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Guided self-help is a structured approach to making change by working through a self-help program of cognitive behavioral therapy (CBT) with some extra support. Unlike traditional self-help, you’re not on your own–a trained therapist provides accountability, helps clarify the material, and assists in overcoming obstacles through check-in appointments. The frequency and duration of these appointments are less than what you will find in traditional face-to-face CBT. To get the most out of your check-in appointments, it’s helpful to come prepared with any comments, questions, or concerns you have along the way.

Yes, guided self-help (GSH) is well-supported by research. Studies show it’s more effective than traditional self-help for reducing depression, anxiety, insomnia, and binge eating, and it is comparable to cognitive behavioral therapies (CBT) delivered in a traditional format. This is especially true when guided support is provided one-on-one by a trained therapist (Cuijpers et al., 2010; Cuijpers et al., 2019; Jensen et al., 2020; Karyotaki et al., 2015; Linardon et al., 2018; Melisse et al., 2023; Richards & Richardson, 2012; Zachariae et al., 2016). This effectiveness likely comes from including CBT’s core elements–cognitive, behavioral, and emotional skills—as well as the benefit of therapeutic support (Watkins et al., 2023; Ebert et al., 2018).

“Skills are difficult at first, they get easier over time, but you’re never done practicing.”

Talk therapy is a general term for when a client or patient talks with a therapist about mental and behavioral health concerns. It can entail unstructured supportive-talk therapy or more structured therapies, such as cognitive behavioral therapies. The guided self-help programs offered at Pivot Behavioral Health are cognitive behavioral at their core and there is someone with whom you will talk. In that way, yes, guided self-help is a form of talk therapy–there is just less talking and more doing.

Cognitive behavioral therapies (CBT; Hofmann et al., 2012) focus on a common set of cognitive, behavioral, and emotional processes that keep people stuck and that can foster change. Central to CBT is a personalized case formulation—a structured understanding of how specific thoughts, feelings, actions, and attention interact to maintain a person’s difficulties. For example, procrastinating to avoid obligations may temporarily reduce anxiety, but it can also lead to poorer work performance and increased worry, ultimately reinforcing the anxiety. The focus is on the immediate situations and responses that create and sustain psychological disorders.

CBT emphasizes immediate situations and responses that sustain psychological challenges, offering practical steps to break these patterns. For example, exposure techniques can help reduce the link between feared situations, fear, and avoidant behaviors. These steps can produce measurable changes, allowing the therapist and client to track progress and adjust treatment if needed. This makes CBT an individualized and iterative process. A trained CBT therapist will not only assess which processes are most relevant for you, they will also remain flexible, updating the treatment plan as new data emerges—which is known as a “working case formulation.”

Stepped-care is a model for delivering mental and behavioral health treatment (Richards et al., 2012). It emphasizes providing services based on a person’s level of need. For instance, some people don’t need to see a therapist at all. Their problems may naturally go away or they may just need some education about what to do differently. Some may need to see a therapist once or twice, while others may need weekly therapy appointments. Fewer need more intensive care, like an intensive outpatient program or inpatient hospitalization. Guided self-help tends to be most helpful for those who have some problems, but only seldom need to see a therapist. If more care is needed, people are “stepped-up” to higher, more intensive levels of care.

Determining who might benefit most from unguided self-help, guided self-help (GSH), or traditional psychotherapy isn’t straightforward. For example, initial symptom severity doesn’t appear to be a reliable predictor of outcomes, as even those with moderate to severe symptoms can benefit from GSH (Ebert et al., 2018; Loeb et al., 2000; Nordgreen et al., 2012). Similarly, individuals with moderate to severe symptoms can show rapid improvement with traditional psychotherapy as well (Lutz et al., 2009). A person’s preference for guided self-help is one predictor of success with some evidence, but more research is needed (Ebert et al., 2018; Wade et al., 2019).

The COM-B model of behavior change (Michie et al., 2011) offers one way to consider who might thrive in a GSH program. This model suggests that behavior change relies on a person’s capacity, opportunity, and motivation for change. Based on this, individuals who (1) have a history of successfully making difficult changes with minimal support, (2) possess the time and energy to invest in making changes, and (3) are genuinely motivated to change may be well-suited for GSH. However, further research is needed to understand which factors best indicate who could benefit from different care levels.

Cognitive Behavioral Therapy (CBT) was originally designed and tested with “WEIRD” populations—Western, Educated, Industrialized, Rich, and Democratic societies (Terjesen et al., 2022)—and reflects cultural values such as individualism and self-determination. As a result, in its traditional form, it may not fully resonate with individuals from different cultural backgrounds (Naeem et al., 2019). CBT is now embracing a broader range of evidence-based change processes, drawing inspiration from Eastern traditions, becoming more flexible in accommodating diverse values, such as respecting interdependence, and focusing on the contextual and functional roots of psychological distress (Hayes et al., 1999; Hayes & Hofmann, 2017). Still, cultural adaptations have proven especially effective (Naeem et al., 2023; Terjesen & Doyle, 2023). These adaptations preserve the core principles of CBT while adjusting its delivery to include culturally relevant metaphors, relatable examples, or even the involvement of family members in treatment (Naeem et al., 2023). Although research on culturally adapted guided self-help CBT is still in its early stages, preliminary findings are promising (Cashelin et al., 2014; Lee & Williams, 2017; Shehadeh et al., 2016; Tol et al., 2018).

With thoughtful adaptation, these programs can be helpful. The self-help workbooks we use here were authored by individuals from majority groups and may not fully address the unique challenges faced by ethnic, gender, and sexual minorities, such as discrimination, inequality, and marginalization. While this is a limitation, the workbooks are designed to flexibly target psychological processes that maintain depression, anxiety, insomnia, and binge eating, allowing you to adapt the activities to reflect your lived experiences and personal goals and values. Our therapists are trained in culturally-competent care and can help you make these adjustments. You’re also welcome to involve your own support system to help you make change—even inviting them to join your check-in appointments. To help you decide if these programs are a good fit, you can preview any workbook to get a sense of the information and skills provided and language used to deliver this information (see the next FAQ item for details) and/or ask any question.

Each program is slightly different. In general, however, all of them will ask you to (1) monitor the automatic patterns of thinking, feeling, acting, and attending that contribute to your problem(s) and the context that they occur, (2) practice new ways of responding so that the old, unproductive habits start to decrease and new, more productive habits start to form, and (3) regularly complete self-report measures so that we can monitor your progress. Check-in appointments will be with a licensed therapist trained in cognitive behavioral therapies. For more information on the specific processes, skills, and techniques you will learn and the language that is used to communicate these ideas, you are welcome to read a preview of the workbooks used at Pivot Behavioral Health:

Guided self-help (GSH) programs are designed to be briefer than traditional psychotherapy. Most people find that six appointments with a therapist are enough to get the most out of GSH (Delgadillo et al., 2014; Donker et al., 2013), though some may benefit from a few extra sessions (Zachariae et al., 2016). However, there are diminishing returns to appointments. If you work consistently through the workbook and do one appointment every other week, the program will take around three months to complete. We don’t encourage working faster than that as you will want to let the material sink in and have enough time to practice the skills.

It is common to have multiple problems. A standard way of approaching this is to start with one problem and then go from there. You can start with the one that is most central, which means it is at the core of all your other problems or it influences your other problems to a large degree. You can also start with the one that has the greatest impact on your life. For instance, we know from the research that treatment for insomnia not only reduces insomnia, but also reduces depression among those with co-occurring depression and insomnia (Cunningham & Shapiro, 2018). Any additional symptoms can then be treated with the second treatment program. You and your therapist can work collaboratively to decide what to do first.

A lot of co-occurring problems may suggest a higher level of care. For instance, someone with chronic pain, depression, trauma, insomnia, and interpersonal conflicts don’t respond as well to briefer forms of cognitive behavioral therapy (Leichsenring & Rabung, 2011), and hence may have a harder time engaging in guided self-help programs. They may need longer forms of therapy, in which a strong therapeutic alliance can be formed and multiple treatment techniques used (Leichsenring & Rabung, 2011). We will assess how many co-occurring problems you have at your intake appointment and determine if you need a higher level of care.

In a lot of ways yes, with some added benefits. Cognitive behavioral therapies delivered over a video conferencing platform can be just as effective at reducing depression, anxiety, insomnia, and binge eating than face-to-face therapy in all kinds of treatment contexts (Giovanetti et al., 2022; Lalor et al., 2023; Levinson et al., 2021; Scott et al., 2023; Wangelin et al., 2016). Telehealth can also be more practical for people as it doesn't require driving to a therapist’s office, thereby saving you time and money (Wangelin et al., 2016). One downside is that there are fewer non-verbal cues for you and your therapist to detect. However, this doesn’t seem to reduce the effectiveness of telehealth.

Yes, services can be provided within PSYPACT states and territories—42 in total. If you live in any of the following states or territories, you cannot receive services at Pivot Behavioral Health:

• Alaska
• American Samoa
• California
• Guam
• Iowa
• Hawaii
• Louisiana
• Massachusetts
• Montana
• New Mexico
• New York
• Oregon
• Puerto Rico
• U.S. Virgin Islands

If you live in any other state or territory, you can be treated at Pivot Behavioral Health.

No, we don’t. The challenges of credentialing across states and the frustrations of working with insurance companies have led to adopting a different approach. We have implemented a payment structure that we believe is fair and flexible. Each part of the program is available for individual purchase, allowing you to customize your treatment to fit your needs and budget. If you’re still having difficulty paying for sessions, please let us know. We are committed to making treatment accessible and are exploring other options to help support those in need. Together we can try to work something out.

Our pilot program will be mostly free. Clients will still be responsible for purchasing their workbooks, but intake and check-in appointments will be free. When our official program rolls out, you will pay for each part of the program as you move through it. You will pay for each check-in appointment before the appointment occurs, including the intake appointment. Payment instructions will be provided before each appointment. After your intake and if you are enrolled (depends on if you are a good fit), then you are responsible for purchasing the workbook. Here’s a detailed breakdown of the costs you can expect:

We are not quite enrolling new clients. We plan to roll out a pilot program in the near future. This pilot program will help us work out any bugs and start to evaluate our programs effectiveness. Our pilot program will be free of charge. Add your contact information here to get notified of our start date.