What is the Difference Between DBT vs. CBT?

Published on: 29 Sep 2021
Clinically Reviewed by Karmen Smith
woman sitting on couch with notebook

Both cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are popular forms of psychotherapy. They have similar goals: to modify behavior. 

  • CBT is a widely used and accepted form of talk therapy. It focuses on changing the thought patterns that negatively affect your emotions, which, in turn, affect how you behave.
  • DBT uses cognitive-behavioral principles at its core, too. But it challenges you by asking you to try and cope with stress, negative thoughts, and emotions by living in the moment. When you practice DBT techniques, you’ll develop constructive thought patterns that result in positive behaviors. When DBT works, you’ll learn how to balance your emotions, so your behavior patterns can be improved. 

The overall goal of both CBT and DBT is to help find a better quality of life while maintaining healthy, functioning relationships. The main difference between CBT and DBT is that cognitive behaviors are rooted in how you feel and think in certain situations, while dialectical behaviors are based on your feelings and actions.

It’s worth mentioning again that while DBT helps you create a constructive action plan, it’s still built upon CBT’s foundational principles⁠— modifying negative thought patterns. Because after all, we do as we think.

In some senses, DBT does go a step further than CBT. It asks you to problem solve, then accept and come to terms with uncomfortable feelings and thoughts. Thus, the emphasis moves away from what you think or feel about a situation or relationship, and instead asks you to challenge and change any unhealthy or self-destructive behaviors that stem from those thoughts.

We’ll review the differences in more detail below and then dive into each type of therapy so you can better understand the two.

What Are the Core Differences Between DBT vs. CBT?

Both CBT and DBT are considered forms of talk therapy. However, the differences between DBT and CBT are key to consider.

CBT practices will teach you how your thoughts, feelings, and behaviors influence each other. The hyper-focused and goal-oriented practices of CBT or cognitive behavior therapy are meant to offer a short-term, structured therapy. It’s through practice that you’ll begin to see long-term results. In essence, CBT depends on a positive change in either a thought or behavior during a single experience. Your CBT therapy will continually add to an overall improvement of emotions, thinking, and actions in your life.

DBT, on the other hand, puts more emphasis on your social and emotional responses to external stimuli. Situations and relationships that were previously difficult for you can become easier. You’ll begin to accept what’s happening at the moment⁠— without having an internal analysis or discussion. DBT is often the therapy of choice if you have overwhelming feelings of rejection or other emotional pain. The goal of dialectical behavioral therapy is to reduce the intensity of emotions and limit impulsive responses.

Similarities in CBT and DBT

Nonetheless, in these types of individual therapy, you’re guided and supported through intensive conversations with a mental health professional. A therapy session can take place in either a group or individual setting. Both therapy models are similar in that you’re taught how your thoughts, feelings, and behaviors intertwine. Finally, both therapies have similar goals:

  • To increase self-awareness in real-life scenarios
  • To reevaluate self-destructive thoughts and behaviors
  • To form healthier response patterns and behaviors

What is CBT?

Cognitive behavioral therapy is a psychotherapy technique that reframes or restructures negative thought patterns. A CBT therapist’s goal when using CBT as a technique is to help you identify specific problems in your daily life and relationships. Sometimes, these will be secondary symptoms of a mental health condition like:

CBT teaches you to take the thoughts and behaviors you’ve identified and apply new thinking patterns. This is done within the context of examining your everyday experiences. In the beginning, you’ll be tasked with becoming aware of negative thoughts, when they happen, in real-life situations, and in real-time. 

Next, specific CBT techniques are used to intercept those negative thoughts. You’ll begin to learn how to reshape your thinking so you can arrive at a more positive (and healthier) interpretation of an event and the thoughts surrounding it. Eventually, this will effectively lead to new, healthier thought patterns and behaviors in general.

One study shows just how effective CBT in online-based therapy sessions can be. When treating seasonal affective disorder (SAD), an acute, but recurring type of depression, CBT was found to be highly effective with 50 – 75% of people responding positively.

Another study shows randomized clinical trials demonstrating that CBT is effective in treating depression in multiple types of delivery systems, including group therapy, telephone consultation, or through guided, online treatment formats.

What is DBT?

DBT therapy offers a slightly different approach. The goal is to teach you first to become mindful of your harmful thoughts and emotions. Then you’ll learn to apply two opposing approaches⁠— acceptance and change. The full acceptance of any experience that’s happening in a given moment offers you the chance to respond in a more constructive manner (which ultimately represents a change of behavior).

DBT is effective for individuals dealing with borderline personality disorder (BPD), which causes acute emotional distress followed by irrational behaviors. The techniques are also used to treat:

  • Generalized anxiety disorder (GAD)
  • Bipolar disorder (BD)
  • Attention-deficit hyperactivity disorder (ADHD)
  • Eating disorders such as anorexia nervosa, binge-eating disorder, and bulimia nervosa

When considering DBT therapy vs CBT, remember that dialectical behavioral therapy principles are built on the foundational theories of cognitive behavior. Almost all human actions begin as a thought, which is a cognitive function of the brain. If you’re struggling with mental health challenges, thoughts can be distorted and emotions can become unregulated. Both of these can lead to destructive behavior patterns, and DBT might be a successful therapy technique for you. 

“Both CBT AND DBT can help us challenge our perceptions and patterns so that we are not stuck in repetitive dysfunctional behaviors.”

Talkspace therapist Dr. Karmen Smith LCSW DD

How to Know Which Type of Therapy is Right for You

The decision on which type of therapy, DBT vs CBT, is best for modifying your specific negative behavioral patterns should be made with your mental health care provider. Both methods have their strengths and weaknesses, and each has been proven effective for different conditions. 

Understanding the difference between CBT and DBT is helpful when deciding which to use. Note that some of the conditions listed here can be treated by either form of therapy, and it ultimately just depends on which you respond to better. 

Research shows that CBT can be hugely beneficial for: 

DBT is often widely suggested for a more severe mental health condition, like: 

  • Recurring suicidal ideation
  • Eating disorder
  • Post-traumatic stress disorder (PTSD). CBT for PTSD can also be helpful.
  • Borderline personality disorder
  • Self-harming behaviors

Still, we’re all unique, and the type of therapy program that works best for each of us will vary. Certain dispositions might come into play when determining whether DBT vs CBT will be the better choice for therapy. Many therapists will begin with CBT therapy and then move on to DBT therapy if and when necessary. The success of DBT vs CBT depends upon open communication between you and your therapist. And remember, if you feel like part of your treatment plan isn’t working, you can always consider other treatment options.

“Your therapist can provide a review of each of the therapies that use; feel free to ask questions for clarification.”             

Talkspace therapist Dr. Karmen Smith LCSW DD

Sources:

1. Psychotherapy | NAMI: National Alliance on Mental Illness. Nami.org. https://www.nami.org/About-Mental-Illness/Treatments/Psychotherapy. Accessed August 30, 2021.

2. Hedman E., Botella C., Berger T. (2016) Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder. In: Lindefors N., Andersson G. (eds) Guided Internet-Based Treatments in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-06083-5_4. Accessed August 30, 2021.

3. Therapy C. Cognitive behavioral therapy. Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK279297/#i2136.gi-sources. Published 2016. Accessed August 30, 2021.

4. Cuijpers P, Noma H, Kayrotaki E. Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults With Depression A Network Meta-analysis. JAMA Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2730724. Published 2019. Accessed August 29, 2021.

Talkspace articles are written by experienced mental health-wellness contributors; they are grounded in scientific research and evidence-based practices. Articles are extensively reviewed by our team of clinical experts (therapists and psychiatrists of various specialties) to ensure content is accurate and on par with current industry standards.

Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.

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