There are many types of therapy currently in practice, and some sound very similar. For example, cognitive behavioral therapy, or CBT, and dialectical behavior therapy, or DBT, have many aspects in common, as well as similar terminology at first glance. Despite looking nearly identical on paper, there are many differences in how they are implemented and which populations they are best for.
At Granite Recovery Centers, not only will we help you understand the differences, but we will help you see which therapy method might be best for you. A trained therapist will assess which theory suits your needs best, but in the meantime, this guide will help you see the major differences between CBT and DBT.
What Is CBT?
CBT is a type of therapy that aims to change your thinking and behavior. It most commonly examines your cognitive distortions, such as all-or-nothing thinking or catastrophizing, and helps to break these habits down. You will learn the intimate relationship between thoughts, feelings, and actions, as well as how changing one will change all three.
CBT uses many techniques to explore your cognitions or thoughts. This can include open questions, the downward arrow technique that gets to your core beliefs, and journaling or thought recording. It also considers your actions or behaviors to help you understand and change your physical actions.
CBT Populations
CBT is one of the most researched theories currently available. According to Medcircle, it is used to treat a variety of mental illnesses and concerns. While it was originally developed for depression, it treats a wide variety of conditions. The most common conditions include:
- Depression
- Anxiety
- Panic disorder
- Trauma
- Substance use disorder
- Eating disorder
This is just a small sample of the populations that CBT is known to be effective with. It also works with a diverse age range and many different cultures, making it one of the most versatile theories currently in use. While it is useful with many populations, some people have found that it does not work for their situation. That’s why other theories like DBT are sometimes used.
What Is DBT?
DBT is theory used in therapy that works on understanding and modulating your affective responses. The “D” part of this theory stands for dialectical. This means to strike a balance between two conflicting thoughts: the need to accept the present moment along with the need to change your response. It might sound contradictory, but this is a highly effective theory with specific populations.
While DBT is not quite as versatile as CBT, it was developed specifically for those with higher affective and arousal responses. Some conditions are known to create high levels of anxiety, anger or other strong emotions. DBT helps you explore these reactions and to find new ways to cope with them. It is a highly intensive form of treatment that teaches you effective ways to handle daily stressors.
DBT Populations
Unlike CBT, which is known to treat a highly diverse range of conditions, DBT is more limited with its intended populations. You can consider it a specialized theory since it specifically treats the affective and behavioral responses from specific conditions. The most common DBT populations include individuals with:
- Borderline personality disorder
- Substance use disorder
- Bipolar disorder
- Trauma and PTSD
Just like with the CBT section, this is only a small sample of conditions treated by DBT. It’s important to note that some conditions can be treated by either CBT or DBT. It depends on your situation. If you are suffering more from severe affective responses and trouble controlling your reactions, then DBT might be better. Be sure to speak with your therapist, and they will help you see which theory is better for you.
True DBT Programs
One thing to note about DBT is that it is a very intensive program. Unlike CBT, which typically lasts for 10 sessions and can be modified to suit most clients, DBT is a rigid program that can take months to accomplish. This makes sense because it was developed to treat conditions known to be resistant to change. According to University of Washington researchers, DBT has four different modules. They are:
- Skills training
- Individual treatment
- Phone coaching
- Consultation team
Since it takes so long to do a complete program, many counselors use DBT-inspired programs. These are relatively short-term programs that are focused on teaching you correct utilization of the skills. These programs cost less and take less time to learn but may not be as effective for those with severe pathologies, such as borderline personality disorder. Be sure to ask your therapist about DBT to see if it is right for you.
Time Differences
Everyone wants to get better as soon as possible, so you might be wondering how long each theory is meant to last. While your condition will ultimately guide how many sessions are required, both theories have an ideal number of sessions.
CBT is typically meant for 6 to 10 sessions. DBT, on the other hand, typically requires several months of frequent sessions. At the same time, CBT can go on for months if your conditions are more severe and need additional work, and DBT-inspired programs can only take a couple of sessions. It all depends on your needs.
While it might seem that DBT is less effective because a true program takes months as opposed to weeks with CBT, we want you to be aware of why DBT takes longer. This theory is most commonly used with conditions that are resistant to other forms of treatment or that cause strong emotions in clients. DBT works on those responses and teaches new ways of reacting, which can be very difficult to internalize.
Treatment Goals
Both CBT and DBT are aimed at giving you more balanced thinking and reactions, but they go about this in very different ways.
CBT aims to help you understand the relationship between thoughts, feelings and behaviors while also helping you recognize cognitive distortions. Cognitive distortions are unhealthy patterns of thinking that affect many people. For example, some people think they can predict the future or know what other people are thinking without asking them. These are typical cognitive distortions.
CBT can be used to treat both pathological and non-pathological concerns. For example, you can see a CBT therapist for depression and anxiety or if you feel that life just isn’t going the way you want. The therapist will help you examine your thoughts and behaviors.
DBT, on the other hand, is meant for more severe pathology. It incorporates mindfulness and other skills that can be used by anyone, but the intensiveness of the program makes it most suitable for those with borderline personality disorder, bipolar disorder or other difficult conditions. The treatment goal is to help you understand completely new ways of reacting to internal and external stress.
If you have non-pathological concerns or more mild conditions, then either DBT-inspired or mindfulness-based CBT would likely be appropriate for your needs.
Group and Individual Treatment
The two most common types of therapy environments are individual therapy, where you meet one-on-one with your therapist, and group therapy, where you meet with other clients in a group session. Some people are more comfortable with group or individual therapy, so you may want to know what is available with each theory.
CBT has been modified for both individual and group therapies. You can do one or the other. You can even participate in both if that is what is right for your needs. One of the best things about CBT is that it is highly versatile and has been modified for nearly every situation. While your therapist will let you know if individual or group therapy is better for your particular needs, you can participate in either and still get the benefits of CBT.
DBT is also effective in individual and group therapy. The difference here is that a true DBT program will have you participate in both. The individual sessions will attend to your personal thoughts and anything that you would feel uncomfortable sharing in a group. The group sessions are helpful with vicarious learning: You will learn how to modulate your reactions while also seeing your peers do the same.
While both are good in individual and group therapy sessions, the difference is that CBT can be used for either while DBT insists on using both.
Distress Tolerance
Everyone feels daily stress. This comes from going to work, dealing with other people, having unexpected accidents, experiencing negative internal feelings, and much more. Many people feel distressed, but people handle stress differently. Those with depression or anxiety are more prone to having difficulties modulating stress. Clients who suffer from bipolar disorder or borderline personality disorder tend to have an even harder time handling stress.
While most forms of therapy will help with distress tolerance, they do it to different degrees. DBT introduces a number of advanced mindfulness techniques to help you accept the situation, reduce the stress and control your reactions. This can be incredibly difficult if you find that your affective responses are typically stronger than others around you. If you suffer from a borderline personality disorder or have an extremely hard time with distress, then DBT will likely be better for your needs.
CBT isn’t as intensive in this regard, so it might be better for your needs. Those who suffer from depression and anxiety also tend to have trouble with distress tolerance. The difference is that this tends to be more moderate than severe. CBT can help you modulate your thoughts, feelings and behaviors so that you learn new ways to cope with stress.
Both types of therapies are good for teaching stress management. DBT is better, but it’s also more intensive and not always appropriate for those who only have mild to moderate difficulties with handling stress. At the same time, CBT is better for the general population but not quite as effective with those who have severe reactions to distress.
Substance Use Disorder
Both CBT and DBT are used for those with substance use disorder. It can be hard to determine which is right for you without knowing your circumstances, but the therapists at Granite Recovery Centers can review your case and see which is best.
Many people who suffer from substance use disorder also suffer from co-occurring diagnoses. For example, you might also be suffering from PTSD, ADHD, depression, anxiety or other mental illnesses.
Our therapists will take this into consideration while also assessing your distress tolerance, affective responses and overall needs. If one theory isn’t clearly better than the other, then the therapist will present both to you to get your input. This will ensure that the right treatment option is picked for you while keeping you involved in treatment.
Conclusion
Both CBT and DBT are evidence-based practices that help with a wide range of conditions. While CBT is more versatile, DBT is better for those who have difficulty managing internal and external stress. We at Granite Recovery Centers offer both modalities along with other types of treatment to help with your substance use recovery. Both of these can be used based on your condition. Let us know your preference, and we can help determine the right course of treatment for you.
