What's the Difference Between DBT and CBT?

Experts estimate that more than one in five adults in the United States live with a mental health condition with varying degrees of severity. These mental health conditions require treatment, and healthcare providers recommend therapies like dialectical behavior therapy (DBT) or cognitive behavioral therapy (CBT) to help you feel better.

CBT and DBT are two forms of psychotherapy or talk therapy where you work with a mental health provider to gain more insight about yourself, understand your condition, and learn skills that help you cope with and manage your symptoms.

While CBT and DBT share some similarities, they are two different therapeutic approaches to treating conditions like anxiety, depression, personality disorders, and posttraumatic stress disorder (PTSD).

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) combines two therapeutic approaches—cognitive therapy and behavioral therapy—to identify harmful or destructive thinking patterns and replace them with positive or more desirable ones. The concept behind CBT is that the way you feel, your behavior, your thoughts, and how other people make you feel are all interconnected and affect your mental health.

Distressing thought patterns and negative conclusions about things or people can cause you to feel bad about yourself, unhappy, depressed, rejected, and isolated. CBT uses different techniques to teach you to face your fears, identify those negative thoughts, find solutions to manage them, focus on the solutions, and develop a greater sense of confidence in your own abilities. 

Unlike therapies like psychoanalysis, which is interested in dealing with your past and understanding why you have negative or intrusive thoughts in the first place, CBT is more problem-oriented and is focused on helping you deal with your current issues as soon as possible. This form of therapy has been effective in treating mental health-related conditions like:

• Anxiety
• Depression
• Substance use disorder (SUD)
• Addiction
• Obsessive-compulsive disorder (OCD)
• Trauma
• Marital challenges

People with physical conditions, such as rheumatism, tinnitus, and chronic pain, may also benefit from CBT, as there's evidence that therapy can help some people manage physical symptoms.

Dialectical Behavioral Therapy

Dialectical behavior therapy (DBT) is an evidence-based treatment specially adapted for people who experience emotions intensely. While this treatment was developed based on the principles of CBT, it emphasizes fixing emotional dysregulation.

Instead of focusing on changing atypical or maladaptive behaviors, thoughts, and feelings, DBT encourages you to be realistic about your thoughts, accept them as they are, and teach you healthy coping mechanisms in the process. 

Most therapists who practice DBT teach their clients strategies like how to cope with stress, be mindful, regulate their emotions, live in the moment, and form healthy relationships with others. They may employ techniques like:

• Individual psychotherapy: One-on-one face-to-face (in-person or online) sessions with your therapist
• Telephone consultation: Sessions with your therapist via phone call
• Skills training group: Learning skills like emotional regulation and mindfulness in a group setting

DBT is the only treatment effective in treating borderline personality disorder (BPD), a mental health condition that causes long-term patterns of unstable moods, difficulty maintaining relationships, and turbulent emotions. 

It may also help treat other mental health conditions like generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, substance use disorder (SUD), and eating disorders.

Similarities Between DBT and CBT

DBT is considered a modified form of CBT, as it uses the principles of CBT. So, both therapies share some overlapping strategies and techniques. DBT and CBT both:

• Rely on the basic principle that people's behavior, cognition, and emotions are interlinked
• Believe that changing disruptive behaviors can significantly reduce emotional distress
• Teach coping skills and management strategies
• Focus on the present experience (rather than past traumas) to deal with current challenges
  

Key Differences Between DBT and CBT

The goals and principles of CBT and DBT are similar, but some differences are evident in the actual techniques and strategies that both therapies adopt.

Key Focus

CBT focuses on changing people’s beliefs and thoughts, while DBT focuses on emotional regulation. Unlike CBT, DBT also addresses mindfulness, interpersonal relationships, and distress tolerance (managing difficult situations).

Mode of Approach

CBT views dysfunctional behaviors, thoughts, and feelings as “unhelpful” and tries to change them or help people build skills to redirect those thoughts. This approach can make it hard for people to accept their beliefs as reasonable or real. 

DBT, on the other hand, incorporates the concept of radical acceptance and validation. Your thoughts and behaviors are not judged, but you learn to accept and tolerate painful thoughts and situations.

Suitable Applications

DBT is more strongly recommended for people with self-destructive behaviors, intense emotion dysregulation, and strong urges for self-harm. Healthcare providers recommend people living with borderline personality disorder try DBT first. 

CBT is the first line of treatment for most other mental health conditions (such as substance use disorder, depression, and anxiety) and is a more popular treatment option than DBT.

Therapy Time-Frame

While there is no “standard” duration of treatment for mental health conditions, CBT is often considered more of a short-term treatment, as sessions are usually once a week and last about 12 weeks on average. DBT, however, is often a year-long (or longer) intensive treatment.

How To Choose the Right Therapy

CBT and DBT are both effective treatments for mental health conditions. However, your healthcare provider will work with you to determine which therapy option is best for you. The ideal therapy will depend on your specific condition, its symptoms, their severity, and what you want to achieve from your treatment. In some cases, therapists can combine aspects of CBT and DBT together to best fit your needs.

For instance, DBT was originally designed for treating borderline personality disorder and is recommended for treating people with ongoing suicidal or self-harm behaviors. It may also be ideal for you if you are experiencing intense emotional dysregulation. On the other hand, CBT may be best suited for you if you want to understand how your thinking patterns may affect your life and want to work on them to overcome your life’s stressors.

To learn which therapy is right for you:

• Have an honest and open discussion with your healthcare provider. They can talk to you about your symptoms and treatment goals and refer you to a therapist.
• Search for a therapist on the Clinical Resource Directory or American Psychological Association Psychologist Locator.
• Explore local sources, such as asking someone you trust for a recommendation or using your school’s counseling center.
  

A Quick Review

Cognitive behavior therapy and dialectical behavior therapy are both evidence-based interventions that help treat different mental health conditions, such as depression, anxiety, and post-traumatic stress disorder.

There are several similarities, but CBT focuses on recognizing and reframing negative thoughts and behaviors. DBT encourages you to accept your thoughts and behaviors and learn healthy ways to cope with your emotions.

If you're interested in either form of therapy, it's important to choose a mental health professional you trust, one who is a good match for you, and one with whom you are comfortable.