CBT vs DBT — understanding your options

Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) are two common types of psychotherapy, also referred to as talk therapy. Both therapeutic approaches are effective for treating depression, anxiety disorder, bipolar disorder, trauma, obsessive-compulsive disorder (OCD), eating disorders, and some personality disorders. But how does CBT vs DBT compare?

This article offers a high-level overview of each therapy and drills down into the specifics, such as how they work, what happens in a typical session, and the length of treatment. With this information, you can better understand your options, ask potential therapists questions, and determine which type of talk therapy — CBT or DBT or something else— is right for you. 

What is DBT therapy vs CBT? 

CBT was developed in the 1960s by psychiatrist Dr. Aaron Beck, who saw a relationship between his depressed clients and their negative thought patterns, outlooks, or cognitions (how they think). He believed that if he could help people adjust their negative or irrational thoughts, they could improve their mood and behavior. He succeeded, and CBT was born.

DBT is an extension of CBT, developed in the late 1980s by psychologist Dr. Marsha Linehan. She was looking to help women diagnosed with borderline personality disorder and chronic suicidal behavior and found that CBT wasn’t effective. Dr. Linehan noticed that CBT’s focus on changing negative thoughts was invalidating to those struggling with more severe emotional dysregulation. She found that focusing on acceptance of a client’s emotions and experiences and teaching them to do the same, was an effective way to help them create change.  

Dialectical means “concerned with or acting through opposing forces.” In DBT (dialectical behavior therapy), the therapist helps the client manage their extreme emotions and impulsive behaviors with radical acceptance and adaptive coping skills. There’s less emphasis on changing thoughts and more emphasis on learning how to accept and manage feelings, thereby creating changes in behavior.

The table below compares the different characteristics of CBT vs DBT.

What is CBT?

The cornerstone of CBT focuses on a person’s irrational or negative thoughts and the painful emotions and maladaptive behaviors that follow. By changing unhelpful ways of thinking, a person can change the way they behave and subsequently improve how they feel. 

While a person’s thoughts or core beliefs are typically the starting point, the relationship between thoughts, feelings, and behaviors is integral to CBT. As such, a therapist may focus on any one of these 3 (thoughts, feelings, or behaviors) throughout the therapeutic process.

Specific cognitive behavioral therapy techniques include:

• Recognizing and reframing negative or irrational thoughts
• Improving problem-solving abilities
• Role playing difficult situations
• Assertiveness training
• Increasing stress management capabilities
• Goal setting

Coping skills to help calm the mind and body may include:

• Deep breathing and muscle relaxation exercises
• Engaging in pleasurable activities
• Fostering self-awareness through journaling
• Mindfulness practices.

How does cognitive behavioral therapy work?

Henry Ford famously said, “Whether you think you can or you think you can’t, you’re right.” This quote illustrates the power our thoughts have on our perspectives. Your beliefs about yourself and the world around you dictate how you feel and what you do. For example, if you grow up in a secure home, you may feel confident and optimistic about your ability to influence your life. However, if you grow up in a troubled home, you may be uncertain about your self-worth and see the world as threatening. 

CBT works by reframing or challenging your “negative” core beliefs. The first step is to identify those beliefs, process the feelings associated with them, and then develop new, more balanced perspectives about who you are in the world. 

For example, the child in that troubled home may have “survived” by staying quiet and out of the way. Thus, their core beliefs may be “my needs don’t matter” and “the way to connect with people is to remain non-confrontational.” With the help of a CBT therapist, this client can begin to process the emotional burden of those “negative” beliefs and create new, more adaptive ways of thinking and behaving. 

What is CBT used for?

CBT was originally designed to treat depression but has since been used to treat symptoms caused by anxiety, OCD, eating disorders, bipolar disorder, trauma-related disorders, and other mental health conditions. It’s a preferred, evidence-based course of treatment because it helps people quickly identify the negative or irrational cognitions and behaviors that are leading to uncomfortable feelings, and offers logic and facts to challenge those distortions. Additionally, CBT’s techniques and coping skills are easy to understand and perform, and are effective in relieving symptoms quickly.

What happens during cognitive behavioral therapy?

A CBT session, like most therapeutic experiences, begins with the provider taking your history and building trust with you. 

Your therapist will want to know about your symptoms and the impact they have on your daily life. Most CBT therapists will focus on the present, but that doesn’t mean your past can’t be discussed or examined. After all, most of our irrational or negative beliefs about ourselves, others, and the world were developed in childhood. 

Once your therapist understands your current struggles, they’ll invite you to reflect on the themes and behaviors that result in painful emotions or conflict. Your therapist will provide psychoeducation and teach you about the connection between your thoughts, feelings, and emotions, and you’ll work together to choose your therapy goals. Looking for people, places, and things that trigger your irrational or negative beliefs, your therapist will begin to challenge, with logic and facts, why those beliefs aren’t true and don’t serve you anymore. 

For example, a negative belief that “my needs don’t matter” may cause a person to feel empty and alone and may prevent them from speaking up for themselves or sharing their needs, even with those who love and respect them. This can cause internal as well as relational conflict and an increase in feelings of depression. 

In challenging this negative belief, your therapist may help you reframe or restructure this cognition by listing reasons why your needs matter, such as: 

• You’re a good person who deserves to be happy
• Your relationships are strengthened by allowing others to take care of you
• Taking care of your needs is an important part of self-love
• You have more to give to others when your needs are met

The therapist may also encourage you to consider times when getting your needs met, or speaking up, had a positive impact on you. 

As you gain a new perspective on your irrational beliefs, your therapist might recommend homework, so you can increase your ability to monitor and challenge your thoughts and practice more helpful ways of thinking and behaving. 

Simple ways to practice getting your needs met might include deciding what to order for take-out with friends or choosing the next movie. Starting with lower emotional triggers can help a person identify how their negative thoughts impact their behaviors and can lead to a mindset of change. 

How long does CBT take to work?

Because CBT is typically focused on the present, the work is direct and solution-oriented, and you’ll likely find that it takes a few months for therapy to work. Focusing on identifying negative or irrational beliefs and reframing or challenging those beliefs in a more positive light, is a skill that can be quickly picked up and applied. 

The use of homework outside of sessions helps to strengthen adaptive behaviors and the development of coping skills to ease disruptive emotions offers quick motivation for change. Seeing a therapist weekly or every other week, a typical course of CBT will take 5 to 20 sessions.

Who can provide CBT?

Most therapists will be familiar with CBT, but it’s best to look for a master’s-level or doctoral-level therapist trained and specialized in CBT. As with any therapeutic approach, finding the “right” therapist, someone you gain quick rapport and trust with, is critical to CBT’s success.

What is DBT?

DBT is an extension of CBT that was first developed to treat borderline personality disorder (BPD). Symptoms of BPD include extreme emotional reactions and impulsive behaviors. As such, DBT is primarily used for those facing more disruptive and chronic symptoms. 

DBT focuses on regulating emotions through validation and acceptance and developing positive coping skills to replace impulsive behaviors. In the reactionary cycle of extreme emotions and impulsive behaviors, gaining control of emotions leads to more control of your actions and thus more positive experiences with others and self.

How does dialectical behavioral therapy work?  

DBT typically includes individual therapy sessions as well as group sessions for skills training. The skills training includes mindfulness practices, interpersonal effectiveness, emotional regulation, and distress tolerance. Some therapists also offer over-the-phone coaching to help clients regulate emotions during a crisis situation.  

Initial individual DBT sessions are focused on validating a person’s thoughts and feelings. While this validation can occur in CBT as well, it’s critical for a person with emotional dysregulation to feel heard. Focusing on change too early in the therapeutic process can have a negative impact, which is why CBT may be less effective for those with extreme emotions and impulsive behaviors. 

The benefits of validation are also why DBT skills training is done in a group setting. This lets the person gain support and understanding from peers while learning how to cope and change. 

What is DBT used for?

DBT was originally designed to treat BPD, but today is used to treat other personality disorders, post-traumatic stress disorder, substance use, self-harm, and suicidal behaviors. It’s most effective for people with extreme and chronic symptoms who’ve been resistant to other cognitive treatments because they felt too simplistic and invalidating. 

What happens during dialectical behavioral therapy?

Similar to CBT sessions, initial individual DBT sessions start with building rapport and history taking. A DBT therapist will ask about your symptoms and the problems they’ve caused. They’ll also spend time validating your thoughts and feelings. Additionally, a DBT therapist will want to know about past trauma and allow time to discuss and process that trauma.  

The DBT skills training consists of 4 modules: 

1. Learning mindfulness practices
2. Improving interpersonal relationships
3. Regulating emotions
4. Increasing distress tolerance

While the DBT skills training is typically conducted in a group setting, these skills can also be learned and reinforced in individual therapy sessions.

Mindfulness practices

Mindfulness practices are used to anchor us to the present and support acceptance. Those with emotional dysregulation and impulsivity react as a way to cope, which typically brings on more problems. Mindfulness practices encourage the person to be in the here and now, without escalating their emotional response. DBT mindfulness skills include deep breathing, sensory observations — what do you hear, feel, taste — and visualizing compassion for others. 

Interpersonal effectiveness

Improving interpersonal relationships is a key part of DBT because relationships suffer when someone is emotionally dysregulated and impulsive. Skills training, such as how to communicate needs, active listening, building empathy, and boundary setting, can help a person more positively — and productively — interact with others.

Emotional regulation

Emotional regulation skills include understanding your emotional responses and building a bigger emotional vocabulary. When you understand and can define why you’re feeling a certain way, you can better communicate your needs. 

This skills training module also includes increasing positive emotions, dealing with emotions before they escalate, problem-solving, relaxation techniques, and changing emotional responses so you do the opposite of what you’ve done in the past.

Distress tolerance

Distress tolerance is a way to increase your ability to manage uncomfortable and painful feelings. Some distress tolerance skills include engaging in physical activity or pleasurable hobbies, helping others, finding meaning in your emotional pain, perspective taking, and radical acceptance. With an increase in distress tolerance, you can be less reactive to and more accepting of your emotional content. 

How long does DBT take to work?

Because DBT includes weekly individual therapy sessions and the potential for group work, and targeted symptoms are more severe and disruptive to daily functioning, DBT treatment can take 6 months to a year. You may start to feel better in a few months as you gain validation for your thoughts and feelings and begin to learn skills to help control and regulate your emotions.

Who provides DBT?

While mindfulness practices, distress tolerance, and healthy coping skills are a part of many talk therapies, a therapist trained in DBT is best suited to work with someone with a history of extreme emotional responses and impulsivity. A full DBT treatment program will include individual therapy sessions as well as group therapy for skills training, however, some DBT therapists are comfortable teaching the skills training in individual sessions.

Alternatives to CBT and DBT

There are a number of talk therapies. And the kind of therapist you need depends on your symptoms, timing, goals, and personal preferences. If you or your therapist don’t think CBT or DBT is right for you, alternatives, such as acceptance and commitment therapy (ACT), exposure therapy, interpersonal therapy, emotion-focused therapy (EFT), and mindfulness-based therapy are other options. If you relate to the behavior or action part of talk therapy, you might also want to consider a behavioral therapist.

DBT vs CBT: which is right for you? 

Deciding which therapy is right for you, DBT vs CBT, depends on your symptoms, the problems you’re experiencing, your mental health history, what you’re comfortable talking about in session, and how much time you have. But you don’t have to go it alone. Most therapists offer free consultations, so getting a professional opinion is the best way to decide between CBT vs DBT. 

If you’re still unsure, start with CBT. It has a lower time commitment, and you’ll know rather quickly whether it’s working. If you’ve been suffering with extreme emotional reactions and destructive impulsive behaviors, such as self-harm, DBT may be more helpful.

Key takeaways 

In this article, we talked about the similarities and, more importantly, the differences in DBT vs CBT, so that you can better understand these therapies and your options. We looked at the philosophy of CBT vs DBT and how they were developed, the individual techniques used in each therapeutic practice, and the time commitment for a normal course of treatment. We also encouraged you to consider your symptoms and their impact on your daily functioning, your past mental health, and your personal goals for therapy as a way to choose between these 2 modalities.

Key takeaways:

• DBT and CBT are talk therapies that explore a person’s thoughts, feelings, and behaviors.  
• CBT focuses on reframing or challenging negative or irrational thoughts as a way to improve mood, while DBT focuses on increasing our ability to accept emotional pain and develop positive coping skills.
• DBT skills training includes mindfulness practices, interpersonal effectiveness, emotional regulation, and radical acceptance. 
• A DBT therapist will spend more time validating emotional content before expecting behavioral changes. 
• CBT is typically focused on the present, while DBT will explore your past, particularly past trauma.

Finding the motivation to take that first step is important. The benefits of counseling include an improved mood, better self-awareness, and stronger relationships. And Klarity is here to help.

Get professional CBT or DBT therapy online or in person

The licensed providers on Klarity practice a variety of therapeutic approaches and offer treatment solutions to meet your needs. You can choose your own skilled and compassionate CBT or DBT therapist on Klarity, a user-friendly platform that simplifies the process of getting help. Make your path to healing as stress-free as possible and find a provider on Klarity today.

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.