Deciding to make contact with a counselor, therapist or psychologist is an important first step. But once that connection has been made, it’s also important to find the right kind of therapy that would work best for you. Two popular forms of psychotherapy are dialectical behavior therapy (DBT), and cognitive behavior therapy (CBT). Both forms of therapy share some overlap in treatment approaches, but there are differences between CBT and DBT—understanding both therapies can better help determine your right next steps.
What is cognitive behavior therapy?
Cognitive behavior therapy is a form of talk therapy pioneered in the 1960s by a psychiatrist in Pennsylvania. “CBT is an umbrella term of therapies that focus on teaching skills to help with thoughts, feelings, and behaviors and the relationship between the three,” explains Jessica Stern, PhD, a clinical psychologist and clinical assistant professor of psychiatry at NYU Langone Health, in New York City. “There are many types of CBT—ones focused on depression and anxiety, a version focused on ADHD, and others for psychosis, bipolar disorder, and even health-related conditions, like chronic pain and smoking cessation.” People can use CBT as their only form of treatment or it can be combined with others, including medications.
What is dialectical behavior therapy?
Dialectical behavior therapy is a more specialized and intensive form of CBT. Because of this, you might see some similarities in the treatment approach. Where they differ is who DBT helps and the steps the therapist and the client take. “DBT was born out of CBT with a more specific aim and approach,” Dr. Stern says. “It is focused on helping individuals manage difficult emotions that can feel very overwhelming as well as navigating difficult or emotional social relationships. It incorporates a lot of mindfulness and learning to manage distress and is based on the concept of “dialectics,” which refers to balancing two seemingly opposite experiences at the same time. In DBT, this is used to balance changing difficult situations and emotions with also accepting them.”
What are the differences between CBT & DBT?
Because DBT was born from CBT, there are many similarities, but there are key differences as well. The first is how long the therapy usually lasts. According to Dr. Stern, most people who try CBT usually go for therapy for three to six months. DBT, on the other hand, can last for up to two years. Another difference? Most of the time, CBT is individual therapy—one-on-one treatment with a therapist. DBT uses this approach as well, but—depending on the therapist—DBT often combines individual therapy with group therapy and between-session coaching. “When group therapy is used, it often focuses on teaching the skills of the treatment (emotional regulation, interpersonal effectiveness, etc.), while the individual therapy component focuses on individualizing those skills and checking in on progress,” Dr. Stern says. “Oftentimes, the group therapy experience can be as powerful as clients can learn from their peers what works and how to practice with one another.” Both approaches rely on the person’s own work on practice assignments, even leveraging homework. “Research has consistently shown that much of the progress in therapy occurs and is solidified between sessions through these assignments,” Dr. Stern points out. “Homework allows people to apply what they learn in sessions to everyday life and collect information from everyday life and bring it into session.” Another difference between the two approaches lies with the therapy focus. CBT emphasizes the thoughts associated with the troubling issues. DBT, on the other hand, focuses on the associated emotions and how the issues affect you socially. “DBT seems to work best for people who are experiencing extreme emotional reactions to their environment. It was first developed to help patients who had a borderline personality disorder, but now is used with people who are cutting themselves (self-harm), thoughts of suicide and sexual assault survivors, to name a few.”
Common CBT techniques (and what they’re used for)
“CBT can be used for many types of people and struggles,” Dr. Stern explains. “There are specialized versions for depression, anxiety, posttraumatic stress disorder (PTSD), chronic pain, psychosis, bipolar disorder, attention deficit hyperactivity disorder (ADHD), anger management, and more.” She also points out that although DBT was initially developed to help people who had suicidal thoughts and tendencies, there is a form of CBT for suicidal ideation, so there is overlap between the two therapies. CBT techniques vary a bit to suit each person who needs it. The most common ones involve keeping a journal, learning relaxed breathing and physical relaxation, and unraveling cognitive distortions. This means identifying something that may not be true, as in “everyone thinks I’m an idiot,” in response to a bad job review. A CBT practitioner may also help their clients learn how to face the painful issues by replaying them in a safe environment and change their responses for a different outcome. Other reasons to try CBT include seeking help for:
Managing stressCoping with emotions that seem to be out of controlManaging symptoms caused by mental illnessLearning how to communicate better or manage conflicts with othersCoping with lossManaging addictions or substance use disordersManaging eating disorders
Common DBT techniques (and what they’re used for)
DBT practitioners also tailor their techniques to suit each patient. If you choose to try DBT, the four common techniques teach: mindfulness (being in the present), how to communicate effectively with the people around you, how to tolerate feelings of distress, and how to regulate emotional responses to events and feelings. “For individuals who may benefit from more than just once-weekly sessions, have chronic suicidal ideation or self-harming tendencies (cutting, burning, etc.), have strong emotions that feel uncontrollable, and/or have a borderline personality disorder, DBT may be a better fit,” Dr. Stern says. “For individuals with anxiety or depression, PTSD or several of the other indications, CBT may be a better fit. Given the overlap, a professional assessment can help determine which may be more suitable.”
How to find the right therapy approach
CBT vs DBT for anxiety
Deciding whether to use CBT or DBT for anxiety is not a decision you must make alone. Finding the right type of therapy is a team effort. That being said, CBT tends to be more effective for treating anxiety. “CBT focuses on looking at thoughts, feelings, and behaviors, which can help with anxiety by managing thoughts and feelings,” Dr. Stern explains. There is also another treatment, based on CBT, called Acceptance and Commitment Therapy, or ACT, which Dr. Stern says is also effective for managing anxiety.
CBT vs DBT for bipolar or schizophrenia
If you’re seeking help for bipolar disorder, DBT may be the way to go, especially if the therapy accompanies medications. DBT can help you manage the behaviors caused by bipolar disease. Likewise, several small studies with people with schizophrenia have found that through the “adaption of DBT to target specific symptoms … patients were aided in achieving a better quality of life.” In both cases, it’s always best to discuss with your doctor the right therapy approaches that work in your unique situation.
Can these therapies help you?
It can take some trial and error to find the right type of therapy. There needs to be a good fit between client and therapist, and client and therapy. Not finding the right therapy at the first try is not a failure, it’s ruling out what doesn’t work—and then you go on to try another type. “It can be helpful and empowering for a potential client to ask a therapist how [they] determine which is the most suitable treatment plan,” Dr. Stern says. “This allows the client the opportunity to hear the therapist’s thought process and to ensure that the therapist understands the client’s experience and needs thoroughly and thoughtfully.” Dr. Stern also recommends asking the therapist about the expected outcomes of treatment, and how they’ll decide if the therapy is reaching its goal. Finally, if you are in therapy and you don’t feel like it is helping, speak to your therapist about your concerns, and see if you can explore other approaches. You and your therapist are a team. Working together improves your chances of success. Up next, 10 of the best movies made about mental health.
Sources
Jessica Stern, PhD, clinical psychologist and clinical assistant professor of psychiatry at NYU Langone Health, in New York CityBeck Institute: History of Cognitive Behavior TherapyAmerican Psychological Association: What Is Cognitive Behavioral Therapy?Psychology Today: Dialectical Behavior TherapyUniversity of Washington: Dialectical Behavior TherapyPositivePsychology.com: 25 CBT Techniques and Worksheets for Cognitive Behavioral TherapyBYU Undergraduate Journal of Psychology: Dialectical Behavior Therapy as Possible Treatment Modality for Schizophrenia
