DBT vs CBT: What’s the Difference?

Worldwide, 10%-20% of all children and adolescents suffer from a type of mental health disorder. The widespread issue of mental illness has led to a rise in popularity for many different talk therapy approaches, including dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT). While it may be reassuring to know there are multiple youth mental illness treatment options available, it can be overwhelming to recognize which one is right for your child.

This article will guide you through the differences and similarities between CBT and DBT therapy treatments by explaining what they are, what skills they teach and for whom they are most effective. Once you’ve learned more about the different types of therapy, you can choose the best treatment path to help your child with more confidence.

Table of Contents

• The Basics About Dialectical Behavior Therapy (DBT)
• The Basics About Cognitive Behavioral Therapy (CBT)
• How Are DBT and CBT Similar?
• What Makes DBT Different From CBT?
• Contact Hillside® About DBT Treatment Options

The Basics About Dialectical Behavior Therapy (DBT)

As a relatively new modality of psychotherapy, DBT many people are not as familiar with the treatment. To increase understanding about DBT, we’ll go over three major questions about DBT treatment:

1. What Is DBT?

DBT is a comprehensive, specialized form of cognitive behavioral therapy designed to reduce the emotional extremes often experienced by those who have a mental disorder. This approach concentrates on helping clients adjust problematic thought patterns and teaching them effective skills for managing emotional extremes. By mitigating the inner turmoil caused by intense emotional highs and lows, DBT enables clients to focus on the core mental health issue facing them.

After a pre-treatment phase during which therapy goals are set, DBT follows these four stages of treatment:

1. Stage 1 – Control: The first stage focuses on helping clients go from feeling as if their behavior is out of their control to regaining control.
2. Stage 2 – Emotions: After behavior has been stabilized, clients work on fully experiencing and understanding their emotions.
3. Stage 3 – Quality of life: Once clients gain better understanding of their emotions and have tools to manage their emotions in an effective way, clients focus on developing a healthy lifestyle and improving their quality of living.
4. Stage 4 – Spiritual fulfillment: Although not necessarily a requirement of treatment, a fourth stage is available for those seeking deeper meaning, connection and completeness through spiritual fulfillment.

Each stage of DBT is intended to help clients move from “feeling miserable and being out of control” to being aware of their own power to regulate their feelings and behaviors. Because suicide is the second leading cause of death among 15- to 24-year-olds, DBT treatment aims to replace self-destructive thoughts and behaviors with more effective life skills. To accomplish this goal, DBT adheres to these four hierarchical treatment targets throughout its therapy stages:

1. Decreasing life-threatening behaviors: These behaviors include suicidal thoughts, threats and attempts, as well as self-damaging actions.
2. Decreasing therapy-interfering behaviors: This means reducing missed sessions and late arrivals, along with behaviors such as remaining silent or refusing to engage during sessions.
3. Decreasing quality-of-life-interfering behaviors: This type of self-destructive behavior includes substance abuse, relationship conflict, physical aggression, excess worry and more.
4. Increasing coping skills: After decreasing unhealthy behaviors, positive skills like understanding emotions, relating to others, enjoying the present moment and accepting one’s self can replace them.

2. What Are DBT Skills?

DBT offers a curriculum of skills, which has been researched and found to be effective in helping people manage their emotions and behaviors. While most DBT skills are taught in a group setting, the skills can also be taught in a family unit or on a one-to-one basis. It is important to note that DBT skills sessions are not the same as individual DBT therapy. The goal for DBT Skills groups or sessions is skill acquisition through psychoeducation.

These are the four main DBT skills modules, with the fifth modules often added when working with young people and their families. Each module comprises of many different skills:

1. Core Mindfulness: Mindfulness is the basis of DBT. Mindfulness is simply the ability to pay attention to the present moment. Mindfulness skills help increase one’s awareness of self and environment, without judgment.
2. Distress Tolerance: The skills in this module help people navigate emotional crises without worsening the situation.
3. Emotion Regulation: The skills in this module help people build an emotionally healthy lifestyle. This involves gaining a better understanding of one’s emotions and reducing emotional vulnerability.
4. Interpersonal Effectiveness: The skills in this module help people maintain healthier relationships by using effective communication while maintaining self-respect and asking for what they want or need.
5. Walking the Middle Path: This includes working with family members to understand different perspectives. Validation skills and the use of dialectical thinking are often the main focus for this module.

3. Who Is DBT Right For?

Because DBT changes the thought patterns that produce severe emotional swings and extreme behaviors, it is a suitable approach for treating a broad spectrum of disorders. Research shows that DBT is an especially effective treatment for those diagnosed with borderline personality disorder (BPD) or those struggling with self-harming behaviors and suicidality. However, many other mental health disorders benefit from DBT, as it can be used to treat a wide range of conditions.

The disorders most commonly treated with DBT include:

• BPD
• Anxiety
• Depression
• Eating disorders
• Disruptive mood dysregulation disorder (DMDD)
• Dependency

DBT is a viable treatment option for adolescents in need of emotional stability or behavioral therapy, with older, more emotionally developed teens being best suited for this treatment. Typically, children younger than 12 or prepubescent children may not be developmentally ready to learn and understand all the DBT skills, but a DBT modification called DBT-C is an adaptation of the therapy appropriate for younger children. In DBT-C, the group therapy element is removed, and a caregiver module is added.

The Basics About Cognitive Behavioral Therapy (CBT)

While recent studies have found CBT is an effective treatment for adolescent anxiety, many people are still unsure exactly what it is. To explain some details about the treatment, we’ll answer three common CBT questions below:

1. What Is CBT?

CBT is a psychotherapy model that explores how an individual’s thoughts, feelings, and behaviors interact. The main focus of CBT is correcting current problems by identifying the negative or false beliefs that lead to them and testing or restructuring those ingrained thoughts. In general, CBT relies on a positive therapist-client relationship to teach clients healthy strategies for dealing with emotional or behavioral problems, which they will eventually use on their own without leaning on the support of a mental health professional.

Although CBT can include a wide variety of practices, the following are three of the main strategies used by CBT therapists to assist clients:

1. Structuring treatment techniques: Based on the client’s individual goals, therapists intentionally select treatment methods for each session that will most benefit the client.
2. Treating emotional response: Because CBT teaches that thoughts directly influence feelings, changing how a client thinks about and reacts to certain situations is essential to successful treatment.
3. Rerouting cognition and rationale: During CBT, clients are encouraged to alter their usual thought patterns by applying logic and reason, which consequently redirects their response.

During CBT treatment, a therapist actively works with the client to disrupt unhealthy thought patterns and uncover how those ways of thinking cause self-destructive behaviors and beliefs. Through addressing problematic patterns of thought, the client and therapist work together to build healthier beliefs and behaviors based on more productive ways of thinking. Typically, someone attending regular CBT sessions will receive homework in-between meetings to practice constructive ways of dealing with negative thoughts.

Examples of CBT homework include:

• Journaling: This includes writing about negative emotions to better process them and identify any thought patterns.
• Practicing relaxation techniques: Clients learn different strategies like deep breathing to calm the mind and body.
• Facing fears: Clients learn how to confront a particular fear instead of avoiding it.
• Role-playing: CBT treatment will include practicing with others for potentially stressful situations and interactions.

2. What Skills Does CBT Therapy Teach?

Because CBT treatment involves a concerted effort to change thinking patterns, clients must learn how to recognize negative thought paths and enact new practices to replace these harmful habits. CBT typically comes with a fair share of unlearning old behaviors along with the traditional teaching of new information.

These are five skills most frequently gained from altering thinking patterns through CBT:

1. Self-recognition: This skill involves learning to recognize the distorted ways of thinking that have created both past and present problems.
2. Reevaluation: Reevaluation allows a client to retrain him or herself to analyze situations through the lens of reality as opposed to past thought patterns.
3. Perspective: This skill allows for examining other viewpoints to understand other people’s behaviors and motivations better.
4. Problem-solving skills: Learning these skills enables a client to turn to healthy coping mechanisms during difficult situations.
5. Confidence: More confidence entails developing a greater sense of self-esteem and confidence in one’s own abilities.

3. Who Is CBT Right For?

The strong emphasis on thinking and behavior placed by CBT makes it an especially suitable treatment for those seeking to overcome specific problems. For those less interested in psychoanalysis and the influence of past events, CBT can be an effective way of addressing current thought patterns and yielding positive behavioral results. CBT can even be used to treat physical conditions like chronic pain in some cases.

CBT is often used to address these disorders:

• Depression
• Post-traumatic stress disorder (PTSD)
• Seasonal affective disorder (SAD)
• Obsessive-compulsive disorder (OCD)
• Anxiety
• Phobias

A broad range of ages can benefit from CBT, especially children and adolescents. Combined with active parent involvement, children as young as 3 can see significant improvements in anxiety levels through CBT. When started at a young age, CBT treatment can be an effective way of preventing future disorders by dismantling unproductive thought habits early. The life skills and practices learned through CBT can be the foundation of a long-lasting healthier lifestyle.

How Are DBT and CBT Similar?

Because DBT has been developed from CBT, there is a considerable overlap between them. Both CBT and DBT are common and effective psychotherapies focused on how thoughts, feelings, and behaviors intertwine. Through talk therapy, both approaches get clients to increase self-awareness, reevaluate self-destructive behaviors, and form healthier habits. Both treatments also place high importance between the therapeutic relationship of the client and the therapist.

DBT builds upon the building blocks laid by CBT. As a subset of CBT, the course of treatment in DBT will also address cognitive restructuring and address distorted thinking. Both modalities will involve homework and therapeutic assignments for clients to complete between sessions.

What Makes DBT Different From CBT?

Despite their similarities, there are some important differences between CBT and DBT. CBT mainly helps clients identify and change problematic ways of thinking and behaving, while DBT also helps clients regulate extreme emotions to improve relationships through validation and behavior change.

In addition to this main distinction, here are five contrasts to consider when weighing DBT vs CBT:

1. Time commitment: Usually, comprehensive DBT is a more involved treatment process than CBT. While CBT consists of weekly therapy sessions, a comprehensive DBT protocol often includes individual therapy, skills training, and coaching calls between sessions for the client.
2. Focus: CBT concentrates heavily on the thinking or cognitive component. While DBT addresses the thinking distortion and changing the thoughts, DBT also concentrates on the emotions. In DBT, the validation of emotions, as well as the understanding that emotions are not only a result of one’s cognition but also a physical experience, are important components of treatment.
3. Interpersonal relationships: Although CBT can concentrate on addressing particular relationships, DBT intentionally focuses on interpersonal connections much more heavily. Because most emotionally provocative situations involve friends, family, or a romantic partner, DBT deliberately teaches ways to control strong emotional responses within such instances.
4. Skills: CBT teaches individuals how their thoughts, feelings and behaviors interconnect and can be changed to generate a more positive outcome. This means the specific skills learned will depend on each client’s personal needs. In contrast, DBT skills are a set curriculum and typically will expect the participant to participate in all of the skill modules.
5. Clinical Presentation: Both CBT and DBT can treat multiple types of disorders. However, since the development of DBT, DBT has become the treatment of choice for Borderline Personality Disorder as well as clients with self-harming or high-risk behaviors.

Contact Hillside® About DBT Treatment Options

As one of the first youth and adolescent residential facilities in the Southeast with DBT-Linehan Board Certification, Certified Clinicians™, Hillside® is fully equipped to provide the therapy your child needs. At Hillside, we focus on helping young people heal through various treatment strategies. Along with our residential treatment, we offer multiple levels of outpatient programs — such as Partial Hositaliztion Program (PHP), Intensive Outpatient Program (PHP), and Intensive In-Home Threapy — so you can choose the treatment structure that’s best for your child and family.

Our virtual DBT parent group also extends to our Day Treatment and Intensive Outpatient options, so clients’ families can be more involved with the program. By teaching children and their families the necessary DBT skills for coping with behaviors together, Hillside offers healing and hope for families. Through all of our therapy programs, our goal is for you to find a way to restore peace for your child and home.

If you think DBT treatment could be right treatment for your family, Hillside is ready to provide the resources and support for your child to discover a life worth living. Contact Hillside today to learn more about our DBT treatment opportunities.