Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are two widely used evidence-based therapeutic modalities. While CBT and DBT have their similarities, they’re two very different techniques that approach mental health treatment in unique ways.
CBT vs. DBT: What’s the difference? And which modality is the best fit for your needs? Keep reading to learn more.
What Is CBT?
Cognitive Behavioral Therapy (CBT) is a present-focused therapeutic modality that is rooted in the belief that our thoughts impact our feelings and behaviors. It aims to shift unhelpful thought patterns, known as cognitive distortions, to ultimately improve emotional well-being and help patients build better behavioral patterns. CBT helps individuals identify and challenge negative thoughts, enabling patients to nurture a more balanced perspective, make better decisions, and hold a healthier view of themselves and the world around them.
Conditions frequently treated with CBT include:
Depression
Eating disorders
Social phobia
Substance use disorder
What Does a Session Using CBT Techniques Look Like?
When utilizing CBT, a therapist will walk their patient through the process of cognitive restructuring: identifying distorted or unhelpful thoughts and replacing them with more balanced, constructive alternatives. It emphasizes noticing—paying close attention to thoughts, feelings, and behaviors, and taking the time to get curious about why they occur and the underlying beliefs and assumptions that shape them.
Once identified, patients learn to challenge these thoughts, questioning their accuracy and exploring more balanced, realistic ways of thinking.. Patients learn to recognize common thinking patterns, such as viewing situations in all-or-nothing terms, assuming they know what others are thinking, or consistently expecting the worst-case scenario. By identifying the unhelpful thought patterns, patients can then learn how to shift them.
Alongside these exercises, a therapist will work with the patient to develop practical tools and coping strategies to manage stress and continually work toward actively noticing unhealthy thought patterns in daily life—not just in session.
What Is DBT?
Dialectical Behavior Therapy (DBT) is a practical, structured, hands-on therapeutic technique that actually first evolved out of CBT. It works to help patients acknowledge their current challenges while becoming aware of the need for and benefits of change, and providing action steps to work toward that change.
DBT was first designed for the treatment of personality disorders, specifically Borderline Personality Disorder (BPD). However, it has since been found to be a valuable tool in treating a wide variety of mental health challenges, as DBT promotes emotional regulation, clear communication, mindfulness, and intentional action.
Conditions frequently treated with DBT include:
Borderline Personality Disorder (BPD)
Obsessive-Compulsive Disorder (OCD)
Anxiety
Depression
Self-harm
Suicidal behavior
Eating disorders
Substance use disorder
What Does a Session Using DBT Techniques Look Like?
DBT is a very structured, actionable style of therapy, making it a great fit for patients who appreciate having a clear, curriculum-like feel upfront. Oftentimes, a therapist and their patient will go through a DBT workbook together over the course of a set number of sessions, talking through different chapters and the skills, concepts, and applications presented. The patient then takes the skills discussed and intentionally practices and implements them into day-to-day life between sessions. This allows them to discover the techniques that most align with their needs and gives them the opportunity to explore and troubleshoot any challenges that come up during the implementation process in their next session.
For example, a client struggling with intense mood swings, emotional dysregulation, and outbursts toward loved ones might benefit from learning and practicing emotion identification, expression, and regulation. Alongside their therapist, they might roleplay conversations to build healthier communication techniques or identify specific skills to encourage the patient to pause and regulate difficult emotions. By learning and utilizing these tools, a patient might notice not only a positive impact on their relationships, but also overall mood stability and fewer mental health symptoms as a result of feeling more well-regulated.
As DBT encompasses a variety of different techniques and skills, it’s not uncommon for therapists to incorporate select DBT skills without specifically labeling the treatment DBT therapy. Radical Acceptance, I Feel Statements, Moment to Pause, and Ride the Wave are common tools used alongside a wide range of modalities for the treatment of many different mental health challenges.
What Do CBT and DBT Have In Common?
DBT was built upon the foundation of CBT, so the two treatment approaches do have similarities. They are both evidence-based talk therapies rooted in the belief that our thoughts, feelings, and behaviors are all connected. Both modalities emphasize developing self-awareness, building healthier behaviors, and nurturing intentional change to achieve the life you aspire to.
Both modalities are also very present-focused, requiring the patient to pay attention to their current reality rather than running away or dissociating from it. You can’t fix what you don’t acknowledge, and both CBT and DBT stem from that belief.
CBT vs. DBT: What’s the Difference?
Though CBT and DBT have similar origins, the two modalities are quite different. Primarily, CBT prioritizes changing unhealthy thought patterns, while DBT highlights the importance of sitting with distress and regulating emotions.
Other differences between CBT and DBT include:
Treatment Duration
Typically, CBT is considered to be a short-term treatment, spanning several weeks or months, whereas DBT is considered to be a long-term treatment, often spanning anywhere from six months to a year or longer.
Versatility
CBT is one of the most versatile treatment modalities and is used to treat a wide range of mental health issues. Because it’s a goal-oriented therapy, it can easily be adapted to a patient’s specific needs. While DBT can also treat a number of different conditions, it’s a more targeted therapy, as it was specifically adapted from CBT for the treatment of personality disorders such as BPD. Patients with relationally-driven challenges or who are struggling with intense emotional dysregulation may benefit more from DBT.
DBT is also used more often than CBT for severe cases involving self-harm or suicidal ideation.
Thoughts vs. Emotions
While CBT is centered around retraining your thoughts, DBT is centered around regulating your emotions. These different focuses each provide a unique approach to treatment.
Change vs. Acceptance
CBT prioritizes change: when a patient experiences an unhealthy thought pattern, the goal of CBT is to shift that thought pattern toward something more balanced and constructive. DBT, however, promotes the acceptance of hard or uncomfortable emotions, working on building distress tolerance while changing the behaviors that result from the feelings. While both treatments do ultimately work toward change, DBT involves a unique layer of acceptance that is not as much of a trademark of CBT.
Connect With the Expert Team at Aspire Psychology to Begin Receiving Evidence-Driven Care
Whether anxiety and depression have become an all-too-familiar part of your life or you’re struggling with emotions that feel out of control, you don’t have to stay in the same cycles. At Aspire Psychology, our compassionate team of therapists in Portland, Oregon is here to provide evidence-based care through modalities like CBT, DBT, and beyond.
Ready to take the first step? Get started with Aspire today.
