I am often approached by people wanting to know whether DBT or CBT is the better approach for them or a family member. Usually, these are people who have done a fair amount of research, but end up unsure whether they might benefit from DBT vs CBT. A lot of the information on the internet comparing the two is confusing and sometimes inaccurate. Below is a comparison of the two treatment approaches, as well as some information about who might be best suited to each form of therapy.
DBT vs CBT: CBT
CBT, short for cognitive behavioral therapy, is an evidence-based treatment focusing on changing thoughts and behaviors to improve mood and anxiety disorders as well as other psychological problems. A typical course of CBT is brief in duration, lasting several months. This is significantly shorter than more traditional forms of psychotherapy, and an abundance of research over the past three decades has shown that CBT is usually more effective too.
CBT therapy sessions are goal-oriented and frequently function to solve a short-term or long-term problem. During the session, the therapist teaches and models skills that will benefit the client. These skills could take the form of different exercises to improve problematic thinking patterns, relaxation training methods, techniques to reduce problematic avoidance, or concrete training to remedy skills deficits, such as social skills deficits. After the skill is taught and rehearsed in session, the CBT therapist assigns the client homework to practice the skill repeatedly throughout the week in order to master it. The following week, the skill is reviewed in session, and the next skill is taught. Through this process, the client learns all the skills she needs to solve her own problems. Sometimes only one skill is taught and consistently developed during the entire course of therapy, as is often the case with cognitive restructuring. Once the client’s mood has improved or problem has been solved, therapy winds down with the expectation that the client now has the ability to be her own therapist the next time a similar situation arises.
CBT has been proven to be the most effective psychological treatment for a multitude of psychological difficulties. These include:
- Anxiety Disorders
- Obsessive Compulsive Disorder (OCD)
- Posttraumatic Stress Disorder (PTSD)
- Mild to Moderate Eating Disorders
- Gender-Identity Dysphoria
- Mild to Moderate Addictive Disorders
- Relationship Problems
- Social Skills Deficits
- Assertiveness Deficits
- Attention Problems
- Some Impulse Control Disorders
CBT treatment varies for each disorder, and there is usually a step-by-step manual called a protocol that the therapist follows to ensure she is providing the best treatment as indicated by the research. Sometimes a CBT therapist will diverge from the protocol as needed, but in most cases, a protocol is required. Significant research shows that therapists who do not use protocol-based treatment have poorer outcomes than those who use CBT protocols as guides. When searching for a CBT therapist, in addition to making sure your therapist has formal training in CBT, asking what protocols they use can help you identify out clinicians who aren’t as familiar with evidence-based therapy.
DBT vs CBT: DBT
DBT is short for dialectical behavior therapy, a relatively new treatment developed by psychologist Dr. Marsha Linehan. DBT is actually a form of CBT, just more specialized to treat certain problems involving persistent emotion dysregulation, extreme impulse-control disorders, severe drug use, and persistent suicidal behavior.
Like CBT, DBT sessions focus on problem-solving and skill-building. One notable difference, however, is DBT almost always requires several weekly sessions. Typically, one group session each week is devoted to learning behavioral skills in a classroom format, and at least one weekly individual therapy session is dedicated to problem-solving and helping the client implement the skills learned in the skills training group. Another notable difference is that DBT includes and encourages the use of phone-coaching, which involves contacting the therapist between sessions for help in using skills. The main reason for the increased frequency of sessions and phone encounters is to help combat severe emotional distress and impulsivity, which can be hard to combat in once-weekly therapy.
DBT Skills training is broken up into four modules:
- Core Mindfulness Skills
- Interpersonal Effectiveness
- Distress Tolerance
- Emotion Regulation
Many of these skills are traditional CBT skills, but packaged and presented in a way that is more relevant to the sorts of challenges DBT clients characteristically face. Core mindfulness teaches people more effective cognitive strategies for making sense of difficult situations. The interpersonal effectiveness module incorporates a mix of prioritizing personal values and traditional assertiveness training. Distress tolerance skills help people learn to cope with strong urges without acting on them. Emotion regulation training focuses on decreasing problematic negative emotions and increasing positive ones.
Partly due to the large number of skills taught throughout a DBT program, DBT lasts anywhere between six months and one year. This longer duration is also due to the fact that the problems DBT addresses are relatively severe, and as a result take longer to remedy. Often people in DBT programs have tried several other treatments but have not benefitted due to the acuity of the problems they bring to treatment.
DBT was originally developed to treat highly suicidal individuals, although several decades of research have found that it is an effective treatment for a number of disorders:
- Borderline Personality Disorder
- Persistent Suicidal Thoughts and Behavior
- Severe Drug Addiction
- Severe Eating Disorders
- Complex Posttraumatic Stress Disorder
- Geriatric Depression
- Severe Impulse Control Problems
- Severe Anger Management Problems
Unlike CBT, DBT treatment varies little from disorder to disorder. Everyone learns the same skills despite working on different treatment targets. This may seem counterintuitive, but works because the people who need DBT usually have some problems with emotion dysregulation and/or impulsive behavior, which are the main targets of DBT. DBT can be a difficult treatment to provide, requiring advanced training. When finding a DBT therapist, it is important to ensure that they have formal training in DBT, either through internship, fellowship, or certification-level experience.