Cognitive behavioral therapy, or CBT, and dialectical behavioral therapy, or DBT are both common models of psychotherapy used to treat a range of conditions, including anxiety, depression, and addiction. Each has its uses and they may be used together or separately. In fact, DBT is a specific form of DBT, so in a sense, they are always done together. Here’s what distinguishes DBT from regular cognitive therapy.
They were developed for different purposes.
DBT was developed specifically to treat people with borderline personality disorder, which is characterized by volatile emotions and interpersonal conflict. Because of this, self-acceptance, validating emotional experiences, and regulating emotions are all heavily emphasized in DBT.
Traditional CBT is very change focused. Patients learn to identify unhealthy, distorted thinking and replace it with healthier, more objective thinking, a process called cognitive restructuring. CBT also emphasizes behavioral change. The creator of DBT, Marsha Linehan, found that her patients resisted the change-focused approach of CBT and so she began incorporating elements like mindfulness and acceptance as a way of validating her patients’ current emotional experiences. The “dialectical” element of DBT comes from this attempt to strike a balance between acceptance and change.
DBT is more structured.
CBT is a bit like a psychotherapeutic toolbox. A patient comes in with a certain problem and the therapist can select certain cognitive restructuring techniques or behavioral learning techniques to help the patient solve the problem. They usually meet once a week, and the patient will practice using using the new technique between sessions. Although CBT protocols are fairly standard, which ones the therapist decides to use depends on the patient’s particular issues. DBT is more of of a boxed set of specific CBT techniques and everyone receives the same basic treatment regardless of his or her condition. These include mindfulness skills, interpersonal effectiveness, distress tolerance, and emotional regulation. These skills are especially useful for the kinds of issues DBT was developed to treat, such as borderline personality disorder, impulse control problems, suicidal thoughts, eating disorders, complex PTSD, anger management problems, and addiction. A CBT therapist will meet with you once a week and assign homework for you to do between sessions. However, in DBT, you will meet twice a week, once individually and once with the group. You may also be encouraged to contact your therapist during the week if you are having trouble. Since DBT is often used to treat people with impulse control issues, such as emotional outburst and addiction, it’s often helpful, or even necessary, to have a lifeline between sessions, in much the same way someone in AA can call her sponsor if she wants to drink.
DBT focuses more on acceptance.
Of the four main components of DBT–mindfulness skills, interpersonal effectiveness, distress tolerance, and emotional regulation–two of them, interpersonal effectiveness and emotional regulation, focus on change, while the other two, mindfulness and distress tolerance, focus on acceptance. This grew out of a need for patients to feel validated in their emotional experiences, but these patients’ increased emotional reactivity also makes it less likely that cognitive restructuring alone will be 100 percent effective. Because emotional reactions can escalate so quickly, they have to learn to tolerate emotional distress long enough to employ techniques of emotional regulation and interpersonal effectiveness. For example, if you suddenly feel overwhelmed with anger, it’s hard to stop and challenge the thoughts behind that anger. A more practical strategy might be to focus on the physical sensations of the anger, or practice deep breathing.
DBT includes a group element.
Typically, DBT will include one individual session and one group session per week. The patient covers specific issues with the therapist individually and then practices core DBT skills in the group session. DBT includes a group element because volatile emotions often lead to stormy relationships. Emotional swings don’t happen in a vacuum; they depend on context, especially social context. Learning interpersonal effectiveness and other skills is more effective in the context of a group, where members can practice new skills in a supportive environment. The group sessions make DBT especially well suited to treating addiction. Many of the pressures people face while recovering from addiction are social. These might be general, like normal family conflicts or interpersonal stress at work, or they may be more specific to addiction, such as friends pressuring you to use again. Practicing DBT skills with the group better prepares you to face those pressures after leaving treatment. It also helps you improve your relationships with supportive friends and family. Having a strong support network is one of the most important ways of protecting yourself from relapse.
DBT takes longer.
CBT focuses on specific problems. Therapists meet with patients once a week and therapy typically lasts several months. Once the protocol is finished, the patient has the skills to handle the problem going forward. In DBT, on the other hand, patients come twice a week-once for individual and once for group–and therapy may last six months or a year. There are two main reasons for this. First, DBT teaches a suite of skills, whereas CBT may only focus on one or two. It naturally takes longer to learn four core skills than one. Second, patients receiving DBT typically suffer from more severe conditions–borderline personality disorder, addiction, severe eating disorders, complex PTSD, and so on. These conditions are more deeply rooted or have an organic component that simply makes them harder to treat. Regardless, DBT has been shown to be effective in treating these conditions.
Both CBT and DBT are effective.
Both CBT and DBT are backed by extensive research and are effective ways of treating many different conditions. Which form of therapy you use will depend on your specific situation and a skilled therapist can help you decide which is likely to work better for you.
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