Cognitive behavioral therapy vs dialectical behavioral therapy:  Which is right for you?

Whether you’re new to therapy or considering returning to it after a break, knowing what to expect from the experience can help you feel more confident in your decision to seek help. But with so many different types of therapists and therapies to choose from, sometimes finding the right fit can feel overwhelming. 

You may have heard of two common types of therapy: cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Both of these therapy types are well-researched and have been proven effective in treating a variety of mental health concerns. Both can impact your thoughts, feelings, and behavior and support you in strengthening your mental health. Learning more about them can help you decide which is right for you. 

Exploring cognitive behavioral therapy (CBT) 

CBT was developed in the 1960s by the American psychiatrist Aaron Beck. Since then, it’s been used to treat a range of mental health conditions including depression, anxiety, eating disorders, substance misuse, obsessive-compulsive disorder (OCD), and personality disorders. Research has also shown it to be an effective component of treatment plans for serious mental illnesses like bipolar disorder and schizophrenia when used in combination with medication and other supports. 

One of the greatest benefits of CBT is its flexibility and wide-ranging applicability. Not only has it been proven effective in treating a wide range of conditions but it can also be used to treat a variety of populations including children, teens, adults, couples, and families. 

CBT is an umbrella term and there are several different types of CBT that your therapist may use, depending on your situation. But standard CBT hinges on three fundamental components, including:

• Identifying negative thought patterns: Sometimes called cognitive distortions, these are the unhelpful or unrealistic thoughts that can keep a person feeling stuck in a pattern of emotional or behavioral difficulty.  
• Challenging cognitive distortions: Once a person has identified negative thought patterns, the next step in CBT is to question the accuracy of these thoughts and replace unhelpful or untrue thoughts with helpful, balanced ones. 
• Behavior modification: Once a person has identified, challenged, and started to change their unhelpful thoughts, they’re more able to replace unwanted behaviors with healthier, more functional coping strategies.

Understanding dialectical behavior therapy (DBT) 

DBT is one of the subtypes of CBT. DBT was developed in the 1970s by the behaviorist Marsha M. Linehan after she attempted to use standard CBT to treat women living with borderline personality disorder (BPD) who were experiencing suicidality and self-harm. Linehan found that CBT in its standard form did not meet the needs of these patients. So she restructured the treatment to include a focus on acceptance, as opposed to strictly focusing on change. This balance of acceptance and change would go on to become the foundation of DBT as we understand it today and would become incorporated into each of the following core principles of this modality, which include:

• Emotional regulation: DBT helps people develop healthy strategies for recognizing, understanding, and managing their emotions. This foundational skill can help support healthy behavior change and improve a person’s quality of life in a variety of ways.
• Mindfulness: A core component of DBT, mindfulness is used throughout treatment to help people learn to observe their thoughts and feelings without judgment and to support greater self-awareness and emotional regulation. 
• Interpersonal effectiveness: This aspect of DBT helps people strengthen their communication skills and improve their interpersonal relationships. It focuses on conflict resolution skills and learning to balance one’s own needs and the needs of others.
• Distress tolerance: One of the goals of DBT is to help people learn to tolerate uncomfortable or distressing feelings in healthy ways. Increasing one’s capacity to hold discomfort (aka increasing distress tolerance) makes it less likely that a person will engage in harmful or destructive behaviors. 

Today, DBT remains one of the most widely used treatments for BPD. But is also used to support people living with anxiety, depression, and those experiencing suicidal thoughts and behaviors or self-harm. 

Key similarities and differences between DBT and CBT

Similarities

• Evidence-based: CBT and DBT are both widely accepted, evidence-based treatment options.
• Talk therapy: In both of these therapy types, therapy happens in conversation between the therapist and client. 
• Emphasis on therapist-client relationship: Both hinge on an effective collaboration between the client and the therapist. 
• Support for behavior change: Both of these therapies seek to balance an emphasis on insight gathering and teaching practical skills to support a client’s goals for behavior change. 

Differences 

While CBT and DBT share some key similarities, there are some important differences between these two approaches as well. 

• Conditions and populations treated: CBT is known for its ability to treat a wide range of conditions and populations. DBT has a narrower focus and is mainly used to support individuals living with BPD, depression, suicidality, and self-harm. 
• Emphasis on emotional regulation: DBT also places a greater focus on emotional regulation since it is often used to treat people living with harmful or self-destructive behaviors. 
• Treatment duration: DBT usually lasts a minimum of six months, but treatment often goes for 12 months or longer. CBT can be short-term or long-term but can be effective in as little as six to 12 weeks. 
• Treatment intensity: DBT treatment is more intense than CBT. The standard DBT treatment package consists of weekly individual therapy sessions (approximately 1 hour), a weekly group skills training session (approximately 1.5–2.5 hours), and a therapist consultation team meeting (approximately 1–2 hours). CBT requires fewer sessions, usually one per week.
• Use of mindfulness techniques: Lastly, mindfulness may sometimes be incorporated into CBT but it is a major part of DBT that is typically incorporated into most aspects of the treatment experience.   

Finding the right type of therapy for you with Rula 

When it comes to choosing the right therapy type for you, there are many factors to consider. But the first step in finding the right support is getting an accurate diagnosis from a mental health professional. This will help ensure that your treatment plan reflects your unique experience and the way your symptoms impact your life. It’s also important to find a therapist you feel comfortable with who offers the specialized care you deserve in a way that fits your lifestyle and your schedule. 

At Rula, we collaborate with an extensive network of behavioral therapists who are experienced in DBT, CBT, and many other treatment modalities. If you’re not sure what type of therapy you need, one of the therapists we work with can provide an evaluation, make a diagnosis, and help you find the support that’s best for you. 

To take the first step, we invite you to explore our therapist-matching program which can connect you with a DBT or CBT-focused therapist in just a few seconds who you can meet with from the comfort of home. From there, you can have your first therapy session as soon as tomorrow, or at whatever time works best for you.

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