Setting up PHP on Mac OS X can be complex due to various methods and potential confusion, but using Bitnami simplifies the process by consolidating everything in one place, similar to Python's virtualenv. The Bitnami MAPP Stack, which includes Apache, PHP, and additional frameworks like Laravel and Symfony, is recommended for an easy installation. After downloading and installing the stack, users are advised to update their PATH in the ~/.bash_profile to prioritize the stack's binaries. For additional setup, users can install the libcouchbase C library using Homebrew and build the PHP-Couchbase SDK from source to match the PHP version in the Bitnami stack. Starting and restarting Apache can be managed via the command line using ctlscript.sh, which also helps in identifying any errors in the configuration. The setup concludes with testing the Couchbase connection using a simple PHP script to ensure everything is functioning correctly.