CBT vs. DBT: Which one is right for you?

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Last updated: 11/08/2023

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Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two popular forms of therapy used to treat a wide range of mental health issues. Though they have many similarities, each approach focuses on different aspects of treatment.

CBT centers on the relationship between thoughts and feelings. It explores how your thoughts impact your emotions and how certain patterns of behavior can contribute to mental health concerns. The main goal of CBT is to replace your negative thoughts and behaviors with healthier ones.

DBT combines elements of CBT with mindfulness practices to address emotional dysregulation. This model emphasizes the importance of validating and accepting your feelings. The main goal of DBT is to teach you skills that can be used to better manage intense emotions and improve communication.

DBT is based on CBT, so there’s overlap between the two. Here’s what they have in common.

Cognitive-focused: Both types of therapy acknowledge the relationship between your thoughts and feelings. They aim to help you understand and change your thought patterns to improve your emotional well-being.
Present-focused: CBT and DBT both emphasize the importance of focusing on the present moment and avoiding excessive worry about the past or the future.
Collaborative: In both therapies, the therapist and client work together to identify distressing patterns of thinking and behavior, set goals, and develop strategies for change.
Evidence-based: Both CBT and DBT are grounded in scientific research and have proven effective at treating a variety of mental health conditions.
Skills-based: Both methods provide practical skills and techniques that can be applied in real-life situations. These include coping skills, problem-solving strategies, communication techniques, and mindfulness practices.

How CBT and DBT are different

Though these two types of therapy run parallel in a number of ways, key differences between them include:

Conditions treated: CBT is commonly used to treat a wide range of mental health issues, including anxiety and depression. DBT, on the other hand, was originally developed to treat people with borderline personality disorder (BPD) but has since been expanded to address other conditions as well.
Approach: While CBT focuses on thoughts and behaviors, DBT places a stronger emphasis on emotional regulation. DBT is grounded in the concept of dialectics, which is the ability to hold two opposing perspectives at the same time.
Setting and format: DBT often incorporates group therapy as a core component of treatment because it helps clients practice interpersonal skills and get support from others who have similar struggles. CBT typically involves one-on-one sessions with a therapist.
Frequency and duration: CBT is typically conducted in weekly or biweekly sessions, with treatment lasting 8 to 12 weeks.¹ DBT often involves more frequent sessions, may include several types of sessions (individual and group), and can last for a year or more.²
Cost: DBT can be more expensive than CBT due to its longer duration and the inclusion of group therapy. One cost analysis of evidence-based therapies showed that CBT was the least expensive, while DBT had the highest price tag.³

What are CBT and DBT used for?

CBT has proved effective at treating a range of mental health conditions, including anxiety disorders, mood disorders (such as depression and bipolar disorder), eating disorders, substance abuse, personality disorders, and posttraumatic stress disorder (PTSD).⁴ It can be adapted to the needs of children, adolescents, adults, couples, and families, and it can be used in combination with medication and/or other forms of treatment.

In addition to treating borderline personality disorder, DBT can help alleviate conditions including substance abuse, depression, PTSD, and eating disorders.⁵ Like CBT, DBT can be adapted for different populations and used alongside other treatments.

Is one more effective than the other?

It depends on a person’s individual needs and the specific mental health condition being treated. Research results are mixed.

In a study of 72 participants with generalized anxiety disorder who were treated with either CBT or DBT, those in the CBT group appeared to show more improvement in anxiety and depressive symptoms.⁶ The DBT group, on the other hand, showed greater improvements in executive function, which is involved in decision-making and self-control.

How to choose between CBT and DBT

It’s worth noting that CBT and DBT can be used together. But if your goal is to choose one or the other, here are some factors to consider.

Symptoms and diagnosis

Start by reflecting on your specific symptoms. If you’ve already been diagnosed with a condition by a mental health professional, it may be easier to pick a type of therapy. Consider which practice aligns more closely with the issues you’re facing. CBT may be a better fit if you have anxiety, depression, or a mood disorder, while DBT may be a better fit if you experience intense emotions—especially in connection with self-harm, addiction, or thoughts of suicide.

Goals and preferences

Think about your treatment goals and preferences. If you mainly need help with identifying and changing negative thought patterns and behaviors, CBT may be a better fit. If you have difficulty managing strong emotions and need tools to tolerate distress and regulate your feelings, DBT’s emphasis on emotional regulation may be more suitable.

Treatment format

Work toward understanding the time commitment and style of treatment you think would work best for you. Are you comfortable sharing your experiences and receiving support from others in a group setting, or do you prefer individual attention from a therapist? Are you willing to commit to more frequent and longer sessions, or do you prefer shorter ones less often?

Cost considerations

Think about your budget and insurance coverage. Consider the potential cost differences between CBT and DBT, as well as any potential out-of-pocket expenses that may impact how affordable therapy is for you. Take your financial situation into account, including how much you’re willing and able to invest in therapy.

What to expect from a session

Both therapies start with an assessment of your specific needs and goals. The therapist will typically start by getting to know you and your reasons for seeking therapy. They may ask questions about your current symptoms, life experiences, and what specific issues you want to work on. They may also ask about your history and any previous therapies you’ve tried.

Cognitive behavioral therapy sessions

A typical CBT session might look like this:⁷

Your therapist will ask you to check in with yourself to assess how you’re feeling today.
To keep things flowing, they’ll connect what was discussed in the last session with what you’ll talk about today.
Together you’ll decide what topics you want to discuss during this session.
You’ll review any tasks or homework assigned between sessions to see how they went.
You’ll talk about the issues on the agenda, with your therapist providing feedback and summarizing key points.
Toward the end of the session, you may establish new tasks or be given homework to work on before the next session.
Your therapist will summarize what was discussed during the session to help you remember key insights and takeaways.

Dialectical behavior therapy sessions

DBT includes four different components, each of which can influence the way a session is held.⁸ These include:

Individual therapy: You’ll work one-on-one with a therapist to learn how to use certain skills to deal with personal challenges. In a standard DBT setup, individual therapy sessions take place once a week for about an hour. You may be asked to identify any recent problematic behaviors or emotions and work on specific skills or techniques to address those challenges.
Skills training group: This is comparable to attending a class where you’ll learn important skills. The group leader teaches these skills, and clients get homework to practice them in their daily lives. These groups meet weekly, usually for 24 weeks. In many cases, this timeline is repeated over a full year.
Phone coaching: If you need help right away when you’re dealing with a difficult situation, you’ll be able to call their therapist for coaching. It’s like having someone guide you on using your skills in the moment.
Therapist consultations: This support group for therapists serves to help them stay motivated and skilled in treating clients with tough problems. These teams meet regularly, usually every week, and include individual therapists and group leaders who work together to provide the best care for each client.

Visit our directory to find a therapist who specializes in CBT, DBT, or both. A therapist can also offer guidance on which kind of treatment makes the most sense for you.

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