if only to start working out what you’re going through, and other approaches they’d recommend. Whatever your situation, broadening your definition of therapy isn’t a bad idea if it means having more tools to feel better and stay even-keeled.
“When you’re incorporating exercise or mindfulness or art therapy, all these other holistic kinds of things, I think that is a prescription towards better mental and behavioral health,” says Wright. “One of the realities of therapy is that you’re typically only in it one hour a week. That can be a very powerful hour. But what about all the other hours in the week?”