Cognitive Behavioural Therapy and Dialectical Behavioural Therapy

Overview

Psychotherapy (also known as talking therapy) is a type of treatment modality used for a variety of mental health conditions. Its primary purpose is to help a person navigate and understand any troubling emotions and problems they are experiencing. Two of the most common psychotherapies include cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT). Despite their similarities, CBT and DBT should not be conflated with one another due to their distinct differences. 

CBT works by helping you identify and change harmful and maladaptive thoughts, feelings, and behaviours. In contrast, DBT focuses on helping you learn to accept these emotions and develop healthier ways to adapt and cope with them. This article will discuss the similarities and differences between CBT and DBT.  

What is CBT?

CBT is based on the rationale that your thoughts, feelings, and behaviours are interconnected and affect one another. Your thoughts influence your beliefs and motives, and consequently, your beliefs will influence your behaviour. In short, if a person has negative thoughts, this will be reflected in the way they act and feel. 

For example, if you have low self-esteem, you might think, “I’m useless” or “I’m never going to be good enough” (thought). This may lead you to compare yourself to others or avoid social settings (behaviour), which may make you feel lonely, frustrated, or hopeless (feeling). If you don’t break out of this cycle, these thoughts, feelings, and behaviours will likely become overwhelming and more difficult to regulate.¹

Taking this principle into account, CBT helps you change these negative thoughts and behaviours by combining two types of therapy:

• Cognitive therapy helps a person identify, reevaluate, and change their negative thought patterns
• Behavioural therapy helps a person learn and practise skills to replace their maladaptive behaviours with healthier coping mechanisms.

How does CBT work?

CBT aims to teach you how to change your thoughts into more positive ones, leading to more positive outcomes. This treatment focuses on the present rather than your past experiences. It takes a direct, practical approach to help you achieve your goals and have more control over your state of mind. 

A therapist will aid you in breaking out of the negative cycle of thoughts by identifying why they are contributing to your problems. They will give you practical advice on managing your problems by guiding you on what positive changes can be implemented in your daily life. 

CBT can be delivered through one-to-one sessions, in groups, through self-help books, or virtually online or via telephone. Typically, CBT treatments occur weekly or fortnightly for 6-20 sessions, each one lasting 30-60 minutes.²

What can CBT be used to treat?

CBT is often labelled the “gold standard” of psychotherapy treatment due to the extensive research that supports its use to treat various mental health conditions.³ 

CBT can help with:

• Anxiety  
• Bipolar disorder
• Depression 
• Drug or alcohol misuse 
• Eating disorders (e.g., anorexia and bulimia)
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Phobias 
• Post-traumatic stress disorder (PTSD) 
• Psychosis 
• Schizophrenia 
• Sleep problems (e.g., insomnia)
• Stress⁴ 

Research has also demonstrated that CBT is effective for the management of chronic physical health conditions, such as:

• Irritable bowel syndrome (IBS)
• Chronic fatigue syndrome (CFS)
• Fibromyalgia 
• Chronic pain^{4, 5}

It is important to note that CBT does not modify the physical symptoms of these stress-related conditions. Instead, CBT helps you cope and reduce your negative emotions, which would otherwise exacerbate your symptoms. 

What is DBT?

DBT is a subtype of CBT and was originally developed specifically for the treatment of chronically suicidal individuals with borderline personality disorder (BPD). This treatment was developed by Dr. Marsha Linehan, who believed CBT did not meet the needs of people with suicidal ideation. Whilst CBT did provide individuals with the fundamentals to develop better-coping strategies, it failed to regulate more intense emotions and prevent suicidal behaviour common in those with BPD.⁶ 

As the name suggests, DBT is derived from the philosophy of dialectics, which refers to a form of reasoning where you discuss and integrate opposing views to come to a solution. 

With this treatment, individuals are introduced to two contradicting strategies:

• Acceptance (i.e., encouraging individuals to understand their emotions are valid)
• Change (i.e., understanding positive changes are necessary for improvement) 

How does DBT work?

Within this treatment, therapists will combine acceptance and change techniques. Your therapist will challenge you to replace any harmful behaviour and encourage you to adopt alternative ways to deal with trauma and distress.

During DBT sessions, trained therapists will teach you how to enhance four core skills, incorporating them into your daily life. 

The four skills that form the core components of DBT are:

• Mindfulness

This focuses on drawing your full attention (mind and body) to the present. Mindfulness is important to reduce your worries regarding the past or the future.⁷

• Distress tolerance

This involves learning how to counteract pain and stress in difficult situations without harmful behaviour.

• Interpersonal effectiveness

This enables you to better manage your relationships to ensure respect for yourself and others. It helps you deal with conflict by improving how you communicate your needs and wants.

• Emotion regulation 

This is important to help you have better emotional awareness and understanding. This allows you to be in control of your emotions and think more clearly.

DBT therapists aim to equip you with these skills. They are taught and practised via different modalities, such as group exercises, individual therapy sessions, or telephone coaching. Sessions usually last 45-60 minutes, and full treatment can take around 6-12 months to complete. 

What can DBT be used to treat?

Although DBT was originally developed for the treatment of BPD, research shows that it is effective for other conditions, including:

• Depression 
• Drug and alcohol misuse
• Eating disorders
• Self-harm
• Suicide attempts⁸

Differences between CBT and DBT

Goals

A major difference is that CBT is more directive and practical. Together you and your therapist will collaborate to identify negative thought patterns and behaviours that you can replace with healthier ways of thinking and behaving. 

DBT is less direct and has a stronger focus on emotional and social aspects. This is because DBT was designed especially for individuals with extreme and unstable emotions.

Philosophies

CBT is more logic-based and promotes the changing of negative emotions and behaviours. 

Although DBT does this as well, it places a greater emphasis on teaching a person to accept who they are by validating their experiences. DBT incorporates more mindfulness and focuses on building relationships.

Type of sessions

The duration of treatment for CBT is often shorter than DBT. CBT can last 6-20 weeks, whereas DBT can last up to a year. 

As DBT encourages enhancing your interpersonal skills, group sessions are more common. CBT can sometimes involve group sessions, too, but this is not a core component of the treatment. 

Summary

CBT and DBT are effective talking therapies that enable you to overcome and regulate emotional challenges. As DBT was adapted from CBT, it’s unsurprising that these therapeutic modalities are quite similar. However, DBT distinguishes itself from CBT as it incorporates training in mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. 

Recovery and rehabilitation can be a slow, difficult process that varies from person to person. At the end of the day, never blame yourself if therapy isn’t working well for you. Both of these treatments can improve your well-being and help you overcome mental symptoms. You can consult your GP for alternative treatments if you do not respond well to CBT or DBT. There are a multitude of other talking therapies and treatments available for mental health or stress-related conditions. 

FAQs

What’s the difference between behavioural therapy and CBT?

Behavioural therapy (BT) is an umbrella term for psychotherapy techniques based on the principle that behaviours are learned and thus can be changed. BT broadly refers to treatments that help change a patient’s maladaptive behaviour. CBT combines cognitive therapy with behavioural therapy. 

Can you have CBT and DBT together?

Whether you choose to opt for one treatment or the other solely depends on your personal situation and which therapy is best suited to address that. DBT is more effective in helping individuals build emotional awareness and acceptance. Whereas, CBT is more structured and directs patients to change their unhelpful habits. 

Do I need CBT or counselling?

Counselling is often used as a general term for all types of talking therapies. However, counselling is a distinct type of talking therapy itself. It differs from CBT as it is used to address severe forms of depression or traumatic, difficult life events that can’t be changed (e.g., bereavement, fertility difficulties, or work-related stress). 

Unlike CBT, your counsellor does not usually provide direct advice or practical instructions. Instead, counselling sessions offer you a safe, confidential space to navigate your feelings and understand the root cause of your trauma. 

How can I get CBT or DBT? 

Consult your GP for a referral to a CBT/DBT therapist. Please note NHS therapy waiting lists can be long due to high demand. 

Some charities and workplaces may offer free therapy or counselling. Mind provides useful tips on how to find a private therapist and how to find NHS therapy.