By Martha McLaughlin
You’ve made the decision to see someone about the mental health issue that’s become part of your life. Great. Now what? How do you decide what treatment is best? There are many types of counseling, but two of the most common are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). They’re both effective, and similar in many ways, but different enough that one may be a better fit for you depending on your personal needs and preferences.
DBT is a specific form of CBT, so the approaches don’t oppose each other, but overlap. CBT came first, and DBT developed as a modification designed for a specific patient group. Today, both are used successfully for a wide range of issues.
What Do CBT and DBT Involve?
As the name implies, Cognitive Behavioral Therapy (CBT) ties together cognition, or thoughts, with specific behaviors. The idea is that feelings and behaviors can be changed by identifying the thoughts and beliefs that prompt them. In CBT, people learn to pull their thoughts into full consciousness and evaluate them for truth and helpfulness.
Two people often respond to the same situation in different ways, because it’s not the situation itself that causes a response, but the perception of it and its meanings. In CBT, you’ll learn to reframe distressing situations by thinking about them differently. This can involve brainstorming alternative ways of looking at the situation and ways you might react to it.
DBT also involves examining and reframing unhelpful thoughts. In addition to the focus on modifying beliefs and behaviors, however, there is also an acknowledgement that we act the way we do for legitimate reasons. Dialectics involves balancing and harmonizing forces that seem to be opposites, and in DBT, those forces are change and acceptance.
How DBT and CBT Are Different
DBT and CBT differ in these ways:
- Focus – Often, a patient and therapist will use CBT to deal with one specific issue. DBT tends to have a broader scope.
- Time commitment – In CBT, you’ll attend one individual therapy session a week, which generally lasts 50 minutes. Most emotional problems are treated in five to 10 months.1 In DBT, you’ll have a group skills training class each week in addition to individual therapy. You’ll also have the ability to contact your therapist between sessions. It lasts for as long or as short a period as needed.
- Skill development – CBT teaches you how your thoughts, feelings, physical states and behaviors are intertwined and how to modify parts of the equation to positively affect others. The specific tools you’ll develop in order to meet your goals depend on your personal needs. DBT, on the other hand, teaches a specific set of skills to everyone who participates. You’ll learn mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation.
- Structure – In CBT, the therapist modifies and adapts treatment freely. DBT is more structured, with therapists trained to follow a specific protocol.
- Focus on relationships – Depending on a client’s needs, CBT treatment may address interpersonal connections, but DBT focuses on them much more strongly and intentionally. The thought is that some people get emotionally aroused more rapidly and intensely than the norm, and that the situations most likely to provoke emotional upset tend to involve friends, family or romantic relationships.2
- Conditions treated – Both approaches can be helpful for a wide variety of disorders, but historically, CBT has been used more often for conditions like depression, anxiety and addiction, and DBT has been used more often for personality disorders and self-harming behaviors.
Counseling isn’t an exact science. It’s good to have options, so if one approach doesn’t feel like the perfect fit for you, you can try another therapy. No matter if you’re using CBT, DBT or another type of treatment, the relationship between counselors and their patients, sometimes called the therapeutic alliance, is a vital part of the equation.3 Some personalities simply mesh more naturally than others, and it’s OK to switch counselors if the relationship just doesn’t click. The important thing is to value yourself enough to take action and get the help you need.
1 Martin, Ben. “In-Depth: Cognitive Behavioral Therapy.” Psych Central, Accessed February 26, 2018.
2 Grohol, John. “What’s the Difference Between CBT and DBT?” Psych Central, Accessed February 26, 2018.
3 Ardito, Rita, and Daniela Rabellino. “Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research.” Frontiers in Psychology, October 18, 2011.