The Surprising Differences Between DBT and CBT – A Therapist Tells All
By Natalie Thomas
I have a confession…I love both DBT and CBT and use them both regularly in my practice as a therapist with clients! To those outside of the therapy world, Dialectical Behavioral Therapy and Cognitive Behavioral Therapy. However, while I love them both, there are certainly differences between the two.
DBT was developed as a branch of CBT so of course there may appear to be slight similarities but realizing the differences can determine the best treatment for a client. In this article I will go over the main differences between DBT and CBT and dive into understanding when to use each modality and with which type of client.
Main Goals of CBT versus DBT in Counseling
CBT is implemented with clients who want to change or reframe negative/problematic thinking. The famous CBT triangle of identifying how thoughts, feelings, and actions interfere with one another is the backbone and the core of what CBT focuses on. CBT also incorporates learning coping skills to help redirect the negative thoughts. CBT can be individually tailored to each client.
DBT is implemented with clients who need support and skills in regulating intense, sometimes uncontrollable emotions. DBT has four components of mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. DBT is more skills focused than CBT and is more structured.
Who Can Benefit from CBT or DBT
While both CBT and DBT are known for being extremely beneficial they both serve different types of clients. CBT has been proven to be helpful for those who experience anxiety, depression, trauma impact, phobias, and obsession compulsion. DBT often tends to be viewed as a higher level of care and is helpful for those who experience borderline personality disorder, substance abuse, self-harm, and eating disorders.
With CBT you focus on how thoughts, feelings, and actions/behaviors all intersect with each other and play a role in how we handle situations. With a client experiencing anxiety taking a thought such as “I’m too anxious to give a public speech in class” and having them work on reframing it and be helpful to decrease the anxiety.
With DBT you have similar aspects as CBT however you focus on emotions and mindfulness more. DBT wants people to achieve the balance of “acceptance” and “change.” This is achieved by finding acceptance for things you can’t change and finding contentment however changing problem behaviors that keep getting in your way of happiness.
Setting and Time Commitment for CBT and DBT
Both of these types of therapies require a different level of time commitment and may even be completed in a different type of setting. CBT can be considered a shorter term therapy. Many people can achieve successful results in just a few sessions. The average sessions for CBT ranges from 5-20 and therapy can take place in an outpatient setting. Clients may meet weekly or bi-weekly then decrease when they feel more comfortable in practicing skills outside of sessions.
DBT on the other hand is considered longer term therapy and the entire DBT program that covers all 4 modules (emotion regulation, interpersonal effectiveness, mindfulness, and distress tolerance) take up to 6 months to complete! Clients meet with a DBT trained therapist weekly along with attending DBT group sessions weekly that teach them each module while helping them practice the skills.
Putting It All Together
I hope you found this helpful in understanding the differences between CBT and DBT. As you can see the goals and diagnosis/type of client play a huge part in determining the best treatment. Remember to always start with a thorough intake and assessment that is collaborative in learning as much as you can about your client and what they hope to achieve out of therapy.
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Natalie Thomas is a licensed clinical social worker (LCSW) and Clinical Supervisor for Firelight Supervision. She provides group and individual clinical supervision for provisionally licensed counselors and social workers, along with clinical consultation for independently licensed therapists. Natalie enjoys supporting therapists develop new skills and find their niche.