CBT vs. DBT: Understanding the Difference

Alexander Draghici
September 5, 2021

CBT and DBT are two of the most popular therapeutic approaches among mental health professionals worldwide. Both therapy modalities utilize a modern, solution-centered, and evidence-based approach to mental health and well-being; helping clients manage a wide range of problems such as depression, anxiety, stress, addictions, and even personality disorders.

therapy session

Given that they rely on the same theoretical frameworks (cognitivism and behaviorism), both approaches are relatively similar. However, each has its distinct features, as we will discuss below.

What Is CBT?

CBT is an acronym for cognitive behavioral therapy, a solution-oriented form of psychotherapy focused on managing and alleviating psychosomatic and mental health disorders. In other words, CBT combines two distinct therapies: cognitive and behavioral.

The basic principle of cognitive behavioral therapy states that how a person behaves is determined, first and foremost, by the way they interpret a given situation. CBT therapists believe that most of the problems (depression, anxiety, stress) people face arise because of the meaning they attribute to the unpleasant events they experience.

The negative thoughts and faulty interpretations you perpetuate will affect your behavior, fuel unpleasant emotions, and shatter your self-confidence. Based on this principle, a CBT therapist will use cognitive restructuring to help you change the way you see yourself, others, and the world. This, in turn, will lead to emotional and behavioral changes.

Furthermore, cognitive-behavioral therapy relies on a series of exercises and practices that target problematic behaviors which can affect your personal, professional, and social life. 

For example, exposure therapy is a strategy that CBT therapists use to help clients overcome specific fears. Recent advances in VR have allowed mental health professionals to use virtual reality exposure therapy (VRET) to treat phobias successfully.[1]

Overall, in terms of effectiveness, cognitive-behavioral therapy has proven to be a valuable tool for people who struggle with eating disorders, depression, and anxiety disorders.[2][3]

What Is DBT?

Founded by Marsha M. Linehan in the 80s, dialectical behavioral therapy was initially designed to help people dealing with self-harm and multiple suicide attempts. Over the years, this approach has been tuned and improved to cover a broader range of pathologies including anxiety, PTSD resulting from childhood sexual abuse, substance abuse and other severe and complex mental disorders.[4][5]

Today, DBT is commonly used to treat people who are suffering from borderline personality disorder (BPD). Current evidence suggests this approach proves effective for individuals with BPD who exhibit high suicide risk.[6]

DBT is among the first therapeutic approaches—derived from cognitive behavioral therapy—emphasizing the beneficial role of mindfulness and acceptance. Aside from identifying and challenging irrational thinking patterns, clients are encouraged to accept themselves and reality (at least the parts of reality they can’t control) and focus on the present moment. By doing so, they can achieve one of the main goals of DBT: to restore the emotional balance they’ve lost as a result of a traumatic event or abusive relationship.

Once a client manages to accept and validate their painful or unpleasant emotions, they can start focusing on the second goal: to change the unhealthy behaviors they perpetuate to cope with pain, loss, and emotional discomfort.

Main Differences Between CBT and DBT

While the two therapy modalities share much in common, they have some major differences that need to be taken into consideration when choosing between the two approaches.

Principles and Core Philosophy

One significant difference between CBT and DBT is the philosophy that governs each of the two approaches. The core philosophy of CBT relies on the idea that how people interpret an event that has happened to them matters far more than the event itself. As a result, CBT focuses mainly on reasoning, challenging irrational interpretations, and helping people internalize a set of Stoic principles that, in a way, allows them to become their own therapists.

On the other hand, the DBT philosophy emphasizes the importance of validating and accepting the unpleasant emotions that result from life’s unexpected hassles. In other words, mindfulness and acceptance (of ourselves, others, and reality) are the fundamental principles that define this approach.

Issues and Conditions Treated by Each Approach

Another notable difference between CBT and DBT is the type of emotional problems that each approach addresses. While DBT was designed to address a relatively specific set of problems (borderline personality disorder, self-harm, suicide attempts), CBT covers a broader spectrum of conditions, from depression, anxiety, and stress to eating disorders, substance abuse, and even personality disorders.

Although it’s easy to label CBT as a universal cure, its effectiveness can vary significantly, especially in complex conditions like personality disorders. For instance, experts believe that while CBT proves highly effective for avoidant personality disorder, DBT remains the ideal therapeutic approach for borderline personality disorder.[7]

Techniques and Treatment Methods

Lastly, it’s important to note that CBT and DBT employ different strategies and techniques to help clients achieve emotional balance and well-being. Cognitive behavioral therapy uses the thought-emotion-behavior triad as a fundamental framework for change. In other words, clients are taught how these three elements can interact and cause problems in their personal or professional life.

For instance, the anxiety (emotion) that makes you avoid driving (behavior) results from the belief (or thought) that you won’t be a good driver and you will cause a terrible accident.

In this particular case, a CBT therapist can encourage you to challenge your negative thoughts using questions such as:

  • What makes you think you won’t be a good driver?
  • What makes you think you can’t become a good driver?
  • What can you do to become a good driver?

As for DBT, one of the leading practices promoted by this approach is mindfulness. That means developing present moment awareness and learning to sit with your feelings, both pleasant and unpleasant. Furthermore, the techniques and principles of DBT are delivered in the form of group sessions composed of four modules. In some cases, clients can also receive individual sessions between the four group modules. Combining individual and group therapy allows clients to regulate their emotions both individually and through healthy interactions.

Summary

Given that both CBT and DBT rely on the same theoretical background, there are many similarities between the two. You can think of DBT as a simplified form of CBT mixed with Buddhist principles and radical acceptance. However, it’s vital to emphasize the differences between these two approaches, especially when you’re unsure which one is best for you. But even if you choose to go with one and realize it doesn’t fit your needs, you can always opt for the other.


References

  1. Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017). Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review. Current Psychiatry Reports, 19(7). https://doi.org/10.1007/s11920-017-0788-4
  2. Atwood, M. E., & Friedman, A. (2019). A systematic review of enhanced cognitive behavioral therapy (CBT‐E) for eating disorders. International Journal of Eating Disorders, 53(3), 311–330. https://doi.org/10.1002/eat.23206
  3. DiMauro, J., Domingues, J., Fernandez, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour Research and Therapy, 51(2), 82–86. https://doi.org/10.1016/j.brat.2012.10.003
  4. University of Washington. (2019). Marsha Linehan | Behavioral Research & Therapy Clinics. https://depts.washington.edu/uwbrtc/our-team/marsha-linehan/
  5. Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C., Niedtfeld, I., & Steil, R. (2013). Dialectical Behaviour Therapy for Post-traumatic Stress Disorder after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder: A Randomised Controlled Trial. Psychotherapy and Psychosomatics, 82(4), 221–233. https://doi.org/10.1159/000348451
  6. Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., McDavid, J., Comtois, K. A., & Murray-Gregory, A. M. (2015). Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder. JAMA Psychiatry, 72(5), 475. https://doi.org/10.1001/jamapsychiatry.2014.3039
  7. Crits-Christoph, P., & Barber, J. P. (2015). Psychological treatments for personality disorders. In P. E. Nathan, & J. M. Gorman, A guide to treatments that work (pp. 851–870). Oxford: Oxford University Press.
Alexander Draghici

Alexander Draghici is a licensed Clinical Psychologist and CBT practitioner. His work focuses mainly on strategies designed to help people manage and prevent two of the most common emotional problems – anxiety and depression.

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