Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are two types of psychotherapy that help clients learn how their thoughts are influencing their emotions and behaviors. They provide valuable skills to make changes that produce a better, more satisfying life.

Today, CBT is one of the most popular types of talk therapy. It’s an evidence-based treatment that helps people overcome emotional issues by helping them discover and change faulty or distorted thoughts or beliefs.

Primarily, CBT works with the way you perceive your reality because your perception frequently determines the way you think and act.

DBT is an evidence-based approach that’s similar to CBT. Rather than simply pointing out thoughts or emotions that are faulty or unproductive, DBT encourages clients to experience these emotions and work through them. It teaches clients skills that they can implement at the time they’re experiencing negative emotions.

Psychologist Marsha Linehan founded DBT to boost the effectiveness of CBT. Furthermore, it placed a greater focus on the emotions and social aspects, and it helped people better regulate their emotions. It’s geared toward individuals that are experiencing more severe, unstable, or harmful behaviors.

Let’s take a further look at each of these individual treatment modalities.

Cognitive Behavioral Therapy

Otherwise known as “talk therapy” or psychotherapy, CBT enables therapists to help clients become more aware of the thoughts and feelings that are occurring in the subconscious. Therefore, they can learn to identify negative or faulty behaviors and start using this knowledge to change for the better.

CBT is based on this assumption: Thoughts influence beliefs and beliefs influence behavior. The process of monitoring, identifying, and changing irrational or unhelpful thoughts can be treated over time. In other words, patients can see the types of thoughts and belief patterns that are causing them to feel or act in a certain way.

With CBT, a talented therapist can effectively help someone experience fewer negative emotions within a handful of sessions. Treatment is short-term, structured, solution-oriented, and focused on the present.

CBT is used to treat various mental health disorders, including:

  •  PTSD
  •  Depression
  •  Anxiety
  •  Obsessive-compulsive disorders
  •  Eating disorders
  •  Insomnia
  •  Sexual disorders
  •  Codependency
  •  Bipolar disorder
  •  Phobias
  •  Substance abuse

CBT works well for all ages, and it can work face-to-face, online, or via video.

Dialectical Behavioral Therapy

DBT focuses on the psychosocial aspects of therapy, which essentially involves the way someone interacts with others in their relationships and various environments. More specifically, it focuses on the psychosocial aspects of family relationships, since those closest to a person usually cause them the most emotional pain.

Primarily intended for those diagnosed with borderline personality disorder (BPD), DBT is also helpful for those with substance abuse disorders (SUDs), eating disorders, and depression.

DBT includes:

  •  Using the biosocial theory
  •  Focusing on emotions
  •  Using dialectical philosophy
  •  Utilizing mindfulness

Here’s one underlying assumption of DBT: People are suffering because they’re unable to regulate their emotions. Clients may not have caused their issues, but to better regulate emotions and enjoy a better life, they must take responsibility for their own treatment. Rather than focusing on who’s to blame, a DBT therapist will help them acquire the skills to lead the kind of lives they truly want. This type of compassionate treatment is proving to be quite effective.

Since Linehan wasn’t satisfied with the way CBT treated individuals with suicidal tendencies, she came up with more treatment interventions that prompted clients to accept themselves, their emotions, their thoughts, and others.

Here are the four main components of DBT:

  1. DBT uses mindfulness techniques to help clients learn how to get out of their heads and into the present moment. Frequently, clients are stuck in the past, which causes their irrational thoughts. So practicing mindfulness allows them to observe their thoughts and emotions, describe them, and participate in them at the moment. This tactic tends to help them regulate their emotional states better.
  2. Interpersonal effectiveness is utilized because individuals struggling with BPD are known for having poor boundaries. DBT helps them learn how to tune into their wants and needs, assertively ask for them, and set appropriate boundaries.
  3. When you accept that pain may come your way, it’s therapeutic. DBT helps clients learn how to skillfully bear pain through various techniques, such as distracting yourself, soothing yourself, and improving the moment.
  4. Emotional regulation can help treat individuals who struggle with feelings of anger, depression, and anxiousness. DBT teaches them how to better regulate their emotions by identifying obstacles that have kept them stuck and increasing the positive events in their lives.

History of CBT and DBT

Cognitive-behavioral therapy is a gold standard talk therapy in the world of psychology today. It has roots in stoicism, which is an ancient Greek philosophy that deals with perceptions, action, and will. Stoics also believed that you could use logic to identify false beliefs that could lead to problem emotions. A large part of CBT is using reason to identify thinking patterns and distortions that can contribute to issues like anxiety, depression, and drug cravings.

It was first developed as a behavioral therapy in the 1920s and had roots in the work of John B. Watson and Rosalie Rayner. In the 1960s, Albert Bandura contributed to the use of behavioral therapy in treating substance use disorders.

Dialectical behavioral therapy was first conceived by a psychologist named Marsha Linahan in the 1980s. DBT was originally used to treat a mental health disorder called borderline personality disorder, which is often difficult to treat. Linahan struggled to find a viable treatment for her own mental illness. To create DBT, she combined cognitive behavioral therapy with the principles of mindfulness and acceptance. Mindfulness is a concept that was introduced through Buddhism and meditation. 

Mindfulness is the idea of being present in the moment without evaluating yourself or things around you. In the world of psychology, mindfulness has significance in helping people calm anxious thoughts and emotions. Where CBT emphasizes the development of coping skills and building up self-efficacy, DBT emphasizes acceptance. Since being developed for borderline personality disorder, DBT has been adapted to be used in treating other issues like suicidal ideation, mood disorders, and self-harm.

The Difference Between CBT and DBT

CBT and DBT are certainly similar in various ways, as DBT grew out of CBT. Both types of therapy allow a therapist to explore a client’s past and see the kind of lens they’re perceiving in their present moment. However, a deep exploration of the client’s history won’t be the major focus, as it is in Freudian psychoanalysis. Instead, there will be an emphasis on modifying faulty or irrational cognitive thoughts and replacing them with more positive, productive ones.

Both CBT and DBT are forms of talk therapy that involve meeting with therapists. They both deal with thoughts and behaviors that can lead to poor coping responses, negative emotions, and relapse. 

The two behavioral therapies diverge in their response to identified problems. In CBT, you develop tools to fight against things like cravings and stressors. In DBT, you learn to accept problems and remain in the moment to avoid letting problems make you feel anxious or depressed. Both strategies are useful to have in certain situations. 

Man pinching his nose under his glasses sitting on a couch in a therapist's office

Another difference is that DBT doesn’t encourage clients to deny their emotions. A CBT therapist may tell a client, “You are not your emotions, so you don’t have to feel those negative ones anymore.”

But a DBT therapist may say, “It’s alright to feel this negative emotion right now. Go ahead and feel the depression. Accept that it’s real for you right now. Acknowledge it. Be mindful of it. However, don’t stay there. Once you’re felt and acknowledged it, become mindful that you’re safe because you’re not that feeling. Then let it go.”

Both CBT and DBT use an approach that’s rooted in cognitive behavior, and they both look at the target behaviors that clients want to reach.

Both collaborate with the client to create goals together, so everyone involved is moving toward growth.

Both CBT and DBT are helpful tools that will help you address, overcome, or regulate emotional challenges.

Specifically, these forms of therapy can help you accomplish the following goals:

  •  Identify and practice effective coping skills
  •  Manage the symptoms of mental illness
  •  Prevent relapses
  •  Learn ways to regulate or manage emotions
  •  Have healthier relationships with others
  •  Cope with grief
  •  Overcome past trauma or abuse
  •  Cope with physical illness
  •  Learn problem-solving skills
  •  Set better boundaries
  •  Retrain your brain to think positive thoughts
  •  Increase self-confidence
  •  Overcome your fears
  •  Learn relaxation skills

If you need behavior therapy, both CBT and DBT can be helpful, as they’re both evidence-based ways to help individuals with a range of mental health issues.

CBT vs. DBT for Your Needs

When you enter a treatment program for substance use disorders or mental health issues, there will be several therapy options that are available. Through treatment, you will always have a treatment plan that guides your objectives and goals. Early in treatment, you’ll sit down with a therapist to make a treatment plan based on your needs. You may go through a biopsychosocial assessment to help determine the needs you have that should be addressed in treatment. 

If you’re going through addiction treatment, you will likely start talk therapy by going through CBT or therapy sessions that use CBT. Cognitive-behavioral therapy is a first-line therapy for substance use disorders. The relapse prevention model of CBT can help you identify triggers and thinking patterns that threaten your sobriety. It also helps to increase your self-efficacy, which is important in resisting cravings. However, DBT may be helpful in other ways. People that struggle with anxiety often catastrophize, which is when you form assumptions that small problems will lead to bigger problems. DBT’s principles that are inspired by mindfulness can help you slow down a racing mind and focus on the here and now.

In many cases, both CBT and DBT can be helpful for addressing different aspects of addiction and other mental health problems. 

Both CBT and DBT are forms of talk therapy that involve meeting with therapists. They both deal with thoughts and behaviors that can lead to poor coping responses, negative emotions, and relapse. 

The two behavioral therapies diverge in their response to identified problems. In CBT you develop tools to fight against things like cravings and stressors. In DBT, you learn to accept problems and remain in the moment to avoid letting problems make you anxious or depressed. Both strategies are useful to have in certain situations.

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