Is CBT Better than DBT? 

Welcome! If you’re one of the many people confused about the differences between Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), then you’re in the right place! In this blog, I’ll review common questions that come up when deciding between CBT and DBT. Hopefully, these questions can lead you to a better understanding of what makes sense for you and what will help you meet your goals. If you’re considering DBT for teens, see our guide on who benefits most and how it works.

Is CBT better than DBT?

Great question! First, let’s break down the differences between these two modalities. CBT is based on the principle that we have distortions in our thinking that get in the way of how we perceive reality. Your therapist will challenge you to refrain from maladaptive thinking, which can look like seeing the world in black and white or assuming the worst option is the most likely one to occur. While we work to change how we look at, and ultimately think about our realities, CBT then guides us in how to change our behavior in a way that better suits our therapy goals. CBT is most often conducted individually in 60-minute sessions. In the research, CBT shows the most efficacy in treating depression, anxiety, specific phobias, and generalized stress. 

DBT includes parts of CBT in that it encourages reframing and challenging of negative thoughts that get in the way of perceiving reality as it is. However, where DBT differs is the emphasis on the balance between acceptance and change of our emotions, thoughts, and behaviors. This principle is based on the belief that, as people, we are both doing the best that we can and, at the same time, also need to work harder to get the things we want. DBT offers individual therapy sessions that are 60 minutes long, as well as a weekly group dedicated to skills and how to apply them. DBT additionally offers phone coaching for problem-solving outside of your therapy sessions. In the research, DBT shows the most efficacy in treating Borderline Personality Disorder, complex trauma, and suicide/self-harm behaviors. Learn more about what DBT for teens looks like here.

Deciding which approach best works for you is an individual choice that is based on what you most want to get out of treatment. Your relationship with your therapist continues to be, by far, the main factor that research has shown to be effective in any treatment. If you’re unsure of which approach might be best for you, consult with a therapist who can assess your needs and help you decide which direction makes the most sense for you. 

Can I do DBT therapy on my own?

The short answer is no, not if you’re looking to learn and experience the full extent of what DBT offers. While you can absolutely learn and practice DBT skills on your own, DBT is designed to be most effective when you have guidance. By doing DBT with a clinician, you get accountability towards your goals and individualized support, where you can get real-time feedback. Furthermore, you can get emotional safety when practicing skills that are designed to help alleviate, tolerate, or change intense emotions. Learning skills on your own can be a great way to start learning more about your own mental health. However, without professional support, the path towards long-lasting change can be slow and challenging, when it doesn’t have to be. 

What are 7 crucial DBT strategies?

DBT categorizes its skills into four different modules: Distress Tolerance, Mindfulness, Interpersonal Effectiveness, and Emotion Regulation. These modules offer different skills that seek to improve our ability to experience the present moment, tolerate distressing emotions, change or accept our emotions, and maintain healthy relationships. Here are a few examples of skills you can expect to learn in DBT treatment. 

  • Dialectics: Dialectics is the D in DBT. This is a strategy all DBT providers use and teach for learning how to accept the nuances of the world and the experiences we have within it. Dialectics tells us there is truth within the many ways you can look at something. It allows for us to balance acceptance with change in our behaviors – whether that is seeking to accept our big emotions that come up or looking to change how we exist in this world.
  • Life Worth Living: Another concept unique to DBT that is central to the therapeutic process and reflects your ultimate goal in treatment. Finding your life worth living means identifying what is needed to create a life that feels meaningful, fulfilling, and worth living despite the difficulties we might face. Building this kind of life takes work and involves learning and practicing the four modules of DBT. With a goal in sight, the challenges of growing and learning new skills can take on a new purpose.
  • Wise Mind: A widely known DBT skill that helps us find our inner wisdom and helps us make decisions that fit into our life-worth-living goals. Wise mind uses the concepts of Emotion Mind and Reasonable Mind, two polar ends where emotions rule our decisions or where facts and reason take charge, despite how we might be feeling. When in either of these two places, we miss important parts of the equation, maybe we lash out in anger when in Emotion Mind, or stick rigidly to “how things should be” when in Reasonable Mind. Wise mind is when we blend the two together, seeking balance over extremes.
  • Radical Acceptance: A distress tolerance skill that asks us to fully accept reality for what it is, no matter how painful or distressing, rather than fighting against it. This skill is about acknowledging what is, without wishing things were different. This doesn’t mean we approve or give up, but accept what reality is so we can move forward with less suffering.
  • TIPP: A distress tolerance skill that uses our body’s chemistry to change our emotional state when experiencing intense emotions. TIPP is an acronym for multiple skills that each work to change our physical state, at least for a moment, to possibly help us move towards more effective behaviors or skills. TIPP stands for:
    • Temperature
    • Intense Exercise
    • Paired Musical Relaxation
    • Paced Breathing
  • Checking the Facts: An emotion regulation strategy that helps us evaluate whether our emotions are matching up with reality around us. It guides us in identifying the emotion that we’re experiencing so we can respond in a way that meets our goals. Checking the facts acts as a foundational skill where, once we know whether an emotion does or does not fit the facts (or meet what reality is), then we work to change it or problem-solve the cause of it.
  • DEARMAN: An interpersonal effectiveness skill that helps us get what we want or say no when we need to. DEARMAN is an acronym of a set of skills that guides us in focusing on key elements in getting to our goal in a conversation.
    • Describe the situation.
    • Express your emotions
    • Assert your needs or desires
    • Reinforce the positive outcome of meeting your request
    • (Stay) Mindful or focused on your goal
    • Appear confident
    • Negotiate if necessary

 

Why do therapists recommend DBT? 

DBT is recommended because of the long-standing research backing its effectiveness in treating intense emotions and complex behavioral concerns. DBT asks us to balance acceptance of who we are and what we deal with, while also giving us the tools to change the behaviors that get in the way of our life worth living. Discover what teens really need from DBT in this detailed guide.

Resources 

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-440. doi: 10.1007/s10608-012-9476-1. Epub 2012 Jul 31. PMID: 23459093; PMCID: PMC3584580.

National Collaborating Center for Mental Health (2009). Borderline personality disorder: The NICE guideline on treatment and management. Leicester/ London: The British Psychological Society & The Royal College of Psychiatrists.