CBT vs. DBT: Which Talk Therapy Is Best for You?
Key takeaways:
Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two popular types of talk therapy used to treat mental health conditions.
There are key differences between CBT and DBT. CBT focuses on changing negative thought patterns and behaviors. DBT focuses on regulating emotions and building skills to cope with emotions and difficult situations.
CBT and DBT treat many of the same conditions, but some people do better with one type over the other. DBT is more often used to treat borderline personality disorder and certain eating disorders.
Table of contents
Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two popular and well-researched forms of talk therapy. Both types of therapy have been found to be effective in treating a range of mental illnesses.
While the therapies overlap in some ways, they have key differences between them. And different people may find one approach more helpful than the other.
This article will describe how CBT and DBT work and highlight their benefits and differences to help you choose the therapy that may be better for you.
Search and compare options
CBT vs. DBT: What are they?
CBT and DBT are two types of evidence-based therapy used to treat mental health conditions like depression and anxiety.
Cognitive behavioral therapy
CBT is considered the most-researched type of therapy. It’s based on the theory that a person’s thoughts and behaviors affect their emotions. The focus of CBT is identifying and changing negative or distorted thoughts that lead to difficult emotions and unhelpful behaviors. It addresses both your thoughts (cognitive) and your behaviors.
For example: You may have the thought, “My boss doesn’t like me.” This thought causes an emotion, like anxiety. The anxiety may cause a behavior, such as overworking so you don’t get in trouble or avoiding your boss. CBT works by questioning that initial thought and replacing it with a more helpful one, such as “I’m good at my job.”
Dialectical behavior therapy
DBT is a type of CBT, but it was developed because CBT wasn’t effective enough in treating some people with certain conditions, like borderline personality disorder.
Rather than focusing on thoughts, DBT focuses more on helping you regulate intense emotions. It teaches you to recognize and accept your emotions. At the same time, it provides tools to cope with difficult situations, make effective decisions, and improve your relationships.
The “dialectical” part of DBT refers to the ability to hold two opposing emotions at the same time. It stems from the philosophical concept of dialectics, where an argument considers opposing or contradictory ideas.
For example: You may feel disappointed in your performance on an exam but also recognize that you tried your best. DBT helps you learn to work with both acceptance and change. It’s possible to accept yourself and all aspects of life while working to make changes.
What’s it like to undergo CBT or DBT?
CBT and DBT are both types of talk therapy, but their approaches are different.
What is CBT like?
A CBT therapist starts by helping you understand the issues or concerns that brought you into therapy. You first work together to create goals and a treatment plan. From there, your therapist will use different interventions to help you reach your goals. In CBT, these may include:
Completing a thought record, where you write down your thoughts, feelings, and behaviors throughout the week
Cognitive restructuring, which involves challenging negative thoughts and replacing them with more productive ones
Identifying more positive behaviors to replace unhelpful behaviors
Finding solutions to help you cope better with problems or difficult situations
Learning relaxation strategies to reduce stress and anxiety
Find the best therapist for you: Here’s our thorough guide to finding a therapist that fits your needs.
Why people go to therapy: Read about key reasons why some people see a therapist and whether it’s right for you.
What is borderline personality disorder? Learn the signs of BPD and the first steps to take for treatment.
CBT is typically an individual therapy session, held once a week. You may be given things to work on between sessions. CBT tends to be a short-term approach to therapy, with treatment typically lasting 12 to 16 sessions. Therapy may continue if your goals haven’t been met. CBT can also be adapted for group therapy.
What is DBT like?
In DBT, the focus is primarily on skills that address your emotions and how you interact with the world.
True DBT is structured and follows a specific manual, with the therapist directing the therapy. Many therapists, however, practice DBT-informed therapy, which is based on DBT but doesn’t closely follow the manual. DBT therapists guide clients through four modules:
Mindfulness: You learn how to be aware, present, and accepting of your thoughts and feelings.
Distress tolerance: This is the ability to cope with stressful moments when they happen. Part of this module is a concept called radical acceptance, which means accepting the reality that life can be painful. Rather than resisting this fact, clients learn how to accept and let go. But in some situations, resistance is important, such as in an abusive situation.
Interpersonal effectiveness: This works on how to communicate with others in a skillful manner and how to resolve conflict.
Emotion regulation: This key component of DBT is the ability to accept and regulate your emotions.
Read more like this
Explore these related articles, suggested for readers like you.
DBT is a comprehensive treatment program that includes 1 hour of individual therapy and a 2-hour skills group each week. You may have homework in between sessions. DBT therapists are often available for phone check-ins.
What conditions can CBT and DBT help with?
CBT and DBT have been shown to be effective in treating a wide range of mental health conditions.
These include:
Depression
Anxiety disorders, including generalized and social anxiety
Obsessive-compulsive disorder (OCD)
Borderline personality disorder
Chronic pain
Post-traumatic stress disorder (PTSD)
Eating disorders
The research hasn’t determined that one approach is definitely better than the other for a specific condition. CBT has been more widely studied for a range of conditions, but there’s plenty of evidence supporting the effectiveness of DBT as well.
DBT was originally developed specifically for people with borderline personality disorder, who tend to struggle with intense emotions. So, the research on DBT for this condition is more established, but both approaches have been found to be effective.
Some people find one style of therapy more helpful than the other due to personal preferences and fit. Factors like your rapport with your therapist can play a role in how effective therapy is for you.
Both CBT and DBT have been adapted for specific mental health conditions. For example:
Trauma-focused CBT (TF-CBT) is a form of CBT adapted for children and adolescents who have experienced trauma.
Radically open dialectical behavior therapy (RO-DBT) is a form of DBT adapted for conditions involving overcontrol. RO-DBT is used to treat eating disorders, depression, OCD, and mental health conditions in people with autism spectrum disorder.
What are CBT and DBT not recommended for?
While CBT and DBT are used to treat a wide variety of conditions, they’re not right for everybody. Because they’re both active, skills-based approaches, they’re not ideal for anyone looking to explore deeper issues or the underlying causes of their symptoms or problems.
If you’re looking to explore your past in depth, psychoanalysis or psychodynamic therapy may be a better fit.
What are the limitations of CBT and DBT?
It’s important to think about some potential issues you may have with each of these approaches. In some cases, CBT and DBT may not be the best approach, and you should consider other types of therapy.
Some of the limitations of CBT include:
Focus on the present: CBT looks at your current thoughts and feelings. It doesn’t explore the past, so you may not analyze factors in your childhood or earlier life that may affect your current mental health.
Negative labeling: Some critics feel that labeling certain beliefs or behaviors as “irrational” or “distorted” is wrong, especially if they developed in response to traumatic events. Trauma responses may include beliefs and behaviors that were necessary for survival and may still be adaptive in some ways.
Long-term effectiveness: CBT has been shown to be effective over the short term for a wide range of mental health conditions. But more studies are needed to determine if the effects last in the long term.
Some of the limitations of DBT include:
Time commitment: With DBT, you’re usually expected to attend weekly individual and group therapy sessions. You often get tasks to work on at home between sessions.
Negative labeling: Like with CBT, there’s concern about negative labeling of beliefs and behaviors.
Lacks trauma processing component: While past trauma may come up in DBT, there’s no formal trauma processing in this approach.
Requires group sessions: Some people may not be comfortable in a group therapy session.
Fewer therapists: DBT therapists must get extensive training, so there are fewer therapists trained in DBT compared to other approaches, like CBT.
How much do CBT and DBT cost?
The cost of CBT and DBT sessions varies depending on factors such as:
Type of therapy: DBT therapists may charge more because getting certified in DBT requires additional training.
Length of treatment: DBT tends to be more expensive because treatment lasts longer, and there are two sessions per week instead of one.
Type of therapist: Psychiatrists and psychologists generally charge more than master’s-level therapists.
Location: Therapists in urban areas often charge higher rates than those in suburban or rural areas.
If cost is a concern, there are some ways to make therapy more affordable. You could consider these options:
Find a therapist who’s in-network with your insurance.
Use out-of-network benefits if you’re seeing a therapist who’s not in your insurance network.
Ask if a therapist offers sliding scale fees based on income.
Work with an intern or pre-licensed therapist who’s being supervised by an experienced clinician.
Use flexible spending account (FSA) or health savings account (HSA) funds to pay for sessions.
Search for a therapist on Open Path Collective, a directory of therapists who offer services at a lower fee.
How to find a CBT or DBT therapist
To find a CBT or DBT therapist, you can search a directory of therapists who are trained in either or both approaches:
CBT: The Association for Cognitive and Behavioral Therapies and the Academy of Cognitive and Behavioral Therapies offer listings of certified CBT therapists. You can also call the National Association of Cognitive-Behavioral Therapists at 1-800-253-0167.
DBT: The Linehan Board of Certification and the Behavioral Tech Institute offer listings of certified DBT therapists.
Other ways to find a therapist include:
Insurance: If you can use your insurance to pay for therapy, you can call your insurance company or use their online directory to find a therapist.
Referral: Ask your primary care provider for a referral.
Online search: Look online for therapists who offer DBT or CBT.
Therapist directory: Search a therapist directory, such as Psychology Today, or one that is specific to you, such as the Trauma-Informed Maternal Mental Health Directory or the Inclusive Therapists’ Directory.
Word of mouth: Ask family and friends for recommendations of therapists they know.
Frequently asked questions
DBT skills classes are groups that teach specific DBT skills, such as mindfulness and effective communication. These structured classes are run by therapists trained in DBT. They’re a good alternative for anyone wanting to learn DBT skills without participating in a full DBT program.
Both types of therapy focus on improving your ability to cope with emotions like stress, anxiety, and anger. But emotion regulation is one of the core components of DBT, which places a greater emphasis on teaching you skills to help regulate your emotions.
Critics of DBT believe that this approach may be too complex for some people, as it involves learning many different tools and includes homework assignments. In addition, trauma processing isn’t a part of DBT, so people with a history of trauma may not have the opportunity to work through their trauma in this approach.
The bottom line
CBT is a widely used therapy that focuses on changing negative thoughts, while DBT is a therapy that focuses on emotional regulation and skill-building. Both approaches are used to treat many different mental health conditions. DBT is more likely to be used for borderline personality disorder, while CBT is more likely to be used for people who have experienced trauma.
Why trust our experts?
References
American Psychological Association. (2017). What is cognitive behavioral therapy?
Association for Behavioral and Cognitive Therapies. (n.d.). Radically open dialectical behavior therapy.
Beltrani, A. (n.d.). Pros and cons of DBT therapy. Palo Alto University.
Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry.
David, D., et al. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry.
InformedHealth.org. (2022). In brief: Cognitive Behavioral Therapy (CBT). Institute for Quality and Efficiency in Healthcare.
Metzner, D. (2021). Inherent limitations of Cognitive Behavior Therapy (CBT). ACA Connect.
Rizvi, S. L., et al. (2024). The state of the science: Dialectical behavior therapy. Behavior Therapy.
Thielemann, J. F. B., et al. (2022). A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Child Abuse & Neglect.
van Dis, E. A. M., et al. (2019). Long-term outcomes of cognitive behavioral therapy for anxiety-related disorders: A systematic review and meta-analysis. JAMA Psychiatry.
Wang, X., et al. (2021). Cognitive behavioral therapy for autism spectrum disorders: A systematic review. Pediatrics.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
