CBT vs. DBT Therapy: What’s the Difference?

CBT and DBT therapy are both very popular, but there are key differences that make each one more effective for different people and use cases.

Mental health is as important as physical health. So whether you’re navigating specific mental health issues or just looking to improve your mental wellness, you deserve a treatment plan that works for you—and that starts with the right type of therapy.

Choosing the correct kind of therapy isn’t always easy, so let’s start with the basics. Two of the most common types of psychotherapy are cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). DBT was originally formed as a subtype of CBT, so both types of therapy share similarities. In fact, some therapists utilize DBT as a type of CBT that incorporates mindfulness. Both types of therapy share the same basic theories around thoughts, feelings, and behaviors. Despite their similarities, though, CBT and DBT treatment have some fundamental differences. Here’s everything you need to know to choose the best type of therapy for you.

What is cognitive behavioral therapy (CBT)?

CBT is a type of talk therapy. As a combination of cognitive therapy (examining our thoughts) and behavioral therapy (examining our behaviors), CBT aims to identify how our thoughts, feelings, and behaviors interact.

With each of us experiencing over 6,000 thoughts each day, there’s plenty of room for us to interpret these thoughts negatively. Negative thoughts can become entrenched, taking a significant toll on our thoughts and behaviors. CBT reminds us that these thoughts aren’t facts. Instead, they can be changed, leading to more positive thoughts and behaviors.

So, how does CBT work? Like any other type of psychotherapy, CBT involves a collaborative approach with your therapist. By identifying and addressing specific mental health issues, you can learn coping skills to manage problems in your daily life. CBT can help you combat irrational thoughts, manage emotions, and combat problematic behaviors.

Studies consistently show that CBT is an effective treatment for a wide range of mental health conditions, including major depression, anxiety disorders, and bipolar disorder. CBT is also easily adaptable for virtual therapy, so clients can easily access quality support from the comfort of their own homes.

What is dialectical behavior therapy (DBT)?

Like CBT, DBT is a type of talk therapy. DBT was originally developed to treat suicidal people with borderline personality disorder (BPD) in the 1980s. Since then, DBT has been adapted to treat people with different mental health conditions, but many people treated with DBT have a primary diagnosis of BPD.

DBT helps people balance their emotions and improve behavior patterns. DBT starts by identifying problematic thought patterns and emotions. Then, with the help of your therapist, you’ll learn how to balance these thoughts with healthier perspectives so you can live a more balanced life. DBT also incorporates group therapy, where people can practice implementing skills.

Unlike CBT, DBT focuses on validation or accepting uncomfortable thoughts, feelings, and behaviors. Instead of changing your behaviors entirely, DBT can help you improve your quality of life and manage your emotions. During therapy sessions, psychotherapists help individuals improve their behavioral skills. Then, people practice these skills during group sessions.

What are the main differences between CBT and DBT?

Although CBT and DBT have some similarities, they’re not the same treatment approach. While some people start feeling better with DBT therapy, others notice a significant improvement with CBT. Here are the main differences between DBT and CBT to help you choose the best treatment option.

Therapy goals

CBT: In general, CBT focuses on goals more than DBT. During CBT sessions, you’ll identify negative thoughts and behavior patterns. Then, you’ll work with your therapist to develop helpful tools to cope with these problems. The main goal of CBT is to help you become your own therapist. You’ll learn how to recognize problematic thoughts, rationalize those thoughts, and re-evaluate them in a more logical way.

DBT: DBT can help you work toward specific goals, but it’s not as goal-oriented as CBT. The main goal of DBT is to help individuals accept themselves, practice emotional regulation, learn how to cope with pain, and avoid destructive behaviors. DBT focuses more on the emotional and social aspects of therapy, while CBT emphasizes behavioral change.

Treatment philosophies

CBT: Compared to DBT, CBT tends to be more logic-focused. During therapy, you’ll practice critical thinking to develop healthier ways of thinking and behaving. Instead of ignoring your worries and hoping they’ll go away, your therapist will encourage you to acknowledge whatever makes you feel stressed. Then, you’ll tap into your logic to rationalize the problem.

For example, if you’re feeling stressed because you have too much homework, identifying how you can complete assignments step-by-step can help you tackle the stress head-on. Then, you can use  a rational approach to find the right solution. Remind yourself of when things like this have happened before and how you coped. Look at the facts of the situation. Try breaking down what you need to do, or figuring out if you can ask someone for help. Instead of turning to black-and-white, worst-case scenario terms, try viewing the issue from an alternative perspective.

DBT: DBT focuses on how a person reacts to others and themselves. During therapy sessions, you’ll use mindfulness skills to find new ways to accept yourself, interact with others, and feel comfortable in your environment. DBT teaches mindfulness techniques to help individuals live with uncomfortable emotions or triggers and accept how things are instead of trying to change them.

Types of sessions

CBT: In many cases, CBT is a shorter form of treatment than DBT. With CBT, many clients will seek therapy for 5–20 sessions. After therapy ends, they’ll apply CBT techniques on their own without significant support from their therapist. If mental health issues persist after therapy ends, clients may progress to a different type of therapy, such as an intensive outpatient program (IOP), to address specific traumas or issues.

DBT: While CBT might last just a few weeks, DBT involves long-term treatment. DBT also involves group therapy. During DBT skills training, people are able to practice DBT skills with others. Most clients also meet weekly with an individual DBT therapist and receive DBT skills coaching as needed.

In DBT treatment, group sessions can be a key component of the therapeutic process. These sessions give people an opportunity to practice DBT skills–such as interpersonal communication and distress tolerance–in a supportive environment. Sometimes, once patients can effectively use DBT skills to regulate their emotions, practice mindfulness, and improve interpersonal relationships, they can transition to standard CBT for further treatment.

What are the similarities between DBT and CBT?

Since DBT is an extension of CBT, these two treatment modalities do overlap. In both CBT and DBT, you will work with a therapist to learn more about your challenges and specific ways to manage them. These two types of therapies often involve answering specific questions from your therapist that help you learn how your feelings and thoughts influence your actions and behaviors. While there are differences between these therapies, they are both often used to treat behavioral disorders.

Is CBT or DBT right for you?

Ultimately, the best way to figure out which type of therapy is right for you is to talk to a mental health professional—a therapist, psychologist, counselor, or social worker. A mental health professional will consider your specific mental health issues, treatment history, and goals so you can carve the best path forward.

If you’ve been diagnosed with a mental health condition, your therapist will also consider your diagnosis to choose the best treatment approach. Because each mental health disorder responds differently to different types of psychotherapy, your therapist will choose the method most effective for treating your diagnosis and symptoms.

For example, many people with mood disorders and anxiety disorders notice a significant improvement with CBT, while people with BPD and suicidal thoughts find DBT helpful. With that said, many people have co-occurring mental health conditions, and some therapists may combine techniques from DBT and CBT to create a comprehensive treatment plan.

And remember: there are many other forms of therapy. If CBT and DBT don’t match your preferences, try researching other treatment options. Some other common forms of psychotherapy include:

• Acceptance and commitment therapy (ACT)
• Interpersonal therapy (IPT)
• Eye movement desensitization and reprocessing (EMDR) therapy
• Mindfulness-based cognitive therapy (MBCT)
• Psychodynamic psychotherapy

CBT vs DBT for specific conditions

CBT takes the approach of changing thought patterns, while DBT aims to balance out strong emotions and feelings. Because of these contrasting methodologies, CBT and DBT are used to treat different conditions. 

Therapists are more likely to use CBT to treat depression, generalized anxiety, obsessive-compulsive disorders, PTSD, and various phobias. The goal is to replace the patient’s negative thoughts with less harmful ones.

DBT, on the other hand, is more often used to treat borderline personality disorders, eating disorders, self-harm or suicidal behavior, and substance abuse. In these situations, the goal is to learn how to cope with the intense emotions behind these patterns to provide the patient with relief.

How can you find the right therapist?

Whether you’re starting therapy for the first time or searching for a new provider, finding the right therapist can feel overwhelming. Sometimes, previous clients are hesitant to return to therapy because they didn’t notice significant improvement. Because the therapeutic relationship is so important to your mental health journey, it’s worth taking the time to research your options to find the best match for your specific needs.

CBT and DBT at Charlie Health

If you want therapeutic support but don’t know what kind of therapy is best for you, Charlie Health may be able to help. Our virtual Intensive Outpatient Program (IOP) provides personalized mental health support for adolescents, teens, young adults, and their families. Our treatment program offers comprehensive access to evidence-based therapy modules, including CBT and DBT skills, so that you can access holistic mental health care from the comfort of your home. After an initial clinical consultation, we’ll build you a customized treatment plan that provides comprehensive support—including CBT and DBT as necessary.

Your therapist and a comprehensive care team will provide support from admission to aftercare, so that you can enjoy individualized treatment throughout every step of the therapeutic process. Our compassionate mental health professionals are here to support you throughout your mental health journey with sustainable healing and evidence-based treatment approaches—including CBT and DBT. Fill out this short form to get started today.