What’s the Difference Between CBT and DBT?

Cognitive behavioral therapy, or CBT, and dialectical behavioral therapy, or DBT, are both forms of psychotherapy frequently used as part of a comprehensive addiction treatment program. Both have been proven effective for treating substance use disorders as well as many commonly co-occurring mental health issues. As the names suggest, CBT and DBT have much in common. In fact, you could say that DBT is a specialized form of CBT. Which is best for you depends on your particular situation. The following is a look at the important differences between CBT and DBT.

CBT Came First

As noted above, DBT is a specialized form of CBT. CBT was developed in the 1960s by psychologist Aaron Beck, based in part on the rational-emotive behavioral therapy, or REBT, of Albert Ellis. Beck was trained as a psychoanalyst but wanted some way of giving his clients more tangible results in less time. The core insight of CBT is that the things that happen to us don’t directly cause our emotions.

Our emotions are a result of our thinking about what happens to us. What’s more, many of our thoughts, beliefs, and assumptions are distorted in such a way that we suffer more than is necessary when things don’t go how we would like. Much of CBT is about identifying and challenging these faulty beliefs and thereby changing our emotional reactions.

Behavior is another important element of CBT. Imagine thoughts, emotions, and behaviors as sides of a triangle. Any change in one has some effect on the others. So, for example, you can change your emotions by changing your thoughts or by changing your behaviors. Therefore, CBT also emphasizes strategies for behavioral change that don’t necessarily require you to feel like doing something. More than anything, CBT represents a fairly large toolkit--skills that therapists can teach their clients to help them better control their emotions and behavior.

DBT Was Developed to Help With Borderline Personality Disorder

DBT was developed in the 1980s by psychologist Marsha Linehan to treat clients with borderline personality disorder, or BPD. BPD is a condition characterized by volatile and intense emotional reactions and frequent relationship problems. For example, someone with BPD might adore a particular friend one day, then feel like that friend has betrayed them--often based on little or no evidence--and switch to hating that person the next day. The friend, understandably, would be confused by this behavior and consequently, close relationships are fraught for someone with BPD. Linehan found that her BPD patients were often resistant to typical CBT.

The main issue was that CBT emphasizes changing challenging emotions by changing faulty thinking. Patients often felt this approach failed to validate their feelings. As a result, Linehan developed an approach to therapy that attempted to balance change and acceptance, and this is where “dialectical” became part of the method. Treatment becomes more of a discussion about which feelings are more valid and which might be constructively altered.

While DBT was originally developed for people with BPD, it has since been adapted for treating other conditions. It has been proven effective for substance use disorders, as well as commonly co-occurring conditions like eating disorders, self-harm, PTSD, and suicidal depression.

DBT Emphasizes Distress Tolerance and Social Skills

In addition to more emphasis on acceptance, DBT also focuses on distress tolerance and social skills. These are particular areas where people with BPD typically struggle the most. CBT focuses on managing challenging emotions by managing thoughts. The volatility and intensity of emotions common in BPD can make this challenging and the patient’s desire for validation may make them less likely to employ cognitive strategies.

Therefore, DBT adds an element of distress tolerance. These are skills include mindfulness and acceptance skills, as well as short-term survival skills like distraction and self-soothing. The idea is that the patient will inevitably feel unpleasant and strong emotions but they can develop the skills to keep them from causing problems in life.

Social skills are another important aspect of DBT. These are typically incidental in CBT. For example, you may have social anxiety resulting from an unfounded belief that others are judging you harshly. Since relationship problems are such a central feature of BPD, it makes sense to give special attention to developing social skills--called interpersonal effectiveness. These include skills like expressing your needs, saying no, and resolving conflict.

DBT Is More Structured

In a way, DBT is more intensive than CBT and it is also more structured--both in terms of time and content. In terms of time, people in DBT typically meet individually with a therapist once a week to work on specific issues and skills. They also have a group session each week, which typically lasts two-and-a-half hours. In between sessions, patients will typically check in with the therapist over the phone.

There are also four specific modules in DBT. Distress tolerance and interpersonal effectiveness are two of them and have been discussed above. The other two include mindfulness and emotional regulation. Mindfulness is especially helpful in distress tolerance. It emphasizes observing emotions and events nonjudgmentally. Emotional regulation includes skills like recognizing and labeling emotions, increasing positive emotions, and applying distress-tolerance techniques.

DBT Has a Group Component

As noted above, DBT typically includes both individual and group therapy. CBT can be used with either or both but doesn’t specifically incorporate both. The purpose of including group sessions in DBT is to give patients an opportunity to practice their new interpersonal and emotional regulation skills in a safe, supervised environment.

Neither CBT nor DBT is necessarily better than the other. It really depends on your specific needs. If you do struggle with borderline personality disorder, major depression, an eating disorder, or PTSD, it’s likely you will need DBT. Each of these conditions carries a very high risk of a co-occurring substance use disorder and if you have both, you need treatment for both. Substance use and mental health issues each make the other worse so it’s crucial to treat them in an integrated way. At The Foundry, we know that everyone seeking help for a substance use disorder has different needs. We offer many options for individualized treatment, including CBT and DBT. To learn more about our treatment options, call us today at (844) 955-1066.

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