CBT vs. DBT Therapy: Key Differences

CBT vs. DBT: What's the Difference and Which Is Right for You?

If you’re looking for therapy to help you with difficult thoughts and emotions, you likely have come across CBT and DBT. You may be wondering what the difference is and which one is right for your goals.

In short, the main difference is that CBT helps you change unhelpful thought patterns that affect how you feel and act. DBT, which evolved from CBT, helps you accept and manage difficult emotions so that you can build skills to change unhelpful behaviors. 

If all of this sounds a bit overwhelming, be assured that you don’t have to make this choice alone. At SOL Mental Health, licensed therapists help match you to the right approach, whether it’s CBT, DBT, or a combination of both.

Key Takeaways:

• CBT and DBT are types of therapies that are backed by research. DBT is a more specialized version of CBT.
• CBT programs are usually shorter (around 12 to 20 weekly sessions), while full DBT programs are typically longer (around 6 months to a year)
• Evidence shows that CBT is most effective for anxiety, depression, obsessive compulsive disorder, phobias, and post-traumatic stress disorder. Evidence supports DBT for self-harm, borderline personality disorder, intense emotional dysregulation, and suicidal thoughts
• Many therapists use a combination of both CBT and DBT to provide the best care

What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (or CBT) is a structured talk-based therapy that focuses on changing disruptive thoughts. Because thoughts, feelings, and behaviors are often linked, this evidence-based approach is shown to be effective in treating conditions such as anxiety, depression, obsessive compulsive disorder, phobias, and post-traumatic stress disorder.

CBT was developed by renowned psychiatrist Aaron Beck in the 1960s. In the years since then, numerous research studies have backed its effectiveness in practice. In fact, it’s one of the most researched therapies in existence. 

CBT is designed to change behaviors by adjusting distorted thought patterns. This works by identifying an unhelpful thought, modifying it, then replacing it with another one.

Here are some examples of core CBT skills and techniques:

• Identifying automatic negative thoughts
• Cognitive restructuring
• Recognizing distortions
• Behavioral activation
• Gradual exposure
• Problem-solving

So what does CBT therapy look like? CBT is typically done in 12 to 20 weekly sessions lasting around 45-60 minutes each. Therapists assign homework or exercises (such as writing down your thoughts or behavioral experiments) in between sessions to help reinforce concepts and build skills.[1] 

What is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy (DBT) is a modified form of CBT designed to help people manage intense emotions. “Dialectical” means that two ideas can be true at the same time: that it’s possible to accept yourself as you are and still work on changing yourself.

DBT was developed in the 1980s by famous psychologist Marsha Linehan to help treat people who experienced borderline personality disorder, intense emotions, suicidal thoughts, and self-harm behaviors. It was designed as a special version of CBT to tackle concerns that CBT alone wasn’t fully addressing.

Compared with CBT, a full DBT program is more structured, more intensive, and requires more sessions. A typical DBT program lasts anywhere from 6 months to a year. It consists of weekly individual therapy, weekly group sessions, and potentially phone coaching in between the sessions.

It’s worth mentioning that many outpatient therapists teach DBT skills during standard individual therapy sessions, a practice called “DBT-informed therapy.”

Here are the four main DBT skill modules:

• Mindfulness: being grounded and present, instead of being overwhelmed and distracted by emotion
• Distress tolerance: being able to cope with intense emotions, without acting on urges that make things worse
• Emotion regulation: understanding, identifying, and turning down the intensity of emotions
• Interpersonal effectiveness: being able to communicate what you need with others without damaging the relationship

CBT vs. DBT: Key Differences

Because DBT is a more involved form of CBT, these therapies are often confused with each other. Not to mention, their acronyms are very similar. An easy way is to view CBT and DBT as “siblings”, where they complement and reinforce each other. 

Simply put, CBT focuses on thoughts, while DBT focuses on emotions. Both of these approaches, in the end, work to change behavior. The technical definitions themselves are not as important when choosing a therapist. What matters more are the approach, conditions, length of program, format, and evidence-based support. Therapists conducting talk therapy often pull skills from both types of therapy modalities. 

CBT’s core approach focuses on changing behavior by adjusting distorted thought patterns. This works by identifying an unhelpful thought, modifying it, then replacing it.

DBT’s core approach focuses on changing behavior by addressing difficult emotions. This works by accepting how you feel, then developing skills to help change behaviors. A dialectical perspective emphasizes that two things can be true at the same time, that you can accept the way you feel and also work to change yourself.

In summary, CBT’s goal is to get you to ask yourself, “Is the thought true and helpful?”, while DBT aims to get you to ask yourself “how can I get through these feelings without making it worse?”.

CBT has the strongest supporting evidence for treating conditions like anxiety, depression, obsessive compulsive disorder, phobias, and post-traumatic stress disorder.

DBT has the strongest supporting evidence for treating conditions like borderline personality disorder, intense emotions, suicidal thoughts, substance abuse, eating disorders, and self-harm behaviors.

CBT programs usually consist of 12 to 20 weekly sessions, which comes out to around 3 to 5 months in total.

In comparison, full DBT programs are longer and can take anywhere from 6 to 12 months to complete. DBT programs are longer because they address long-standing emotional and behavioral patterns, instead of just a single symptom cluster. 

CBT usually involves weekly individual therapy sessions with homework in between (designed to reinforce skills).

DBT usually involves weekly individual sessions, weekly group sessions, and phone coaching sessions in between. 

Many outpatient therapists also incorporate DBT skills into their standard individual therapy sessions (“DBT-informed therapy”), which overall is less intensive than a full structured DBT program. 

As one of the most studied therapies in existence, CBT’s efficacy has been backed by research ever since it was developed in the 1960s. 

A study by Mortina et al. in 2023 evaluated the effectiveness of CBT on social anxiety. They found that nearly 75% of the patients in their study reported positive results after completing a course of CBT. In addition, up to 98.5% of the study participants maintained those positive results in the following year.

Evidence supports the effectiveness of DBT for the treatment of specific conditions. For example, one study conducted in 2014 by Stiglmayr et al. found that 77% of BPD patients who participated in outpatient DBT no longer met the criteria for the condition after one year of therapy. 

Linehan’s study in 1991 examined the effect of DBT treatment on patients with BPD who had chronic episodes of self-harm. She found that after one year of DBT treatment, patients experienced less severe and fewer instances of self-harm and less inpatient psychiatric stays compared with patients who received standard non-DBT treatment. 

This section covered a lot of information, but you don't need to memorize all of these differences. The goal is to recognize and envision yourself in one of these two approaches.

CBT and DBT Examples: What Each Looks Like in Practice

Here are some examples of skills and techniques that you will encounter in CBT and DBT therapy, along with some real-world examples for each of them.

Keep in mind that the techniques introduced in this section are intended to be practiced with a therapist and shouldn’t be thought of as “one-off” solutions.

Thought Record

One of the most common exercises in CBT is keeping a thought record. This involves writing down a distorted thought and weighing the evidence that supports and contradicts that thought. 

For example, let’s say that you receive harsh feedback from your boss at work one day. You may have thoughts like “I always do a bad job at work, I’m horrible at this job.” With this exercise, you write down your thought, then list reasons that’s for and against it. Then you replace the thought with another one. So you might replace the previous thought with “I had a bad day and was tired, but last week my boss complimented my project. So, I know I’m capable of doing well at work.”

This helps you distance yourself from your thoughts and respond to them with facts and evidence rather than fear.

Graded Exposure (Fear Ladder)

This technique helps you learn to cope with stressful situations by slowly exposing you to your fears in a step-by-step fashion. For example, if you have social anxiety, you might begin by making eye contact with a cashier at the store, then progress to asking a stranger for directions. Next, you could move up to the next step by staying at a social event for at least 30 minutes. 

The key is that each step is progressively more difficult, so that you can gradually learn to cope with more challenging situations through prolonged exposure, instead of avoiding them.

Behavioral Activation

Behavioral activation involves scheduling small meaningful activities, like a short 10 minute walk, even when you’re not feeling motivated. For example, people with depression may not feel like doing anything and may just want to sleep in bed. However, with behavioral activation, you would schedule yourself to take a short walk, even if you don’t feel like it. 

This technique works because taking action can be followed by improved mood, which breaks the low-mood/inactivity loop.

TIPP (Distress Tolerance)

TIPP is a skill designed to “pump the emergency breaks” during situations where you experience intense emotions that make it hard to think clearly. For example, you might be feeling hurt after an intense argument and might have the urge to send a nasty message that you might end up regretting. To “pump the brakes” you can do things like splash cold water on your face, do paced breathing, or progressive muscle relaxation. 

This works by toning down your initial state of emotional arousal, so that you can manage your emotions and reduce the urge to act out on them. 

Opposite Action (Emotion Regulation)

This technique works exactly as its name implies – when you experience an unjustified emotion that urges you to take an action, you do the opposite. For example, if you feel ashamed or sad, your emotions might urge you to cancel plans and isolate yourself. You would then check whether the urge fits the facts, then take the opposite action. In this case, that would be going out and participating.

This works because it weakens the cycle where emotions feed on the particular behaviors they encourage.

DEAR MAN (Interpersonal Effectiveness)

This skill is a step-by-step framework that helps you ask for what you need from others without damaging the relationship. For example, you might want to ask your roommate to stop playing loud music at night. DEAR MAN stands for “Describe, Express, Assert, Reinforce, while staying Mindful, Appearing confident, and Negotiating.” Using this step-by-step process can help you express your needs in a way that maintains your relationship with your roommate.

This works by keeping the focus of the conversation on the request, instead of driving it towards conflict and disagreement. 

If you’re unsure which approach best fits your situation, you don’t have to figure it out alone. SOL’s team of licensed therapists can assess what’s behind your symptoms and choose the right approach for you, whether it involves CBT, DBT, or a combination. Appointments are often available the same week. 

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CBT or DBT: Which One Is Right for You?

Here are some signs that CBT might be the right fit for you:

• When your distress is driven by negative thoughts, rumination, or worry
• If you’re dealing with anxiety, depression, panic disorder, phobias, OCD, or insomnia
• If you’re looking for a structured, shorter-term, goal-driven process
• If you’re drawn to the idea of homework, exercises, and measurable progress

If you can relate to some of these things, it doesn’t mean that you’re locked into CBT as a treatment option. You can think of this list more as a starting point for your conversation with your therapist. 

Here are some signs that DBT might be the right fit for you:

• When you deal with emotions that hit hard, feel unbearable, and drive impulsive decisions that you regret later on
• If you find that your relationships are intense, unstable, or keep falling apart
• If you struggle with urges to self-harm or chronic suicidal thoughts
  • If you're in crisis right now, call or text 988 (Suicide & Crisis Lifeline)
• If you’ve tried talk therapy in the past and found that just “addressing thoughts” didn’t really fully tackle the problem 

If some of these things speak to you, it doesn’t mean that DBT is the only option. You can think of this list more as a starting point for your conversation with your therapist. 

Because DBT is a form of CBT, many therapists use a blend of both. Many of the techniques taught in DBT complement the ones learned in CBT. Therapists often integrate CBT, DBT, and other evidence-based approaches to design the most effective therapy program. With all this being said, your job is to recognize the need to find support. Your therapist will collaborate with you after their assessment to design a therapy approach, whether it’s CBT, DBT, or a mixture of both. 

Integrated care, where medications are used in combination with therapy, works best for certain conditions. Your care team with SOL helps coordinate integrated care under one convenient platform. 

What Treatment Looks Like at SOL Mental Health

After you’ve made your booking with SOL, you may be wondering what to expect. Before you get started, SOL does the hard work for you by verifying your insurance coverage. Most major providers are in-network with SOL, making the process even more streamlined. 

A licensed clinician will assess you to find out what’s driving your symptoms. This assessment helps them develop a collaborative treatment plan and match you to a CBT, DBT, or combination approach. Your treatment plan can be adjusted by your clinician, as needed. If integrated therapy with psychiatry is indicated, then it can be conducted with one care team under the same platform. 

During your program, SOL offers convenient options for in-person and video visits across CO, MD, NY, VA, and Washington, D.C. Appointments are offered the same week (and often the same day), helping make sure that your therapy visits fit into your schedule. 

“When a new patient asks whether they need CBT or DBT, I often tell them that both treatment modalities have tools to help them feel better and we’ll pull from both techniques as I get a better sense of what you are struggling with. If a patient displays a lot of emotional dysregulation in session, it’s a sign to start with DBT. However, if patients are in their head and I witness a lot of negative thoughts, I’ll start with CBT- in particular, thought identification. But ultimately I usually use a combination of both.” (Ruby Mehta, LCSW)

No matter whether CBT, DBT, or a combination is right for you, the first step remains the same - talking to someone who can help guide you. Book a same-week appointment through SOL, in person or by video.

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FAQs About CBT vs. DBT

Yes, DBT expands on the foundations of CBT by emphasizing mindfulness, acceptance, and emotional regulation. These skills can help people who struggle with intense emotions.

Many therapists incorporate a blend of both CBT and DBT to help their patients. This hybrid combines a CBT thought-based approach with DBT skills. Over time, the therapy may progress from focusing on a stabilizing DBT approach to more thought-based CBT work. 

Evidence supports the efficacy of CBT as the first-line (“gold standard”) treatment for anxiety and depression. DBT can be added if the patient struggles with intense emotional reactivity or self-destructive activity.

No. Although it was initially developed to treat BPD, DBT has been shown to be effective with other conditions as well, such as intense emotions, impulsiveness, eating disorders, substance abuse, and post-traumatic stress disorder. 

Patients in CBT programs typically notice improvements in 12 to 20 weekly sessions, with early changes noted at around 6-8 weeks in. Because full DBT programs are more involved, the timeline for improvement varies more than with CBT, but changes may be noticed around 6 to 12 months. 

As both CBT and DBT are standard evidence-based treatments, they are usually covered by most insurance providers. With SOL, all the hard work is done for you right from the start. SOL verifies your coverage before your first visit and coordinates in-network with most major insurance plans.

References:

1. Hofmann, S.G., et al. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. — https://pmc.ncbi.nlm.nih.gov/articles/PMC3584580/
2. Linehan, M.M., et al. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064. — https://pubmed.ncbi.nlm.nih.gov/1845222/ 
3. Stiglmayr, C., et al. (2014). Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study. Borderline Personality Disorder and Emotion Dysregulation, 1:20. — https://pmc.ncbi.nlm.nih.gov/articles/PMC4579507/
4. May, J.M., Richardi, T.M., & Barth, K.S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. Mental Health Clinician, 6(2), 62–67. — https://pmc.ncbi.nlm.nih.gov/articles/PMC6007584/
5. Chand, S.P., Kuckel, D.P., & Huecker, M.R. Cognitive Behavior Therapy. StatPearls, NCBI Bookshelf. — https://www.ncbi.nlm.nih.gov/books/NBK470241/
6. American Psychological Association. Cognitive Behavioral Therapy (CBT) for Treatment of PTSD. — https://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy
7. Cleveland Clinic. Dialectical Behavior Therapy (DBT). — https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt

Other References:

Chapman AL. Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont). 2006;3(9):62-68.

Wenzel A. Basic Strategies of Cognitive Behavioral Therapy. Psychiatr Clin North Am. 2017;40(4):597-609. doi:10.1016/j.psc.2017.07.001

Nakao M, Shirotsuki K, Sugaya N. Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosoc Med. 2021;15(1):16. Published 2021 Oct 3. doi:10.1186/s13030-021-00219-w

Heath N, Midkiff MF, Gerhart J, Turow RG. Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample. Psychother Res. 2021;31(8):1001-1011. doi:10.1080/10503307.2021.1878306

Morina N, Seidemann J, Andor T, et al. The effectiveness of cognitive behavioural therapy for social anxiety disorder in routine clinical practice. Clin Psychol Psychother. 2023;30(2):335-343. doi:10.1002/cpp.2799