The Differences Between CBT and DBT
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There are many different types of therapy used for mental health treatment. When choosing a therapeutic method, it can be hard to determine which is best for you. Two common and successful types of therapy are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). These therapeutic methods help people resolve internal and external conflicts, have more control over their thoughts and emotions, and have a healthier relationship with themselves. This post will go over the difference between CBT and DBT to help you understand the distinctions and decide which is right for you.
What is CBT?
Cognitive Behavioral Therapy (CBT) is a goal-oriented type of talk therapy. The word cognitive comes from the Latin word “cognoscere”, which means “to recognize”. Therefore, a main difference between CBT and DBT therapy is that CBT is centered more around being conscious of what’s happening internally. The goal is to recognize the negative beliefs we have. Through this awareness, we can change negative thoughts into a more positive mindset. Ultimately, CBT gives you tools to respond to situations more effectively and improve your quality of life.
What Does CBT Treat?
CBT is used for a wide range of mental health diagnoses and life challenges. The Cleveland Clinic says that CBT treats mental health issues that include (but aren’t limited to):
Depression
Anxiety
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Attention-deficit/hyperactivity disorder (ADHD)
Phobias
Substance use disorder (SUD)
Eating disorders
CBT has been found to largely help depression. BMC Psychiatry found that CBT has a 62.2% recovery rate for individuals with depression. This is higher than those who participated in normal counseling, with recovery rates being 44.4%. While both CBT and DBT can be used to treat depression, CBT tends to be more effective in recovery from depression. CBT can also be used for non-mental health disorders such as challenges in interpersonal relationships or struggles with self-worth.
Cognitive Distortions
One of the main features of CBT is identifying cognitive distortions. Cognitive distortions are dysfunctional thinking patterns that lead to negative thoughts and behaviors. It’s normal to have cognitive distortions and it’s nothing to be ashamed of. Therefore, identifying these distortions can make us more aware of the thought patterns needing healthy modification. Here are some of the many common cognitive distortions:
All-or-nothing thinking: Also known as black-or-white thinking. This thinking causes us to see the world in extreme opposites and not see the gray area in a situation. For example, “If I can’t get an A on this exam then I’ll have failed.”
Catastrophizing: Taking a situation and spiraling it to the worst conclusion. For example, “My crush doesn’t like me back, meaning that no one will ever like me back, meaning I’ll be alone forever.”
Filtering: Dismissing the positive and focusing on the negative. For example, “Today has been a horrible day because I was five minutes late to work.”
Jumping to conclusions: Making assumptions without evidence. For example, “My partner didn’t text me back, they hate me.”
Personalization: Blaming yourself when the issue is out of your control. For example, “It’s my fault my coworker got fired and I could’ve prevented it.”
Cognitive distortions can be debilitating, and CBT can help minimize these false perceptions of reality using tools like the CBT Triangle.
CBT Triangle
This CBT triangle is taken from https://positivepsychology.com/cbt-triangle/
One way to reduce the intensity of cognitive distortions is through the CBT triangle. The CBT triangle illustrates how our thoughts, behaviors, and feelings are connected. Any point of the triangle can positively or negatively affect the other two points. One of the main goals of CBT is to shift negative thoughts from cognitive distortions into a more hopeful mindset. By doing this, one’s emotions and behavior will also be more optimistic since, according to the CBT triangle, it’s all connected. The CBT triangle can be used as so:
Negative thought: Recognizing your original negative thought that caused the negative cycle following. Ex. I am unlikeable.
Behavior: Recognizing the behavior that fed the negative thought. Ex. Not talking to new people and not reaching out to friends.
Emotions: Recognizing the emotions that followed the negative thoughts and behaviors. Ex. Feeling isolated and alone.
If a person shifts the negative thought to a more positive one, it can change the whole triangle to create a healthier lifestyle. For example:
New thought: Finding a reframe for the original negative thought. Ex. I am likable. I have my best friend.
Behavior: Recognizing the behavior that followed that new, positive thought. Ex. Socializing with your best friend more and meeting their friends.
Emotions: Recognizing the emotion that followed the behavior and positive thought. Ex. Feeling connected and confident.
While it seems simple, changing one's thought process is not easy. That’s why it is recommended to work with a therapist throughout this process. Through repetition and consistency, growth surrounding your thought process is definitely possible. If cognitive reframing interests you, you can look at Trust Mental Health’s CBT worksheets for anxiety to learn more about different coping skills.
How Does CBT Work?
CBT is a type of talk therapy, meaning you work with a therapist to work on CBT skills through discussions. CBT can happen in individual therapy or in group therapy. For individual therapy, the first couple sessions are more about the therapist getting to know you. That way, the therapist can tailor treatment to your specific needs. After these first few sessions, your therapist will explore issues on a deeper level and help you shift your negative mental perceptions into more balanced thoughts. Your therapist might give you worksheets to complete outside of sessions too.
Average Length of CBT
The NCBI states that CBT is usually a short-term treatment but the length of treatment depends on the individual. Some people can feel better after a few weeks while others benefit more from several months of sessions. Sessions are usually once a week and can be offered online or in person, depending on the clients' needs and therapist’s availability. Sessions are typically 45 minutes to an hour long.
What is DBT?
Dialectical behavioral therapy (DBT) is a type of talk therapy developed through CBT. The difference between CBT and DBT is while CBT focuses on reframing one’s mindset, DBT focuses more on distress regulation for those who experience intense emotions. It centers on accepting your emotions, learning how to manage them, and changing unhelpful behaviors. Mind UK states that “dialectical” means understanding how two opposing ideas can simultaneously be true. In DBT, the two opposite ideas are accepting yourself and also accepting change in your life. Through this, DBT patients can invoke change without judgment or shame.
What is DBT Used to Treat?
DBT was created to help people who struggle with intense or extreme emotions. One of the key principles of DBT therapy is the treatment of personality disorders. The DBT and Menal Health Services clinic found that 77% of previous patients no longer meet the criteria for Bipolar Personality Disorder (BPD) after one year of DBT treatment. However, DBT has been proven to help other diagnoses as well; the Cleveland Clinic states DBT can be used for other conditions, such as:
Anxiety
Depression
Post-traumatic stress disorder (PTSD)
Self-harm
Suicidal ideations
Substance use disorder
Bipolar disorder
Eating disorders
And more
Four Main DBT Skills
DBT consists of 4 main skills:
Mindfulness: This skill involves staying present in the moment instead of stressing over the past or future. This can be done through breathing exercises, non-judgmental attention towards the self and others, using the five senses, and doing a body scan.
Distress tolerance: This skill involves dealing with painful situations and emotions. While negative emotions are painful, distress tolerance can help cope with these feelings to lead to a more fulfilling life. This is also useful for preventing self-destructive behaviors.
Interpersonal effectiveness: This skill involves improving our relationship with others. Some strategies for interpersonal effectiveness include proper communication, conflict management, and boundary setting.
Emotion regulation: This skill involves helping people understand and manage their emotions to reduce suffering. The key principles of emotion regulation include understanding that emotions are normal and important to the human experience while also learning how to regulate painful emotions.
A Common DBT Skill
DBT has many acronyms to help clients remember important information. One acronym is STOP, a distress tolerance skill to use when you’re feeling overwhelmed by stress or negative emotions. It lets us stop and process our emotions so we can continue our daily routine feeling more satisfied.
S: Stop. If you notice yourself getting worked up, pause the situation at hand.
T: Take a step back. Physically and mentally step away from the stressful scenario to gather yourself.
O: Observe. Notice your internal and external reactions. This includes your thoughts, feelings, and bodily sensations. What’s going on in your mind? How do you feel physically?
P: Proceed mindfully. Based on your observations, plan your next actions mindfully. What will serve you best at this moment? This could be taking a longer break or problem-solving before proceeding.
How Does DBT Work?
Like CBT, DBT is also a type of talk therapy, conducted in a therapeutic individual setting or group setting. The main difference between CBT and DBT therapy is what is taught in the sessions, while the session pacing remains the same. Usually, the first couple of sessions are about getting to know each other so the therapist can tailor treatment to your specific needs. After the first couple of sessions, you will have deeper conversations and learn coping mechanisms to regulate emotions and behaviors. Your therapist may give you worksheets for DBT to complete outside of sessions too.
Average Length of DBT Treatment
The average length of DBT treatment mainly depends on the individual and how much support the client needs. The Cleveland Clinic states that the length of DBT treatment is around six months to a year, however, it can last for several years depending on individual goals. Sessions are usually once a week and can be offered online or in person, depending on the client's needs and the therapist’s availability. Sessions are typically 45 minutes long to an hour.
When to use CBT Therapy vs. DBT Therapy
When choosing between CBT vs. DBT therapy, it is important to recognize your own needs and understand your differences. Explore both the techniques and if one sounds more interesting or beneficial than the other, try that therapeutic method. It is also not uncommon to do both. CBT therapy vs. DBT therapy can also be discussed more thoroughly with a therapist. You can reach out to a professional who practices these therapeutic methods and talk to them about what they would recommend.
If you are a California resident and interested in CBT or DBT therapeutic services, Trust Mental Health has a BIPOC team of therapists trained in these therapeutic methods. CBT Therapy in California and DBT Therapy in California are accessible to you through the Trust Mental Health website, and you can be assigned a therapist who suits your unique needs within 48 hours of contact. We also provide therapy in Irvine if you are an Irvine resident or live close by.
FAQs
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Everyone is unique, so it depends on your personal needs and preferences. If you have mental health diagnosis(s), then you can check the list above saying what disorders CBT therapy vs. DBT therapy technically treats. You can also look at the difference between CBT and DBT to decide. If you are looking to challenge negative beliefs and thought patterns, CBT would be better for you. If you are looking to manage extreme and/or painful emotions, DBT would be the better option.
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There are many benefits of CBT and DBT depending on the individual's needs. Some benefits include reducing symptoms of mental health disorders, being more aware of one's thought process, leaning on healthy coping mechanisms, improved relationships, handling life’s problems more effectively, and feeling more control over life.
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No matter what you are going through, learning coping skills to handle life can always improve one’s mental well-being. Therapy is a form of self-care, and you deserve support if you are struggling with internal and/or external conflicts. No one should walk through life alone, and there is no shame in getting help. CBT and DBT can also be beneficial if you have tried other forms of therapy and they have been unsuccessful.