Cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two popular psychotherapy treatments that can help with a variety of mental health issues. They share many similarities, but it is crucial to understand the differences. To understand the differences between CBT vs DBT, let’s start by explaining the former.
What is CBT?
Dr. Aaron Beck developed cognitive-behavioral therapy (CBT) after recognizing that many of his depressed patients experienced spontaneous, negative thoughts about themselves. Today, it is one of the most widely-studied theories in psychotherapy.
CBT is an evidence-based treatment that focuses on the relationship between your thoughts, feelings, and behaviors. Essentially, this practice believes that life isn’t a sum of what happens to us. Instead, it’s about what we think happens to us.
Therefore, CBT focuses on changing negative thoughts and behaviors. Ideally, by changing these thoughts and behaviors, you can start to feel better.
Typically, CBT is a short-term treatment- lasting between 6-10 sessions- and it tends to be direct and collaborative. Most therapists structure their sessions each week, and they often assign homework to reinforce skills in between therapy appointments.
What does CBT Treat?
Most commonly, therapists use CBT in treating anxiety and depression. However, CBT also treats other conditions, including:
- Social anxiety
- Panic disorder
- Negative or spiraling thoughts
- Feelings of hopelessness
- Relationship troubles
- Low self-esteem
- Substance use
- Eating disorders
Additionally, many therapists use CBT in conjunction with other therapeutic modalities, like Eye Movement Desensitization and Reprocessing (EMDR), person-centered therapy, or family therapy.
Popular CBT Interventions
CBT often involves many questions. These questions might include:
- What are your thoughts about what happened?
- What feelings did you have as a result of those thoughts?
- How has what happened affected your beliefs about yourself?
- How has what happened affected your beliefs about the world?
- What are the consequences of engaging in that particular action?
- What is a healthier way to respond to that situation?
Your answers can help you and your therapist understand patterns and triggers in your life. For instance, maybe you always feel anxious and frustrated after a phone call with your mother. To cope, you eat a few bowls of ice cream almost immediately after hanging up. By strengthening your insight on this cycle, you have more power to change it.
Understanding Cognitive Distortions
Cognitive distortions refer to unhealthy thinking patterns that impact your mood and behaviors. There are many cognitive distortions, and most of us struggle with them routinely. Some examples of cognitive distortions include:
- Dichotomous thinking: Assuming the extremes. Things are good or bad. You are perfect, or you are a failure.
- Catastrophizing: Assuming the worst-case scenario will happen.
- Personalizing: Assuming someone else’s behaviors are a direct reflection or response to you.
- Fortune-telling: Assuming you can predict what will happen in the future.
- Discounting the positive: Discarding positive news or emotions and only focusing on the negative elements.
- Overgeneralization: Assuming everything is one way based off a single shred of evidence or past example of it being that way.
CBT Thought Records
CBT thought records help people track their behavior, feelings, and thoughts. The goal is to help you pinpoint triggers and recognize healthier ways to cope with them.
These thought records are typically organized and written in the following format:
- Facts of what happened (who, what, where, when, and why)
- Your emotional and physical response to this event
- Did you have any physical signs of stress, such as elevated heart rate or sweating?
- Did you feel angry, sad, disappointed, or anxious?
- Were you placing unnecessary blame on yourself after this incident?
- What are unhealthy thoughts and behaviors that made up your initial reaction?
- Did you think about harming yourself or others?
- Did you enact any harm on yourself or others?
- Did you verbally or physically lash out?
- Did you make any faulty assumptions about other people in the situation?
- Did you do anything impulsive like use drugs?
- Try an alternative, healthy reaction.
- Try a breathing technique to calm down.
- Journal about your feelings to process them.
- Practice mindful meditation.
- Be creative: draw, paint, write, or play a musical instrument.
- Listen to music.
- Try physical movement, like going on a walk.
- Talk to a friend or loved one that you trust.
- Take a shower.
- Hug a pet.
- Do something productive to keep your hands busy.
- Write about your alternative thoughts & alternative behaviors.
- Indicate your current feelings.
CBT thought records strengthen awareness of automatic thinking. By “pausing” before your reaction, you can change your response. Instead of acting out in an unhealthy way, you can choose a different coping skill.
Doing this over time can strengthen your response system. Eventually, you can learn to replace maladaptive habits with healthier ones.
Thought tracking helps distinguish unhealthy thoughts from unhealthy ones. Eventually, you learn to ask yourself, “What are the automatic thoughts running through my head when something happens to me?
An example of an automatic thought is thinking, “I deserve to be punished” when you perceive something bad happens. A CBT therapist might encourage you to challenge this negative thought to see if you can reframe it in a more realistic view.
Thought tracking helps pinpoint the thoughts that can feed into a downward spiral. For example, instead of assuming that you deserve to be punished, you might shift that thought into:
- I am worthy and deserve better than this.
- That person’s actions have nothing to do with me.
- There is nothing I could have done to prevent that person from doing that.
- This situation is out of my control, and that is okay.
- I handled this the best way that I know how, and I will continue improving.
If you struggle with your mental health, you may struggle to slow the negative thoughts that occur to you on a daily basis. Thought stopping can help with this constant movement.
Thought stopping is a visualization technique. In some cases, you may verbally say, stop, when you experience a negative thought. In other cases, you may imagine a stop sign or even flick a rubber band on your wrist to remind yourself to “snap out of it.”
Downward Arrow Questioning
This therapeutic technique helps people reveal their underlying assumptions. It involves your therapist asking a series of different questions.
- Why do you feel like “I deserve to be punished?”
- What does that thought mean to you?
- What is your core belief? Some examples of core beliefs include:
- If you struggle with trusting people, do you believe that everyone will inevitably hurt you?
- If you struggle with lying, do you believe that you have to put up a facade to impress others?
- Are you mind-reading, or did they explicitly say that?
- Is there evidence for what you’re feeling, or does it only feel true?
We aren’t always aware of these underlying thoughts. CBT helps decode them. Recognizing our core beliefs and motivations helps us work through negative thoughts and reduce unhealthy responses.
Roleplaying Situations and Thoughts.
It’s often helpful for people to practice confronting uncomfortable situations with a trusted therapist. This exercise helps them imagine themselves in the scenario and effectively anticipate how to respond.
In roleplaying, you can work through their emotions in real time. The goal is to feel more prepared when navigating interpersonal situations.
Some examples of situations that might benefit from roleplaying include:
- Confrontation about an unhealthy relationship.
- Navigating a break-up.
- Quitting a job.
- Standing up for yourself to a loved one.
- Talking yourself through a situation where you want to act impulsively.
Is CBT Right For You?
CBT can be tremendously helpful in understanding the relationship between your thoughts, feelings, and behaviors. If you struggle with depression or anxiety, this method is one of the most well-known treatment modalities in mental health.
What is DBT?
Dr. Marsha Linehan originally developed dialectical behavior therapy (DBT) to treat suicidal and crisis behaviors. Linehan had a personal history living with borderline personality disorder. Her own experiences helped shape her approach to helping others.
DBT integrates the Buddhist principles of mindfulness with some aspects of CBT. This treatment helps people develop healthier self-perceptions and views of the world.
What Does DBT Treat?
DBT can be effective for people struggling with suicidal thoughts and self-harm tendencies. DBT is commonly used to treat borderline personality disorder. DBT can also help with:
- Eating disorders.
- Substance abuse.
- Early trauma.
- Relationship problems.
- Attachment issues.
Popular DBT Interventions
DBT often includes both individual and group components. Both components focus on strengthening self-awareness while teaching practical life skills. DBT is broken into four parts: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Mindfulness refers to being aware and conscious of the present moment. The practice of mindfulness is a large part of DBT, as it helps with emotion regulation and impulse control. People who are more mindful in their daily lives tend to feel happier and more stable.
Mindfulness exercises vary, but they all support you in learning how to raise insight into what you’re experiencing in real time. Some techniques include:
- Deep breathing.
- Proogressive muscle relaxation (tightening and releasing various muscle groups).
- Single-task chores or tasks.
At times, escaping from your emotions can feel impossible. Therefore, it’s important to learn how to deal with these emotions as they arise and before they lead to self-destructive behaviors. Emotion regulation skills include:
- Recognizing and naming emotions as you feel them.
- Exposing yourself to your emotions.
- Speaking about your emotions more objectively- rather than assuming they are “good” or “bad.”
- Sitting with emotions, rather than acting on them.
- Practicing problem-solving skills to reduce emotional pain.
This part of DBT focuses on distracting to avoid destructive behavior. To find different ways to practice distress tolerance, use the acronym A. C. C. E. P. T. S.
- Activities. Do something to keep your hands busy, like painting or writing.
- Contribute. Find ways to help others, like cleaning the house or cooking for someone.
- Comparisons. Aim to stop comparing yourself to others. Try meditation or self-affirmations.
- Emotions. Regulate your emotions by practicing mindfulness. Learn to identify your emotions and recognize how they impact your decision-making.
- Push away. Push away intrusive thoughts. Practice skills related to thought-stopping and reframing.
- Thoughts. Be mindful of your thoughts when they arise. Try to avoid being less judgmental of them. Keep a journal to track these thoughts to notice trends.
- Sensations. What do you physically feel in your body? Do these sensations tell you anything about yourself? Track your responses in your journal.
DBT also focuses on strengthening the relationships you share with other people. Interpersonal distress can increase emotional pain. That’s why these skills can be so critical. In DBT, you may work on techniques related to:
- Learning to ask for help.
- Building greater self-respect through positive affirmations and positive self-talk.
- Asserting your needs.
- Distinguishing unhealthy interpersonal dynamics in your life.
Is DBT Right for You?
DBT is suitable if you struggle with self-harm or suicidal thoughts and tendencies. It’s also been proven effective for those with personality disorders.
DBT is an action-based commitment. You must be willing to put in the work to receive the benefits. Make sure you talk with your healthcare professional to decide which treatment plan is best for you.
How to Find a CBT or DBT Therapist near You
If you’re ready to start therapy, it can help to talk with a trusted medical professional for a referral. Ask your doctor if they have any providers they recommend. It’s also important to understand the different types of mental health providers and which ones could be of help to you or your loved one.
You can also search for therapists online or ask friends or family for referrals. Remember that it’s okay to interview different therapists to find the right match. You want to find someone you can trust. This trust may take a few weeks to develop. Give them a chance to know you, and allow yourself to try new skills before dismissing them.
No matter your circumstances, CBT vs DBT can help you improve how you cope. Both practices can also help harness your self-esteem and increase your overall life satisfaction.