CBT vs DBT – The Similarities and Differences between CBT and DBT

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If you have spent time exploring different therapeutic approaches, you will have come across both cognitive behavior therapy and dialectical behavior therapy (CBT vs DBT). Both are evidence-based forms of psychotherapy that help you restructure your thoughts and help you deal with your emotions better. You may also learn how to change your maladaptive behaviors to improve your quality of living. 

Both forms of therapy focus on working with your thoughts and behaviors to impact your emotions positively. While CBT is used to treat various psychological conditions ranging from depression, anxiety, and interpersonal difficulties, DBT is used to treat borderline personality disorder in particular. 

What is Cognitive Behavior Therapy?

Cognitive Behavior Therapy, or CBT, is a form of talk therapy rooted in Aaron Beck’s theories. We have previously written about how rational emotive behavior therapy (REBT) and cognitive behavior therapy are similar and different. While REBT is a form of talk therapy that explores irrational thinking patterns and replaces them with more logical thoughts, CBT uses a less confrontational approach. CBT also has a large body of evidence proving that it is an effective form of therapy for treating anxiety and depression. CBT is based on the following core principles:

  • Your psychological issues stem from maladaptive thinking patterns
  • Your psychological difficulties are often learned behaviors that may have helped you at some point in life but are now unhelpful
  • You can unlearn these maladaptive behaviors and replace faulty cognitions with useful ones so that your symptoms become less severe over some time. 

In short, CBT-oriented therapists help you to change your thinking patterns by 

  • Recognizing cognitive distortions that affect your thought processes
  • Replacing cognitive distortions with more realistic thoughts
  • Change core beliefs that maintain these cognitive distortions
  • Replace maladaptive behaviors with helpful ones
  • Practicing relaxation techniques such as progressive muscular relaxation and deep breathing to induce calmness

Although CBT is highly structured and therapists often follow a manual, they also have the leeway to alter their therapeutic approach depending on each client’s concerns. CBT also emphasizes the importance of maintaining a thought diary, in which you will record the triggering events, thoughts and emotions you experienced at that moment, and the consequent behaviors you engaged in. 

During therapy sessions, your therapist will discuss your diary (a form of homework) and help you recognize your cognitive distortions, core beliefs that maintain them, and maladaptive behaviors that complicate things further. Then, they help you restructure your thoughts and unlearn behaviors that maintain your psychopathology. 

cbt vs dbt

What is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is an evidence-based treatment for long-term mental health conditions such as personality disorders, substance abuse disorders, and eating disorders. Marsha Linehan developed it for the treatment of borderline personality disorder in 1993. Since then, it has been proven effective for a range of chronic conditions that regular CBT sessions cannot address. 

DBT uses a multi-pronged approach to treat patients and almost always involves four stages. 

  1. Pre-assessment: The first stage consists of pre-assessment, during which the clinician evaluates your clinical history and arrives at a provisional diagnosis. During this stage, the therapist decides how effective DBT will be for your problems. Once the therapist decides DBT will help you, you will usually be offered the following:
  2. Individual therapy: Like CBT, individual DBT sessions last around 50 minutes on average but may involve more than once-a-week sessions. These sessions help you to reduce self-harm behaviors, improve interpersonal skills, and avoid counterproductive behaviors. The therapist may also explore traumatic incidents in the past, especially during childhood and adolescence. You may be allowed to address traumatic incidents in a safe environment and feel validated. 
  3. Group therapy: Group therapy is an essential part of DBT. You will work with other clients under the therapist’s guidance to address issues that commonly bother everyone. This is also an opportunity to develop interpersonal skills and explore areas in which you may have difficulties. Some of the skills you will learn during group therapy sessions are emotion regulation, distress tolerance, mindfulness meditation, and interpersonal skills. 
  4. Telephone coaching: Unlike other therapeutic modalities, DBT encourages clients to contact in between sessions over the telephone. These are often mandatory and help the client to reduce self-harm behaviors and address suicidal thoughts. Telephonic conversations with the therapist aim to eliminate hospitalizations and injuries. 

DBT has been found to be particularly helpful for those with borderline personality disorder and substance use disorders. DBT goes much deeper than CBT, addresses past trauma, and helps the client to come to terms with it. 

DBT may be well-suited for treating

  • BPD (strong evidence)
  • Eating disorders
  • Trauma from abuse
  • Bipolar disorder
  • Self-harm disorders
  • Suicidal ideation and behavior
  • Substance-use disorders
  • PTSD
  • Depression

Similarities Between DBT and CBT

DBT and CBT are talk therapies that are evidence-based and effective for various mental health conditions. There are several similarities between the two modalities. 

  • CBT and DBT help you manage thoughts, behaviors, and emotions. 
  • They help you gain deeper awareness about your thought patterns, core beliefs, triggers, and maintaining factors. 
  • Both modalities allow you to address maladaptive behaviors and replace them with helpful activities. 
  • CBT and DBT require you to keep thought diaries and complete homework assignments. 

It is important to note that although DBT stands on its own feet as a form of therapy, it derives much of its theoretical basis from CBT. Hence, it is common for clients to feel many similarities between the two. 

DBTCBT
DBT takes many months to even years as it addresses chronic psychological and psychiatric conditions.CBT is a structured modality of therapy that often lasts only a few weeks. While most therapists work around 16 sessions, this may vary in real-life scenarios. 
DBT is an evidence-based treatment for borderline personality disorder, substance use disorder, eating disorder, and other chronic and deep-rooted conditions. CBT is more effective for anxiety and depressive syndromes, which can be addressed by changing maladaptive behaviors and challenging core beliefs. 
DBT involves group therapy and telephonic contact in addition to individual sessions. CBT usually consists of only individual sessions. 
DBT addresses past trauma and childhood experiences. This makes it suitable for addressing deep-rooted interpersonal and intrapersonal difficulties. CBT focuses on the here and now, making it ideal for managing general and specific anxiety disorders and mood disorders. 
DBT attends to the client’s emotional needs by validating them when necessary. Emotion regulation and distress tolerance are essential aspects of DBT, through which clients learn to validate and manage their emotions. CBT focuses on addressing maladaptive thoughts and behaviors and works on the premise that positive emotions follow when faulty thoughts and behaviors are addressed. 
DBT is a more intensive form of therapy suitable for treatment-resistant individuals. Most people who opt for DBT often have a history of unsuccessful attempts with CBT, acceptance and commitment therapy (ACT), and solution-focused brief therapy (SFBT).CBT is often the first-line treatment approach for those who enter therapy. Personality disorders are often identified during therapy, and many individuals who enter CBT are encouraged to attend DBT later. 

CBT vs DBT for Treating Certain Illnesses

It must now be clear to you that CBT helps treat anxiety and mood disorders. At the same time, DBT is preferable when it comes to personality disorders, addictions, and other long-standing issues. However, some therapists may choose either therapeutic modalities to treat certain conditions. 

If you only have anxiety disorders such as generalized anxiety disorder, specific phobia, or panic disorder, CBT is a practical treatment choice. 

  • It helps you recognize triggers and use techniques such as relaxation to calm down. 
  • Therapists will also teach you to address common cognitive distortions that cause anxiety, such as catastrophizing, overgeneralization, and “shoulds and musts.” 
  • Over time, you will learn to tell yourself that your distorted thoughts can be replaced by realistic thoughts, while helpful behaviors can replace maladaptive ones. 

DBT, on the other hand, will teach you how to manage the distress associated with anxiety and practice mindfulness during an anxious state. 

  • DBT is effective in long-term anxiety disorders when a person has failed to respond to CBT. 
  • As DBT involves group sessions, people with social anxiety may benefit from it too. 
  • DBT is suitable for chronic depressive conditions, where improving interpersonal relationships positively affects mood. It is important to note that most people with borderline personality disorder experience chronic anxiety and depression.

CBT is an effective choice if you have acute anxiety or mood disorder. However, if you have been experiencing anxiety and depression for a long time and have not responded to CBT, you may benefit from DBT. 

How to Tell if CBT or DBT is Right For You

Ideally, the therapist should decide to choose CBT or DBT to help an individual. However, most clients today are aware of different therapeutic modalities, which has psychoeducational benefits. If you are planning to choose between CBT or DBT yourself, here are a few things to consider:

  • CBT works well for anxiety and mood disorders
  • DBT is an evidence-based treatment for personality disorders (borderline personality disorder in particular), and other chronic conditions
  • CBT is time-bound and tends to be less expensive. DBT requires several sessions and is generally costlier than CBT. 
  • You may not need DBT if your problems are not long-standing or chronic. 
  • Finding a DBT-trained therapist may be difficult. Most psychotherapy programs teach CBT to trainees, so CBT-oriented therapists are easier to find. 

If you think you have a long-standing psychiatric or psychological condition, DBT may help you better as it addresses past trauma, childhood experiences, and difficult emotions. If your symptoms are not complex and are mostly related to depression and anxiety, CBT is very effective

Is CBT or DBT better for treating depression?

CBT is an effective treatment for depression. It helps clients recognize automatic negative thoughts and replace self-defeating thoughts with helpful ones. It also teaches clients to maintain an activity schedule and encourages them to engage in physical activity. On the whole, CBT is an evidence-based treatment for depression. 

However, some people do not respond to CBT and continue to remain depressed or have mood swings often. These individuals may have borderline personality disorder or persistent depressive disorder (previously known as dysthymia). DBT is an effective treatment option in such cases. 

At the end of the day, your therapist will help you make the right decision based on how you respond to therapy, regardless of the initial treatment of choice. 

Is CBT or DBT better for treating anxiety?

There are different kinds of anxiety disorders. Examples include specific phobias such as arachnophobia (fear of spiders) and cynophobia (fear of dogs), agoraphobia (fear of open spaces), panic disorder, and generalized anxiety disorder. 

Specific phobias usually respond well to behavior therapy, which involves systematic desensitization. On the other hand, generalized anxiety disorder and panic disorder respond well to CBT. If you are suffering from one of these anxiety disorders, CBT or behavior therapy may help you more than DBT. 

However, if you have been experiencing bouts of anxiety along with other symptoms such as interpersonal difficulties, substance abuse, and self-harm behaviors, you may benefit from DBT. The answer is quite clear: if your symptoms are complex and anxiety is one of the many symptoms you experience, you may benefit from DBT more than CBT. 

Can Dialectical Behavior Therapy And Cognitive Behavioral Therapy Be Used Together?

Yes, Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) can be used together, and this approach is known as Integrated CBT-DBT. It combines the strengths of both therapies to create a more comprehensive treatment plan. DBT focuses on emotional regulation and interpersonal effectiveness, while CBT targets cognitive restructuring. By integrating these approaches, individuals can address a broader range of issues effectively, making it particularly useful for conditions like borderline personality disorder. A skilled therapist can tailor the combination to suit the specific needs and goals of the client.

Final verdict on DBT vs CBT

Although CBT and DBT have many similarities, they are different treatment modalities used to very different conditions. Their approaches, methods, and treatment styles differ significantly. While CBT employs fewer therapy sessions, DBT is a long-term treatment approach particularly suited for personality disorders and treatment-resistant psychological conditions. 

Deciding between the two methods can be confusing, especially if you are unfamiliar with these terminologies. Speaking to an experienced therapist and seeking their advice will help you make the right decision, and seek the help you need. 

FAQs

Are CBT and DBT effective for adolescents?

Yes. CBT and DBT are effective for adolescents, and the therapist should decide the treatment modality to be used. 

Is CBT more cost-effective than DBT?

Yes. CBT requires fewer sessions and hence is more cost-effective. However, DBT is more suitable for complex psychological conditions such as borderline personality disorder. 

Can I combine CBT with DBT?

Some therapists may weave in aspects of CBT and DBT based on individual requirements. This is known as the eclectic approach. However, make sure that the eclectic therapist is equally proficient in both forms of therapy. 

What if a DBT therapist is unable to arrange group sessions?

This can happen more often than you may imagine. In such scenarios, the therapist tries to teach you distress tolerance, emotion regulation, mindfulness, and interpersonal skills during individual therapy sessions. Your treatment may lack the group dynamics associated with DBT, but you still gain from the skills you learn. 

Is DBT effective for all chronic mental health conditions?

Not really. DBT is specifically helpful for borderline personality disorder. It also helps people with substance abuse disorder, eating disorders, persistent depressive disorder, etc. However, it is not the treatment of choice for everyone and every chronic mental health condition.

Jaiyant Cavale, Clinical Psychologist
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