Psychotherapy: DBT vs. CBT

Reading Time: 4 Minutes

In addiction and mental health treatment, we often hear the term “talk therapy” or psychotherapy, which often means cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT). If you or a loved one has been diagnosed with a mental health or substance abuse disorder and received therapy, you may be familiar with these terms. Both CBT and DBT have similarities and are often confused with one another, but DBT originated from CBT, and each psychotherapy modality has its own unique approach to treating mental health and substance use disorders.  
Both CBT and DBT are rooted in the core belief that healthy thinking and behavior patterns can reduce distress and promote well-being. Negative thoughts and feelings may stem from depression, anxiety disorders, traumatic experiences, and chronic stress and may increase the risk of addiction. Multiple studies support the link between addiction and chronic negative thinking. So, when we address these negative thought patterns in a formalized setting by using CBT or DBT, we can often work through and, over time, minimize symptoms related to our mental health or substance use disorder.

What is cognitive behavioral therapy (CBT)?

Cognitive-behavioral therapy (CBT) is the most common therapeutic modality used for addiction and mental health disorders. Cognitive-behavioral therapy, in its simplest form, helps people understand their underlying emotions and thought patterns that influence their behaviors and actions. The goal is to change these thought patterns. The founders of CBT believe “our thoughts cause our feelings and behaviors, not external things, like people, situations, and events,” and we can learn to change how we think and respond. Specifically, CBT works to uncover automatic negative thoughts that can lead to emotional difficulties. The goal is for people to understand negative thoughts and feelings that influence behaviors and change these distortive thoughts and emotions into positive thought processes that can lead to healthy behaviors. You can be in control of your thought processes and can have the power to block out automatic negative thoughts. Changing these thought processes can lead to a behavioral shift over time.  

So, if we change our thoughts, then we change our beliefs, and as a result, our behaviors and emotions change. For example, you believe that other people judge you or do not like you, so you avoid social situations, which, over time, leads you to feel lonely. CBT will work to replace the negative thought of “people don’t like me” with positive thoughts, which will evolve into positive behaviors and emotions so you can be around people without feeling anxious and, therefore, will have fewer feelings of loneliness.

What should I expect from CBT?

CBT is typically a structured, short-term treatment of about 10 to 16 sessions. It is usually one-on-one with your therapist and does not involve group therapy. Benefits may even become noticeable within a few sessions. CBT is goal-oriented and present-focused, meaning that your therapist will work with you to establish what you want to change about your present behaviors and then dive into stepwise therapy sessions to replace negative thinking patterns that are affecting your mental health. This stepwise approach means that you must complete each phase successfully before you can move on to the next phase:

  • Functional Analysis: The stage of CBT where you learn to identify problematic beliefs  
  • Actual Behaviors: The second stage of CBT, where new skills are learned, practiced, and applied to real-world situations  
  • Behavior Change: The final phase of CBT that encourages you to take steps towards implementing a developmental transformation.

Psychotherapy_ DBT vs. CBT

What does CBT treat?

  • Eating disorders, particularly bulimia nervosa (BN) and binge eating disorder (BED) 
  • Substance-use disorders 
  • Depression 
  • Anxiety 
  • Trauma 
  • Obsessive-compulsive disorder (OCD) 
  • PTSD

What is dialectical behavior therapy (DBT)?

Dialectical behavior therapy stems from CBT and is similar in that it is rooted in the same belief that healthy thinking promotes well-being, and it aims to help people better manage their thoughts, emotions, and behaviors. However, while CBT is focused on changing negative thought patterns, DBT is focused on accepting these negative thought patterns, tolerating the emotions associated with them, and promoting positive change into healthy behaviors and interpersonal relationships. Dialectical means two opposites can both be true. DBT seeks to unite two conflicting situations, acceptance, and change, in order to help people learn to accept past experiences and their current situation while they learn to manifest the internal peace needed for healthy change. 

The relationship between DBT and intense emotions

An inability to manage and tolerate intense emotions can lead to high-risk behaviors such as suicidal attempts. When an individual cannot regulate their emotions, they may be unable to reduce the intensity of their emotions when they are feeling them too deeply or are unable to feel any emotions when they are numb. DBT was initially used to help people suffering from suicidal behaviors and borderline personality disorders but is now used to help treat a wide spectrum of mental health and substance abuse disorders. Your therapists will work with you to identify and consciously choose behaviors that will help you manage impulses that would previously have led to self-destructive or relationship-destructive behaviors. The goal is to replace these unhealthy impulses with self-soothing and distraction behaviors that will help you to survive a future crisis such as a relapse or suicide attempt.

What are the goals of DBT?

DBT differs from cognitive behavioral therapy in that it has four main strategies:

  • Core mindfulness: Mindfulness focuses on your ability to be present at the moment.  
  • Distress tolerance: Distress tolerance works towards accepting negative emotions rather than trying to push them away. 
  • Emotion regulation: Emotion regulation helps individuals learn to manage difficult emotions instead of negatively acting upon them.  
  • Interpersonal effectiveness teaches individuals to interact with others respectfully and confidently, maintain self-respect, and build healthy relationships.

What should I expect from DBT?

DBT is a long-haul, meaning that it is often a months-long to a year-long process where both individual and group therapy sessions are required. Individual therapy DBT often involves 60-90 minute weekly sessions that occur with group sessions that allow you to practice skills like interpersonal communication in a supportive and safe environment. The group therapy component is important because a huge component of DBT has to do with interpersonal relationships.

What does DBT treat?

  • Borderline personality disorder 
  • Eating disorders 
  • Trauma 
  • PTSD 
  • Depression 
  • Bipolar disorder 
  • Suicidal ideation and behaviors 
  • Substance use disorder 
  • Self-harm behaviors

If you are struggling and curious to learn if these and other therapies can help, please call us anytime 24/7: (888) 629-6707


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