There are a lot of options out there to address emotional problems. Two of the most prominent types of therapy — DBT and CBT — have similar names and approaches. How do you choose between DBT vs CBT?
With substantial contributions from Grace Anderson, Ph.D.
What Are CBT and DBT?
Cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are both forms of psychotherapy. Typically, both involve meeting once weekly with a therapist specifically trained in that respective approach. Both CBT and DBT are effective in treating various mood, anxiety, substance-related, emotional, and behavioral problems.
CBT and DBT have many things in common. For example, both therapies:
- strive to create improvement in your current life as soon as possible
- sometimes encourage you to face feelings and situations that are uncomfortable, if it’s safe and healthy to do so
- will ask you to do homework between sessions
- focus on fixing things in your life that aren’t working for you
Key Differences in Treatment Course
For CBT, the typical course of treatment for a single condition is approximately 3 to 6 months. However, the exact length of treatment depends on many factors. These include the severity of the condition, whether there are multiple conditions, complexity of your life circumstances, and so on. CBT therapists use specific treatment protocols tailored to different mental health conditions to guide the treatment. You and your therapist would discuss the issues you are facing and work together to develop a treatment plan that best fits your needs.
Adherent DBT
Adherent DBT (including all of the components of DBT) usually lasts six to twelve months. It includes three core components: weekly individual therapy, weekly skills group training (group therapy), and phone coaching. DBT skills training covers four core topics, known as “modules”: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. For some people, completing two rounds of skills training is recommended, which is why treatment can extend to 12 months. Phone coaching provides real-time guidance from your therapist on how to apply the skills when problems arise between therapy sessions. Adherent DBT programs are structured and strict, often enforcing firm attendance policies, and they can be both time- and cost-intensive.
Many DBT therapists provide DBT-informed care instead of full DBT adherence. This means that they offer individual therapy that incorporates DBT skills. This approach is generally less time- and financially demanding. For individuals in DBT-informed therapy who want to attend the accompanying group therapy, many areas offer standalone DBT skills training groups they can attend. Depending on the therapist, DBT-informed therapy may or may not include phone coaching or strict attendance requirements.
The Focus of CBT
CBT looks at problems in terms of thoughts, emotions, sensations, and behaviors. To address a problem (e.g., anxiety), a CBT therapist will recommend different strategies with a goal of altering the thought processes, emotional experiences, or behaviors that make up the problem. As a result of making these changes, the problem improves.
For example: let’s say you suffer from insomnia. A CBT therapist might examine what you’re thinking, feeling, and doing throughout the day that can affect sleep. She may recommend that you spend less time in bed, or recommend a change in your self-talk around sleep. Changes like these can improve the quality of sleep and decrease the time spent waiting to fall asleep.
The Focus of DBT
DBT is a specialized form of CBT. Essentially, that means DBT is CBT, but with a focus on helping you learn how to cope with difficult or intense emotions and with the problems those emotions can create. As such, DBT can be more effective than traditional CBT at reducing emotion-driven behaviors including:
- cutting (a form of self-harm)
- emotional eating
- problems with drugs and alcohol use
- Angry outbursts
DBT was originally developed in the 1980s and ’90s to help people who were chronically suicidal or diagnosed with borderline personality disorder. However, DBT has been used more broadly since then because we have discovered how useful it is for other problems.
Unlike other forms of CBT, DBT draws on some of the philosophy and practice of Zen Buddhism. It teaches people mindfulness practices that help you understand and manage your emotions. Mindfulness is the foundational module within DBT, and many of the skills taught in DBT incorporate mindfulness.
For example: If you struggle with anger that escalates into conflict at work, a DBT therapist might teach you mindfulness skills to help you notice the early signs of anger. They might also teach you distress tolerance skills to pause before reacting, and interpersonal effectiveness skills to communicate clearly without escalating the situation.
How to Choose between CBT and DBT
The most important factor to consider in choosing DBT vs CBT is the type of problem you have. Some problems that are a better fit for CBT are:
- Excessive worry
- Panic attacks
- Phobias
- Post-traumatic stress disorder (PTSD)
- Social anxiety or work anxiety
- Obsessive-compulsive disorder
Some problems that are a better fit for DBT are:
- A habit of cutting people out of your life and later regretting it
- Self-harming (like cutting, burning, hitting yourself)
- Suicide-related (plans, attempts, gestures) thinking and behavior
- Unstable or overly intense relationships with others
- Anger problems or anger management
- Fears of abandonment
- Difficulty with chronically intense emotions
Some problems that can be addressed by either CBT or DBT are:
- Drug or alcohol use problems
- Depression
- Procrastination
What CBT and DBT Have in Common
CBT and DBT have many things in common. For example, both therapies:
- strive to create improvement in your current life as soon as possible
- sometimes encourage you to face feelings and situations that are uncomfortable, if it’s safe and healthy to do so
- will ask you to do homework between sessions
- focus on fixing things in your life that aren’t working for you
Consider a consultation
For some people, the decision about which type of therapy to pursue is not obvious. If the best option for you isn’t clear, consider a one-session consultation with a therapist trained in one or both therapies. They will be able to give you an informed opinion and explain their recommendation to you.
How to Find a Good CBT or DBT Therapist
- Make sure that the therapist you plan to see has extensive training in whichever type of therapy you have chosen.
- To find a good CBT therapist, consider using the clinical listing at the website for the Association for Behavioral and Cognitive Therapies.
- To find a good DBT therapist, check the clinical directory of DBT programs and therapists available at this site.
- Experienced DBT therapists often work (or have worked) as part of an adherent DBT program. If you are looking to find an adherent therapist or enroll in an adherent program use this site.
Feel free to contact us for help finding a therapist to suit your needs — whether you are in the New York City area or not. We are happy to help if we can!
