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DBT vs. CBT: Comparing and Contrasting Two Popular Mental Health Therapies

Talk therapy is an umbrella term for various therapy types like CBT and DBT. Both methodologies are well-known tools that  support recovery from addiction or trauma. In talk therapy, an individual talks back and forth with a therapist, who listens carefully and asks guiding questions so that, together, they can address difficulties the individual may be facing. Not all talk therapy, however, delivers the same results. Many different modes of therapy exist, and depending on the individual, one method may be better suited than others in addressing their concerns.

As a result, many therapists specialize in one or several specific therapy techniques, adapting their treatment to best fit the individual. Of the many types of mental health therapies, two of the most popular are Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT).

While DBT and CBT have much in common, it’s helpful to learn about the basics of both these modes of therapy to figure out which one might prove most effective for you, a loved one, or a client.

What is CBT?

The main goal of cognitive behavioral therapy is to help change how an individual thinks and acts. A therapist using CBT techniques generally helps an individual think differently about their life concerns — with the goal that this new way of thinking will trigger new, more positive feelings and thus lead to more desirable behaviors.

CBT focuses on the connection between thoughts, feelings, and behaviors. An individual who thinks they will fail at finding a new job, for example, is likely to feel sad and unmotivated and thus may not to put much effort into finding a new job. In contrast, an individual who thinks they simply need to apply for jobs consistently to land a new one is more likely to feel hopeful and motivated and thus more likely to send in applications and network for a new position.

CBT aims to change people’s thought patterns to encourage positive action. This is because people can often hold on to negative or false beliefs that don’t have a firm basis in reality. Someone who has lost a parent might think they will never be loved again. Another person who has not gotten admitted to their top choice college might think their entire future is ruined. Yet there is no solid reason for these people to believe they will never again receive love or achieve success.

How CBT Works

A therapist using CBT works with an individual to figure out their thought patterns and how those patterns might be pushing them towards behaviors and habits that are self-destructive or unhelpful. To a person who keeps thinking, “I will never find a new job,” a therapist might suggest adopting a new, more realistic thought pattern, such as “I have landed jobs before, therefore, I know I can land one again.” By pointing out the faulty reasoning behind negative thinking, CBT can help people change their thinking habits, the emotions they experience, and the behaviors they adopt.

CBT is very goal-oriented. As such, it can be used short-term to manage very specific issues. For example, an individual could use CBT to improve their sleep — and see significant results in just weeks. Other more complicated goals can take much longer to attain. Therapists using CBT will likely take an active role in advising and guiding the individual toward their desired goals.

In addition, CBT requires that individuals participate actively in the therapy — even outside of therapy sessions. Individuals set goals and are often given “homework” to practice techniques introduced during the sessions. For example, a person in recovery might be given the assignment to distract themselves when the urge to drink comes up at a party during the weekend. Then at the next appointment, the therapist and individual can discuss how well those distraction techniques worked.

Shortcomings of CBT

CBT does have its detractors. Because CBT is very structured, some therapists find the mode too narrow. Individuals who are more interested in delving into unconscious impulses or intense psychoanalysis may find CBT too rigid.

However, CBT has been proven through peer-reviewed studies to effectively treat several mental illnesses, such as depression, anxiety disorders, obsessive-compulsive disorders, post-traumatic stress disorders, phobias, and more. The effectiveness of the treatment depends on a strong, positive relationship between the individual and the therapist. In addition, the individual must be willing to change their thought patterns and behaviors for CBT to succeed.

What is DBT?

There are some significant differences between CBT and DBT, however. While CBT stresses changing negative thoughts, feelings, and actions, DBT stresses a balance between acceptance and change. This means individuals receiving DBT are encouraged to accept thoughts, feelings, and actions, even when they are uncomfortable or feel difficult to bear.

The main goal of DBT is to help individuals better manage their emotions and thereby improve their behaviors. An individual who has many negative thoughts, for example, would be encouraged by the therapist to consider more positive ideas. The individual then can have a more balanced perspective and, as a result, improve their behavioral skills.

The emphasis on both acceptance (also called validation) and change is why this mode is called “dialectical” Two ideas that seem opposed to each other are forced to coexist. An individual going through DBT is asked both to accept that their thoughts, emotions, and behaviors are currently troubling them and may continue to be part of their experience — and to work to gradually change those thoughts, emotions, and behaviors over time.

Core DBT strategies include:

  • Distress tolerance — DBT teaches individuals to better cope with their situation or sit with uncomfortable thoughts or emotions. For example, an individual who engages in self-harm when they feel upset might learn how to ride out their feelings until it lessens in intensity and disappears.
  • Emotional regulation — DBT shows individuals how to manage intense emotions in healthy ways. Individuals who drink or use to manage their emotions, for example, would be supported as they find new, less destructive ways for self-soothing.
  • Interpersonal effectiveness — With its focus on improving relationships, DBT helps individuals create and maintain relationships by setting healthy boundaries and communicating more honestly. For example, an individual who tends to react with great anger when a friend disappoints her might learn how to speak calmly and express her feelings. Individuals undergoing DBT are likely to practice their interpersonal skills during group sessions.
  • Mindfulness — DBT emphasizes being present in the moment. This helps individuals pay better attention to what they are thinking or feeling. The technique can have a soothing, calming effect, making individuals less emotionally and behaviorally reactive to distressing situations.

The History of DBT

First developed in the 1980s, DBT was initially developed for individuals with borderline personality disorder. A key symptom of borderline personality disorder is unstable relationships due to excessive fear of abandonment, impulsivity, and mood changes. Individuals with borderline personality disorder can overreact in many situations, which often drives other people away. DBT helps these people manage their emotions and actions more effectively by learning to tolerate painful or uncomfortable feelings without engaging in harmful or self-destructive behaviors.

Applications for DBT

DBT has been proven through studies to be helpful for people experiencing borderline personality disorder by helping individuals change to adopt healthier behaviors and engage less frequently in unhelpful behaviors. However, DBT today is used to treat people with many different mental health concerns. People with chronic suicidal ideation or self-harm habits have also been helped by DBT, for example. Primarily, DBT is employed with individuals who have overly emotional reactions to help them manage life in a less reactive way.

DBT usually lasts a year or longer and generally includes individual talk therapy and group therapy for the individual undergoing it. The group therapy sessions focus on interpersonal skills, allowing people to practice their skills in a safe, therapeutic environment.

Key Differences Between DBT and CBT

While DBT and CBT have many similarities, the two stand apart in a few notable ways. Here are the main ways in which DBT and CBT differ from each other.

  • CBT focuses on changing problematic thoughts, emotions, and behaviors. In contrast, DBT puts its primary focus on regulating emotions to improve interpersonal relationships.
  • CBT tends to focus on logic, with the goal that individuals adopt a less pessimistic viewpoint. DBT, in contrast, emphasizes the individual’s relationship to themselves or others.
  • CBT is concerned primarily with change, while DBT focuses on a balance of acceptance and change.
  • DBT includes additional skills such as distress tolerance, mindfulness, and acceptance.
  • DBT usually includes group therapy and one-on-one therapy to help individuals practice new skills in an emotionally safe environment.

Which therapy is right for you: DBT or CBT?

Both DBT and CBT have a strong record of helping people with various mental health illnesses and concerns. In general, if the main concern is managing strong emotions or relationships, DBT is more likely to be recommended. If the main concern is changing negative thought patterns, CBT is the therapy more likely to be helpful.

More specifically, DBT is known to work best for individuals with borderline personality, substance abuse, self-harm, or eating disorders. CBT is used more widely and is known to work for depression, anxiety, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder. Thus, individuals seeking addiction therapy, for example, might be most helped by DBT, while an individual struggling with depression might want to try CBT first.

Finding the Best Fit for Therapy

Because therapy treatment really must be customized to the individual in order to be effective, an experienced therapist can determine which therapy will be best suited for any given person. If an individual has tried either CBT or DBT previously, their experiences with the therapy from that time should inform their current treatment.

In fact, because DBT and CBT have many similarities, many therapists who specialize in one approach might incorporate part of the other in their therapeutic practice. A therapist can recommend a form of treatment that works best based on a person’s unique situation, history, and perspective.

Whichever therapy is chosen, it is important that individuals be patient as the benefits tend to accrue over time. It usually takes at least a few weeks in order to begin seeing the benefits of therapy.

At All Points North Lodge, we can support your mental health needs with a personalized treatment plan. Contact us today to set up a consultation.

*We cannot understate the importance of working with a doctor and therapist as you recover. None of this content is intended as medical advice.

Speak with your providers to find a plan and strategies that work for you. If you don’t have a therapist or provider, give us a call.