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What’s the difference between CBT and DBT?

By Olivia Guy-Evans, published March 09, 2022

by Saul Mcleod, PhD


What is cognitive behavioural therapy?

Cognitive behavioural therapy (CBT) is a widely used type of psychotherapy which helps people to identify their unhelpful thinking patterns and behaviours, then work together with the therapist to restructure these into healthier thoughts and behaviours. 

Chart explaining how thoughts, emotions, and behavior interrelate in CBT (Cognitive Behavioral Therapy)

CBT emerged in the 1960s in the work of psychiatrist Aaron Beck who noted that certain types of thinking contributed to emotional problems – which were labelled automatic negative thoughts.

People commonly seek CBT for help in treating anxiety disorders and depression, but it can be helpful for a number of other mental health disorders or any mental distress.

CBT focuses on changing the automatic negative thoughts that contribute to, and worsen emotional difficulties, depression, and anxiety. 

What is the idea behind CBT?

CBT is based on the idea that how we think (cognition), how we feel (emotion), and how we act (behaviour) all interact together. Therefore, negative, and unrealistic thoughts can result in feelings of distress and in turn have a negative impact on actions.

CBT aims to help people become aware of when they make negative interpretations and behavioural patterns and helps to develop alternative ways of thinking and behaving which aims to reduce psychological distress. 

What are some techniques used in CBT?

Identifying negative thoughts – this involves learning about how an individual’s thoughts, feelings, and situations can contribute to maladaptive behaviours. 

Practising new skills – this can involve practising coping skills and rehearsing them with the therapist to use in real-life situations. 

Goal setting – this is an important step in recovery. The therapist teaches the individual how to identify their goals, distinguish between short- and long-term goals, and focus on the process as much as the end outcomes. 

Problem-solving – CBT can help people to identify and solve problems that arise from life stressors and reduce the negative impact of psychological and physical illness. 

Self-monitoring – this can be done through diary work – tracking behaviours, symptoms, or experiences over time and sharing them with the therapist.

This can help provide the therapist with the information needed to provide the best treatment. 

What is dialectical behavioural therapy?

Dialectical behavioural therapy (DBT) is a type of CBT which was originally intended to treat borderline personality disorder but has since been adapted to treat other conditions. 

This type of therapy is used to help people who have difficulty with regulating their emotions or are exhibiting self-destructive behaviours such as eating disorders, substance-use disorders, or those who exhibit self-harming behaviour.

DBT helps to address thoughts and behaviours while incorporating strategies such as emotional regulation and mindfulness. 

The goal of DBT is to teach people how to develop healthy ways to cope with stress, regulate their emotions, and improve relationships with others. This therapy can help people who may lack useful coping skills and find that they move from one crisis to another. 

Why was DBT developed?

DBT was developed by Marsha Linehan in the 1980s to help people with suicidal thoughts, who often had a diagnosis of borderline personality disorder (BPD). Individuals with BPD often suffer with the following symptoms:

  • Experience intense emotions

  • Have difficulties with their relationships

  • Their actions are very impulsive

  • Their thinking is very black and white

Therefore, DBT was developed to help people with DBT manage these core symptoms by providing them with skills to reach their goals.

This way, people with BPD would know how to respond to challenging situations or manage relationships, to improve their quality of life overall. 

What are some techniques used in DBT?

There are four modules which are covered in DBT:

Mindfulness – DBT teaches people to be focused on the present moment and feel grounded. This is especially useful for those struggling with an unstable sense of self and difficulties staying focused on the present.

After focusing on the present moment, the idea is that the automatic negative thoughts are not engaged with. 

Emotion regulation – DBT helps people learn how to manage their emotions so that intense emotions do not end up controlling the situation.

They learn that they can choose how to react to negative/strong emotions. They can also learn to avoid situations that they know will trigger strong emotions.

Distress tolerance – DBT teaches people how to manage upsetting situations such as helping them to think about some of the healthy things they can do to manage their behaviour and emotions so that they do not act impulsively or risky. 

Interpersonal effectiveness – DBT aims to teach people to communicate in healthy and respectable ways. It can teach assertiveness and how to put in healthy boundaries with others. It can build listening skills, conflict resolution skills, and helps to build trust with others. 

What are the differences between CBT and DBT?

DBT is a type of CBT, and they therefore have similar concepts such as both aiming to alter negative and unhelpful thought patterns and teaching useful coping skills.

However, they both have distinct differences which will be described below.

Difference in emphasis

Both CBT and DBT ultimately aim to help the client change their thought patterns, however CBT focuses more heavily on thought patterns and their redirection compared to DBT.

CBT helps people to identify when they are using cognitive distortions such as catastrophizing, mental filtering, and overgeneralization and to learn to drop these types of thinking. 

DBT places more emphasis on balance and the relationship between acceptance and change. In DBT there is not a heavy reliance on changing thoughts.

Rather, the client is more mindful and accepting as they validate themselves in reality, but it is not the active challenging process that happens in CBT. 

Difference in time

CBT is usually completed after a short amount of time. The sessions will focus on specific problems with set goals in mind so there is something to work towards.

CBT will usually finish once clients reach their goals which is typically within 6 to 20 weeks. DBT on the other hand usually involves sessions over a longer period of time where the therapist can consider the whole picture and help the client work through several issues.

DBT will often take at least 6 months to complete all the modules and can even last years in some instances. 

Difference in practice

CBT nearly always takes place in a one-on-one setting with the therapist. The client and therapist work together for the duration of the session and then the client will often have homework to take home.

In addition to individual weekly sessions, most DBT treatment also features a weekly group therapy component.

In these group sessions, people learn skills from one of the four modules and practice these skills as group settings offer a safe and supportive environment to complete this. 

Difference in the kind of change created

CBT primarily helps clients to recognise and change their problematic patterns of thinking and behaviour so that they have a healthier and more realistic outlook on life.

DBT primarily helps clients to regulate their intense emotions and improve interpersonal relationships through validation, acceptance, and behavioural changes. 

Difference in suitability

There is a difference in how suitable each therapy is for improving the symptoms of mental health conditions. For depression, anxiety, obsessive compulsive disorder (OCD), phobias, and posttraumatic stress disorder (PTSD), research has shown that CBT tends to be the more effective treatment. 

In comparison, DBT tends to be better suited to those with BPD, self-harming behaviours, and chronic suicidal ideation. 

What can CBT and DBT help with?

CBT is used to treat a range of conditions including:

  • Anxiety

  • Depression

  • Bipolar disorder

  • Addiction 

  • Anger

  • Eating disorders

  • Panic attacks

  • Phobias

  • Personality disorders

Aside from mental health conditions, CBT has also been used to help people cope with:

  • Chronic pain

  • Divorce or break ups

  • Grief

  • Insomnia

  • Low self-esteem

  • Relationship problems

  • Stress management 

Although DBT was developed with borderline personality disorder in mind, the techniques used in DBT can be effective for many of the following mental health conditions:

Aside from mental health conditions, DBT has also been used to help people cope with:

  • Intense emotions

  • Managing challenging situations

  • Relationship difficulties 

  • Self-injurious behaviour and suicidal ideation

  • Extreme stress

CBT and DBT have shown to be very helpful for a variety of different issues. Some of the notable benefits include:

  • Improving communication skills

  • Healthier thinking patterns and a greater awareness of negative thoughts

  • Improved ability to make healthier choices

  • Greater insights into one’s own life

  • Improved coping strategies to manage distress

  • Being able to view situations from another perspective

  • Helping people to move towards a solution 

  • Learning more about one’s own goals and values

  • Developing skills for facing challenges in the present and in the future

Effectiveness of CBT 

CBT is one of the most researched types of therapy, in part because treatment is focused on highly specific goals and results can be measured relatively easily. 

  • Meta analyses have found that CBT is strongly effective, especially in improving the symptoms in people with anxiety-related disorders, including OCD, PTSD, as well as in anger problems, drug abuse, and general stress (Hofman et al., 2012). 

  • Another meta-analysis found that CBT is a moderately effective treatment for anxiety disorders when compared to a placebo (Carpenter et al., 2018). 

  • As well as face-to-face sessions, CBT has found to be effective as online sessions (Kumar et al., 2017).

  • CBT has also been used with children and adolescents, with findings suggesting that this therapy can be effective in treating symptoms of depression and anxiety in these age groups (Oud et al., 2019). 

  • An analysis of CBT for insomnia supports the effectiveness of this treatment and for the prevention of relapse of primary insomnia (Okajima et al., 2011). 

Effectiveness of DBT

  • Linehan et al. (1991) conducted the first randomised controlled trial of the effectiveness of DBT on women with BPD. It was found that after completion of DBT, participants showed significant improvements for chronically suicidal and self-injurious behaviours. 

  • A more recent meta-analysis of the effectiveness of DBT on those with diagnosed BPD found that most studies reported significant reductions in suicidal ideation, self-injurious behaviour, depression, and anxiety (Bloom et al., 2012).

  • Since its introduction, DBT continues to be an effective psychotherapy for BPD, with one study finding that after a year of therapy, around 77% of patients no longer met the criteria for the diagnosis of BPD (Stiglmayr et al., 2014). 

  • DBT is often recommended as a first-line treatment of BPD and has been shown to reduce the need for medical care and medication by as much as 90% (May et al., 2016). 

  • As well as being effective for BPD, there is also evidence that the skills learnt in DBT reduced depressive symptoms, improved affective control, and improved the mindfulness self-efficacy of those with bipolar disorder (Van Dijk et al., 2013). 

  • DBT has also shown to help treat some of the symptoms associated with posttraumatic stress disorder (PTSD). It was found in a study that after completion of the therapy, individuals with PTSD were less likely to attempt suicide, self-harm, and had reduced feelings of shame, anxiety, and trauma-related guilt (Harned et al., 2014). 

How to seek therapy

If you want to start CBT or DBT, you can start by consulting with your doctor or a mental health professional. They may be able to make a decision as to whether they recommend either CBT or DBT depending on your symptoms.

Alternatively, you can look for a qualified individual to provide the therapy.

Look for someone who is qualified in CBT or DBT and make sure to ask questions about what conditions they specialise in, whether they have experience helping people with symptoms like yours, and that they can expect from you during therapy. 

When is a good time to seek therapy?

As therapy can be effective for a range of issues, you do not necessarily have to have a diagnosed mental health disorder to seek CBT or DBT, nor do you have to wait until life becomes so overwhelming to seek help.

If you feel as if you have one or several problems which have been interfering with your daily functioning and making your quality of life poorer, you can seek help. 

What are some things to consider?

There is often a lot of work that is required to get all the benefits from CBT and DBT. CBT involves completing homework assignments that the therapist sets so you need to be prepared to be engaged in this.

DBT often has group therapy sessions which many people may not be comfortable with, although it is often essential for practising the skills learned in the modules. 

Ensure you choose the right therapist for you. Consider whether you feel comfortable divulging personal information to the therapist.

Don’t be afraid to seek a different therapist if the one you have does not quite suit your needs. When choosing a therapist, consider thinking about what your deal breakers are, qualities that are important and any other characteristics you value. 

Be prepared to talk about issues that can be difficult to discuss. You may also be encouraged to challenge your automatic negative thoughts and consider things from another perspective which can be hard to do but is important in the therapeutic process.

When you are ready to seek therapy, think about the following:

  • What type of therapy you want – whether it be CBT or DBT. Likewise, whether you want individual therapy or group therapy. 

  • What are your main goals for therapy and what would you like to come away from therapy achieving? 

  • Whether you can commit the time to therapy sessions each week – what days and times are most convenient to you? 

Do you need mental health help?

USA

Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/

1-800-273-8255

UK

Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email [email protected].

Availiale 24 hours day, 365 days a year (this number is FREE to call):

116-123

Rethink Mental Illness: rethink.org

0300 5000 927

Fact Checking
Simply Psychology content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication.

About the Author

Olivia Guy-Evans obtained her undergraduate degree in Educational Psychology at Edge Hill University in 2015. She then received her master’s degree in Psychology of Education from the University of Bristol in 2019. Olivia has been working as a support worker for adults with learning disabilities in Bristol for the last four years.

How to reference this article:

Guy-Evans, O. (2022, March 09). What’s the difference between CBT and DBT? Simply Psychology. www.simplypsychology.org/whats-the-difference-between-cbt-and-dbt.html

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