Two of the most commonly used, evidence-based forms of psychotherapy include cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT). While CBT and DBT are both designed to enhance the quality of life for clients, they do so in different ways. Broadly speaking, CBT provides clients with helpful strategies to alter unhealthy thought and behavior patterns, whereas DBT strengthens clients’ acceptance of their experiences to, ultimately, help them regulate potentially destructive behavior. This aspect of acceptance is one of the key differences between CBT and DBT.
Individuals may seek out therapy to address a wide range of situations and concerns. Yet, because there are certain circumstances where either CBT or DBT may not be appropriate, it can be helpful for individuals to have a basic understanding of each therapy before entering treatment. Furthermore, the presence of self-destructive behavior, as well as the intensity of such behavior, can serve as a basis for what type of therapy may be the most effective for a client.
At Wisconsin Wellness, we offer both CBT and DBT as part of our many outpatient treatment program options for clients. Within the state of Wisconsin, we are the premier behavioral health treatment practice because we place our clients first. Due to our commitment to using evidence-based practice and trauma-informed care, we can address a wide variety of presenting concerns that clients may be facing. Meanwhile, learning more about CBT and DBT in treatment can be especially valuable for potential clients, as it will allow them to understand what to expect from these modalities at our treatment facility.
A Brief Overview of Cognitive-Behavioral Therapy (CBT)
Before pinpointing the key differences between CBT and DBT, it can be helpful to address each therapy separately. First, CBT is a type of talk therapy (psychotherapy) that combines aspects of cognitive therapy and behavior therapy. Cognitive therapy brings focus to maladaptive thought patterns and how to alter them, whereas behavior therapy teaches individuals how to replace harmful behaviors with healthier ones. In bringing both of these types of therapies together, CBT helps clients change destructive ways of thinking to inform healthy behavior change.
According to the publication Cognitive Behavior Therapy by authors Chand, Kuckel, and Huecker, CBT was originally developed by the American psychiatrist Aaron Beck in the 1960s. In his practice, Beck began to notice parallels in the clients he was seeing with depression, specifically that these clients shared distorted cognitions. Thus, CBT was created in an effort to help clients identify these cognitive distortions and to provide effective strategies for modifying them.
As the aforementioned publication explains, “CBT is based on a straightforward, common-sense model of the relationships among cognition, emotion, and behavior.” In the CBT model, three aspects of cognition are addressed. These include:
- Automatic thoughts: Consists of the thoughts that automatically surface in an individual’s mind when navigating daily life. These thoughts are unpremeditated and habitual and can be either positive or negative.
- Cognitive distortions: Consists of internal mental filters (often errors in logic) and biases that affect thought patterns in negative ways. Some examples of these thoughts include all-or-nothing thinking, labeling, jumping to conclusions, and discounting the positive.
- Underlying beliefs or schemas: Consist of the beliefs that an individual has about themselves, others, and the world around them. In CBT, underlying beliefs or schemas are categorized into core beliefs and intermediate beliefs.
Furthermore, CBT is structured and goal-oriented. It requires a therapist and client to work together collaboratively to identify specific patterns of cognition and associated behavior that stir internal conflict. Once these patterns are effectively identified, the therapist can provide the client with suggestions for modifying these patterns over time.
One of the core components used in CBT is cognitive restructuring. According to the American Psychological Association (APA), cognitive restructuring is a technique used “to help the client identify their self-defeating beliefs or cognitive distortions, refute them, and then modify them so that they are adaptive and reasonable.” Other techniques that are often used in CBT include guided discovery, exposure therapy, relaxation, and thought-stopping, among others.
A Brief Overview of Dialectical Behavior Therapy (DBT)
Like CBT, DBT is also a type of talk therapy (psychotherapy) that utilizes components of cognitive therapy and behavior therapy. Yet, DBT is unique in that it encourages clients to foster radical acceptance of their experiences. By implementing radical acceptance into the present moment, clients will generate the self-esteem and mindfulness needed to become more aware of maladaptive behaviors and, thus, work to adjust them accordingly.
As explained in Psychiatry (Edgmont), DBT initially developed as a treatment for borderline personality disorder (BPD) and associated suicidal behavior. However, since its development, its use has expanded to treating many different conditions and symptoms. DBT is particularly valuable for helping individuals manage intense emotions and symptoms due to its utilization of mindfulness strategies.
Additionally, the aforementioned blog notes that there are five functions of DBT treatment. These five functions include:
- Enhancing capabilities: Involves improving essential life skills. The following four skills are also highlighted as the four main principles of DBT:
- Mindfulness skills
- Interpersonal effectiveness skills
- Emotion regulation skills
- Distress tolerance skills
- Generalizing capabilities: Involves generalizing treatment lessons to the individual’s life outside of treatment
- Improving motivation and reducing dysfunctional behaviors: Involves enhancing clients’ motivation to change while also eliminating maladaptive behaviors
- Enhancing and maintaining therapist capabilities and motivation: Involves continued support, training, and encouragement for DBT therapists to sustain motivation for treating clients
- Structuring the environment: Involves curating both treatment environments and client environments outside of treatment in a manner that promotes progress rather than in a way that reinforces maladaptive behavior
Furthermore, as explained above, there are four main principles of DBT. The publication Dialectical Behavioral Therapy for Adults with Mental Illness: A Review of Clinical Effectiveness and Guidelines by authors Peprah and Argáez details each of these four principles, stating:
Mindfulness skills emphasize observing, describing, and participating in the present moment efficiently and without judgment. Interpersonal effectiveness skills range from acting assertively to maintaining self-respect. Emotion regulation skills include strategies for changing emotions and the tendency to respond with appropriate emotions. Distress tolerance skills are strategies to control impulsive actions and to radically accept difficult life events.
In working to enhance these capabilities, individuals living with severe emotional symptoms can learn how to understand and accept difficult feelings rather than resist or avoid them.
Similarities of CBT and DBT
On the one hand, it is important to understand that CBT and DBT share many similarities. For instance, both are types of psychotherapies, which involve engagement in collaborative discussion between a client and a therapist. Additionally, both therapies can help individuals better understand how highly interconnected their cognitions, emotions, and behaviors are. In gaining awareness of these connections, clients can also gain insight into the underlying factors that are informing continued distress in their lives.
Furthermore, both CBT and DBT are present-focused therapies that provide clients with skills that they can actively apply to their daily lives. They help clients address maladaptive behaviors and, in turn, work to adjust them, yet they do so in different ways. This aspect of treatment is where these therapies begin to blossom into their own unique approaches to growth and transformation.
Highlighting the Differences Between CBT and DBT
Understanding the differences between CBT and DBT can help individuals feel more confident in selecting an approach that fits their unique needs and goals for treatment. Nevertheless, it can be helpful to understand that treatment professionals will work alongside each individual during this process of treatment selection, ensuring that treatment is customized to the individual’s specific circumstances.
Emphasis of Treatment Approach
As mentioned previously, the main difference between CBT and DBT is that DBT encourages clients to cultivate acceptance of themselves and their life experiences to enhance emotional regulation. CBT, on the other hand, encourages clients to modify negative thoughts and emotions to improve cognitive functioning and inform behavior change.
Additionally, in contrast to CBT, DBT also emphasizes the role of relationships in wellness. Emotional instability and poor interpersonal skills can undoubtedly increase the intensity and frequency of relational conflict. Fortunately, DBT’s emphasis on cultivating interpersonal effectiveness alongside emotion regulation and distress tolerance skills specifically works to improve relationships. As individuals learn how to set boundaries, assert personal needs, and strengthen their communication skills, they will feel more confident in their ability to build healthier interpersonal dynamics with friends, family, and other loved ones in their lives.
Meanwhile, these unique emphases of treatment are not the only differences between CBT and DBT.
Time Commitment
Another notable difference between CBT and DBT is time commitment. More often than not, DBT involves more comprehensive engagement in treatment compared to CBT. This is to ensure proper and lasting skill development for clients. CBT is often used as a short-term approach to behavior change, whereas DBT can require a lengthier commitment to treatment. Sessions may also be longer in duration for DBT. In addition, CBT typically consists of individual psychotherapy sessions, whereas DBT often consists of both individual psychotherapy and group psychotherapy in tandem.
Goals for Treatment
Yet another difference between CBT and DBT is their unique goals for treatment. The main goals of CBT include identifying and modifying destructive cognitions and implementing solution-oriented strategies to bring about positive change in daily life. Meanwhile, the main goal of DBT is to help clients regulate their emotions more effectively using mindfulness strategies which, in turn, works to enhance self-esteem, relationships, and overall quality of life.
Factors to Consider When Choosing Cognitive-Behavioral Therapy (CBT)
As highlighted in the aforementioned publication Cognitive Behavior Therapy by authors Chand, Kuckel, and Huecker, CBT was originally developed to treat cognitive distortions that are commonly experienced in those struggling with depression. Yet, “Since then, it has been extensively researched and found to be effective in a large number of outcome studies for psychiatric disorders including depression, anxiety disorders, eating disorders, substance abuse, and personality disorders.” Additionally, as the publication points out, CBT is also effective when used alongside medication when treating serious mental disorders. Furthermore, it is not only beneficial for adults but also for children, adolescents, couples, and families as a whole.
Like every therapy, CBT does have its limitations. For instance, CBT may not be the right treatment option for those who are continuing to endure the long-lasting effects of untreated trauma. This is because, during CBT sessions, strong emotional states may be invoked. As a result, those with complex trauma may find it difficult to feel safe or comfortable confronting their emotions or errs in cognition. Rather, for those seeking recovery from trauma, therapies such as eye movement desensitization and reprocessing (EMDR) may be more effective.
Meanwhile, the publication titled In Brief: Cognitive Behavioral Therapy (CBT), published by the Institute for Quality and Efficiency in Health Care (IQWiG), provides specific advice for those wondering whether or not CBT could be beneficial for their unique circumstances. As the publication states, “To really benefit from cognitive behavioral therapy, you have to be committed and willing to put in enough effort. The therapy can only help if you actively take part in it, you are open and honest with the therapist, and also work on your [concerns] between the sessions.”
When Dialectical Behavioral Therapy (DBT) Could Be More Beneficial
Some situations and symptoms may respond better to DBT treatment compared to CBT treatment. For example, when self-destructive behaviors are present, DBT may be a more effective treatment option. Self-harming behaviors such as cutting, suicidal ideation, suicide attempts, and eating disorders may all respond better to DBT. Although attempts of self-harm may be misunderstood by many, these attempts often stem from an inability to self-regulate. Thus, DBT can be beneficial as it can help clients understand the underlying motives for their behavior and, thus, promote healthier and worthwhile coping strategies.
Indeed, DBT also does have its limitations. For instance, DBT may not be the best fit for clients who experience rigid thought patterns. In this case, CBT may be a better fit. Additionally, individuals who are enduring severe symptoms of psychosis, learning disabilities, or other cognitive impairments may not respond well to DBT. It is also not specifically targeted to address trauma or post-traumatic stress, though it may be helpful in reducing self-medicating or other maladaptive behaviors in an attempt to cope.
As with CBT, it is important that individuals engaging in DBT are also committed to changing their behavior. While working with a therapist during sessions can foster great change, clients must be prepared to apply the lessons that they are learning in treatment directly to their daily lives to experience its benefits.
Incorporating CBT and DBT In Treatment at Wisconsin Wellness
At Wisconsin Wellness, we are committed to incorporating a wide variety of therapeutic tools and modalities to foster client wellness. While both CBT and DBT provide valuable benefits for mental health treatment, it is important to consider that these approaches are not the best fit for every client. Because we prioritize individualized care, we work with our clients to ensure that the modalities we implement into treatment plans are customized to address their unique needs and recovery goals. In addition to CBT and DBT, some of the other treatment approaches we offer as part of our outpatient treatment programs include:
- Acceptance and commitment therapy (ACT)
- Anger management
- Accelerated resolution therapy
- Biofeedback
- EMDR
- Mindfulness-Based Stress Reduction
- Motivational Interviewing
- Neurofeedback
- Play therapy
- Rational emotive behavior therapy
- Somatic experiencing
- Holistic modalities, including breathwork and mindfulness
Meanwhile, we recognize how challenging it can be to determine best-fit treatment approaches for our unique life situations. For this reason, we foster client-therapist collaboration when crafting treatment plans. This allows clients to voice their wants, needs, and aspirations for the treatment journey while also gaining a better understanding of what each therapeutic modality can do for healing.
No matter what an individual may be seeking healing from, we at Wisconsin Wellness want to walk alongside and guide them as they work to enhance and improve their lives in the way they are striving for.
Cognitive-behavioral therapy and dialectical behavior therapy are two of the most commonly used psychotherapies. Despite how similar they sound and the many elements they both share, CBT and DBT also have distinct differences. For example, CBT uses cognitive restructuring techniques to help individuals identify and modify maladaptive cognitions and behaviors, whereas DBT promotes acceptance and mindfulness skills to facilitate behavior change. Additionally, CBT can be effective in treating a wide variety of symptoms and diagnoses characterized by cognitive distortions. DBT, on the other hand, may be more effective for treating severe emotional disturbances and self-destructive behavior. At Wisconsin Wellness, we are committed to helping clients develop individualized treatment plans to overcome life’s challenges. Learn more by calling (920) 404-2100 today.