CBT vs DBT: What's the Difference?

The difference between cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) is that DBT is a more specific type of CBT.

Why was DBT developed then?

CBT is a generalized therapy program that can be modified to treat different conditions. However, some modifications are significant enough to warrant a specific name by themselves, like DBT.

Let’s look at the differences between DBT and CBT, and when each of them are typically used.

What is CBT?

CBT can be used for a wide variety of mental illnesses including (1):

• Depression
• Anxiety disorders
• PTSD
• Insomnia
• Eating disorders

It’s been proven to be more effective than most other treatment options for these conditions and several more. However, that doesn’t mean that a better treatment couldn’t be developed in some cases.

CBT can be tricky to understand, but essentially a therapist uses it to help a client identify maladaptive (negative) beliefs, examine them, and correct them.

For example, someone with anxiety may have incorrect beliefs about how others perceive them. These can be broken down and reshaped into more accurate beliefs that cause less anxiety.

While there are some limitations of CBT, there are many situations where it can be used effectively.

In addition, CBT can be combined with most other types of therapy to form a more comprehensive treatment plan.

What is DBT?

Dialectical behavior therapy (DBT) was developed by Marsha M. Linehan back in the 1980s (2).

It was specifically designed as a modified form of CBT in order to treat borderline personality disorder (BPD) and suicidal patients (3,4).

Research has shown that DBT can be more effective than CBT in patients with certain conditions beyond BPD as well. It’s mainly used in conditions where mood is a significant factor like:

• PTSD
• Depression
• Drug problems
• Traumatic brain injuries
• Eating disorders
• General mood disorders

The 4 Modules of DBT

While there’s still flexibility in DBT, it’s more structured than a general CBT program.

There are 4 main modules that are the focus of DBT.

Each module plays a critical role in treatment:

• Mindfulness - The foundation of DBT which teaches subjects to observe and examine emotions without judgment. It’s the first step in responding healthily to negative emotions.
• Acceptance and change - Typically addressed within the first few sessions of DBT. It focuses on accepting situations, thoughts, and emotions as they are, and then learning how to change them in a repeatable, effective process.
• Distress tolerance - This module focuses on dealing with periods of great distress (e.g. losing a job, death, illness, etc.). More specifically, distress tolerance involves learning to confront the discomfort during the periods and taking constructive actions, instead of avoiding them, which can exacerbate a condition like BPD.
• Emotion regulation - This module is meant to help a subject examine and control emotions (to a reasonable degree). Skills like mindfulness are necessary for this part of treatment.

What’s the Difference Between CBT and DBT?

CBT is a great general therapy for those with mental disorders.

New research keeps finding new conditions that it can be applied to effectively. However, it’s naïve to think that general CBT is right for everyone, which is why researchers are creating modified versions like DBT that can be applied in specific situations.

When is CBT or DBT the Right Treatment?

CBT is the more popular and well-known treatment protocol in most situations regarding mental health.

More research is needed to know exactly when DBT should be chosen over CBT. Some research shows that they have a similar effect in certain populations, so the choice may just come down to patient preference or treatment availability.

In general, DBT is typically prescribed over CBT for borderline personality disorder, but more research is still needed for most physicians to prescribe it for other conditions. However, if initial CBT treatment isn’t successful, following it up with DBT is a possibility.

References

1. Cognitive–behavioral therapy
2. Dialectical Behavior Therapy
3. Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients
4. Naturalistic Follow-up of a Behavioral Treatment for Chronically Parasuicidal Borderline Patients