Dialectical Behavior vs. Cognitive Behavioral Therapy - Verywell Health

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Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are types of psychotherapy (talk therapy).

CBT is one of the most common forms of evidence-based psychotherapy. It helps a person identify and change maladaptive thought processes and behaviors.

DBT is an evidence-based treatment that is derived from CBT. Instead of changing maladaptive thoughts and emotions, DBT encourages experiencing and accepting the emotions and developing healthy ways to cope with them.

Read on to learn more about the similarities and differences between CBT and DBT.

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What to Know About Cognitive Behavioral Therapy

CBT is a well-established psychotherapy used to treat a variety of mental health conditions and symptoms, including depression, anxiety, post-traumatic stress disorder (PTSD), phobias, and substance-use disorders.

How Does Cognitive Behavioral Therapy Work?

CBT operates on the principle that thoughts influence beliefs, and beliefs influence behavior. This chain of effects also influences emotions. For example, a person who thinks that others judge or don't like them may avoid social situations, which then may lead to them to feel lonely. CBT aims to change unwanted behavior by identifying, addressing, and modifying problematic or irrational thoughts. The reverse may also be effective (changing behaviors may change thoughts).

CBT typically involves:

Learning to reevaluate negative thought processes
Relaxing the body and calming the mind
Confronting instead of avoiding fears
Developing healthy coping skills
Building self-confidence and self-esteem

CBT can be modified and tailored to specific purposes or situations. For example, while based on the same principles, CBT for depression may employ different techniques for eating disorders than CBT would.

Delivery of Cognitive Behavioral Therapy

CBT is typically a structured, short-term treatment of about 10 to 16 sessions. Benefits may even become noticeable within a few sessions. CBT is goal-oriented and present-focused.

Basic CBT techniques include:

Education and discussion about the condition, how it affects the person, and what treatment will entail
Learning and practicing skills and strategies (such as problem-solving or realistic thinking) to change problematic thoughts, feelings, and behaviors
Learning how to apply these skills to future problems

CBT can be administered in a number of settings, including face to face or virtually.

Where to Get Cognitive Behavioral Therapy

To find a therapist who practices CBT:

Are CBT and DBT My Only Options?

CBT and DBT can both be helpful in treating mental health conditions, but they aren't the only options available. Other therapies and programs, as well as medications and, in some cases, procedures, may be better suited to you and your needs. Talk to your healthcare provider or mental health professional about treatment choices.

What to Know About Dialectical Behavior Therapy

DBT was developed by Dr. Marsha Linehan as a treatment for borderline personality disorder (BPD). Dr. Linehan found that CBT didn't address the needs of people with suicidal ideation and actions as effectively as needed and developed DBT based on the principles of CBT.

DBT treats people who have strong urges to harm themselves or who engage in self-destructive behavior. It has also proved effective at treating other mental health disorders, such as mood disorders, substance-use disorders, eating disorders, and PTSD.

How Does Dialectical Behavior Therapy Work?

DBT strives to teach skills and tools needed to handle stress. Instead of changing negative thoughts (as seen in CBT), DBT helps change maladaptive coping strategies into productive ones with the goal of improving emotion regulation and interpersonal relationships.

The four key components of DBT are:

Cognitive behavioral theoretical framework
Validation
Dialectics (when two seemingly opposite things are true at the same time/the integration of seemingly opposing viewpoints)
Radical acceptance (accepting that pain, stress, and other negative things may happen, but you have the tools to cope with them)

DBT assumes that:

Everything is interconnected
Change is inevitable and constant
Opposites can integrate

Delivery of Dialectical Behavior Therapy

DBT is designed to have four stages:

Stage 1:

Stabilize the person
Decrease imminent life-interfering behaviors (such as suicidal or self-harm actions)
Reduce behaviors that interfere with therapy (such as missing appointments or refusing to take necessary steps)
Address factors that interfere with quality of life (such as substance use, unemployment, or inadequate housing)
Replace dysfunctional behaviors with skillful ones

Stage 2:

Called the stage of "quiet desperation"
Behaviors and actions are under control, but emotions are not well-regulated
The goal is to help the person experience a full range of emotions
PTSD is treated (if applicable)

Stage 3:

Ordinary life problems are addressed

Stage 4:

Increase a sense of completeness
Reach the highest level of functioning

Are All Four Stages Necessary?

DBT was designed to start at the first stage but is flexible and can be modified for individuals with less intensive needs.

Comprehensive DBT involves four components:

Skills training group:

Learning behavioral skills to enhance capabilities and replace other unhealthy behaviors
Takes place in a group setting that runs like a class
Group meets for 2.5-hour weekly sessions, for a total of 24 weeks (often repeated to form a one-year program)
Group leader teaches skills and assigns homework for using skills in everyday life
Focuses on four main skills: Mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation

Individual psychotherapy:

Focuses on enhancing motivation and learning to apply the learned skills to specific challenges and situations in the person's life
Discussion of individual goals
Typically involves weekly 60–90 minute sessions and happens concurrently with skills training group sessions

Telephone consultation/coaching:

Provides in-the-moment coaching on using skills effectively and coping with difficult situations that come up in the person's everyday life
The person can call their individual therapist between sessions when they need help

Therapist consultation team:

Support for DBT providers who work with people who have severe, complex, or difficult-to-treat disorders
Helps therapists stay motivated, manage burnout, share knowledge, and give the best care they can
Teams are made up of individual therapists and group leaders who share responsibility for an individual's care
Teams typically meet weekly

A full DBT program takes about a year, but shorter programs (sometimes called DBT-informed programs) are offered in some situations.

Where to Get Dialectical Behavior Therapy

To find a therapist who provides DBT:

Which Treatment Is Best for You?

Which treatment to choose depends on the person's needs and goals.

Both treatments are evidence-based and can help with addressing, overcoming, and regulating emotional challenges.

Though they have similar outcome goals, there are key differences between the therapies, including:

CBT tends to be short-term, while DBT is typically a one-year commitment
CBT encourages changing negative thoughts and emotions, while DBT promotes accepting negative emotions, feeling them, and letting them go

There is overlap in which mental health conditions can be treated by CBT and/or DBT, but research suggests there may be situations where one is better suited than the other.

CBT has proved effective in treating:

DBT may be well-suited for treating:

BPD (strong evidence)
Eating disorders
Trauma from abuse
Bipolar disorder
Self-harm disorders
Suicidal ideation and behavior
Substance-use disorders
PTSD
Depression
Adolescents with mental health disorders and/or symptoms

Which Treatment Should I Choose?

Before deciding on a treatment, talk to your healthcare provider or mental health professional. They can go over your needs and goals with you and help determine the course of action that works best for you.

Can Dialectical Behavior Therapy And Cognitive Behavioral Therapy Be Used Together?

Because DBT was developed as an extension of CBT, it incorporates some of the training skills and aspects of CBT. They are considered to be part of a family of interventions operating on the belief that changing maladaptive behaviors can help decrease problematic behaviors and emotional distress.

CBT is more established, while DBT is newer and currently studied to determine its effectiveness and applicability in different situations.

Summary

CBT and DBT are types of evidence-based psychotherapies.

CBT focuses on identifying, addressing, and changing maladaptive thought processes and behaviors.

DBT was developed as an extension of CBT with a stronger focus on acceptance, emotion regulation, and interpersonal relationships.

CBT has been shown to be effective at treating a number of mental health conditions, including anxiety, depression, and OCD.

DBT was developed to treat BPD, particularly for people with BPD who show self-harm or suicidal ideation or behaviors. It has also been shown to be effective for conditions such as eating disorders and substance-use disorders. It is currently being researched to see if it may help in other situations.

Research suggests that DBT may be especially helpful for adolescents.

A Word From Verywell

If you are experiencing symptoms of a mental health condition, talk to your healthcare provider or mental health professional about treatment options. Depending on your situation and needs, CBT or DBT may be beneficial to you.

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