You’ve probably heard of Cognitive Behavioural Therapy (CBT) and Dialectal Behavioural Therapy (DBT), but understanding the differences between the two can be challenging. There’s a good reason for that, and it’s not just the similarity in their names. CBT and DBT stem from the same philosophy, and there’s a lot of overlap in the two approaches. However, they also have some important differences.
If you’re considering therapy, you may find one of these approaches helpful. Both have scientific research backing them up, and they treat some of the same disorders. Given their similarities, how do you know which one is right for you? Here’s a rundown of the basics of CBT and DBT and what they have to offer.
What is Cognitive Behavioural Therapy?
According to Psychology Today, CBT is based on the idea that our thoughts, behaviours, and emotions all affect each other. This means that we don’t have to try to change our emotions directly in order to feel better. Learning healthier patterns of thinking and acting can help clients improve their emotional state, even with feelings that are often very hard to deal with directly.
People tend to think of therapy as a lengthy process that requires a grueling journey through painful events of the past, but CBT approaches psychological problems differently. By identifying the disordered thinking and unhelpful patterns of behavior that cause their distress, clients can have an impact on difficult emotions. This is true even with intense emotions that have seemed to be inescapable. Many find that they regain a sense of stability and peace that has eluded them for years.
If you’ve struggled with painful emotions for a long time, that may sound a little like magic. But the truth is that CBT creates changes through measurable, systematic work. By learning new skills in a supportive environment, under the guidance of an experienced therapist, clients can change their lives for the better. Here’s a glimpse of what that might look like.
How does CBT work in therapy?
Because CBT focuses on learning and practicing specific skills, clients usually don’t have to continue seeing their therapist over long periods of time. Most people find relief in only five to 20 sessions. At that point, they are able to apply the skills they’ve learned to their lives in ways that persist, helping them to maintain a healthy, functional state.
CBT follows a systematic approach that’s designed to address each client’s individual needs. It’s often carried out in a one-on-one session with a therapist, but it can also be effective in group therapy sessions.
After an initial assessment, the therapist helps the client identify the thoughts, feelings, and behaviours that are causing their distress. They then work together to change the patterns that are keeping the client stuck. This requires the client to become aware of the actions and thoughts that aren’t helping them. They then learn new ways to react and behave. This work may include:
- Journaling to identify thoughts that contribute to times of emotional distress.
- Questioning the assumptions that are contributing to the distress.
- Roleplaying to learn healthier ways of responding.
- Exposure therapy to help clients safely confront fears in a supportive environment.
- Mindfulness practices, such as medication or breathing exercises, in order to help clients cope with strong emotions.
CBT has been shown to be remarkably effective in a short period of time. But to fully benefit from this approach, clients have to commit to doing some work between sessions. This helps them develop the skill they’re learning and become comfortable using them.
What is Dialectical Behavioural Therapy?
DBT was drawn from the practice of CBT. It was originally developed to treat borderline personality disorder, which is resistant to treatment. Since then, it’s been expanded to help clients with other conditions that are notoriously difficult to treat, such as eating disorders and substance use disorders.
“Dialectical” refers to the concept of balancing opposite concepts. It helps clients to avoid black or white thinking, so they can instead develop a balanced approach to life. The biggest dialectic in DBT is the idea of embracing both self-acceptance and change. We’ll get back to that later.
Because DBT is a subset of CBT, there are many similarities between them. However, while CBT is largely focused on helping clients change ways of thinking and behaving that don’t serve them, DBT is more intensive and has a different focus. In this approach, the goal is to help clients learn to regulate extreme emotions. They also work to improve their relationships through changed behaviours. The main goals of DBT are:
- Mindfulness, or living in the moment.
- Learning healthy ways to cope with stress, also known as distress tolerance.
- Regulating emotions.
- Improving relationships.
One of the big differences between the two approaches is that DBT typically requires a longer time commitment. Clients often benefit from a course of DBT that can last from six months to two years. This usually includes group therapy as well as individual sessions. As with CBT, clients are asked to complete homework on their own, to help them develop new skills.
How does DBT work in therapy?
An important aspect of DBT is that it takes place in an accepting, non-judgemental environment. Changing how you cope with strong feelings and how you interact with others can feel overwhelming, and therapists encourage clients to do this work with an attitude of self-acceptance and kindness.
It may sound paradoxical to strive to accept yourself and make significant changes at the same time, but the truth is that it’s the most effective way to move forward. Acceptance helps people lower their defenses and feel safe enough to face their problems. This is the dialectic at the core of this approach.
Like CBT, DBT also begins with an assessment, to help the client and therapist identify what they want to achieve in therapy. Once that is done, the therapist can begin, often giving the client worksheets to use at home, to help them start working toward their goals.
During individual sessions, the therapist goes over the client’s homework and helps them identify the behaviors they want to address together. They may practice important skills for each situation, including:
- Self-soothing techniques to help the client to develop distress tolerance.
- Mindfulness techniques to become grounded in the moment, interrupting spiraling emotions.
- Identifying feelings without judgment.
- Using the acronym GIVE (be Gentle, show Interest, Validate the other person’s feelings, and try to have an Easy attitude) to help guide behaviour in relationships.
They can then agree on some goals, or targets, for the client to work on between sessions. These can be new goals or a continuation of previous work. The therapist regularly assesses the client’s progress.
In group DBT sessions, clients come together to learn and practice the skills they’ve been working on in individual therapy.
Some therapists also offer phone coaching if the client needs extra support between sessions. This kind of quick check-in can help clients who become overwhelmed by difficult emotions and need some guidance to help them respond the way they want to, instead of just reacting to how they feel.
What disorders do CBT and DBT treat?
Again, there is quite a bit of overlap between the two therapeutic approaches. Naturally, this means CBT and DBT are both effective at treating some of the same conditions. In general, DBT is a more intensive approach, and it’s often preferred for use in conditions that are more complex and difficult to address.
CBT, on the other hand, has been shown to help clients address a specific issue in their lives, such as a certain phobia. This doesn’t mean that you wouldn’t benefit from CBT if an issue is causing you intense distress and impacting many areas of your life. Ultimately, the only way to know which approach is best for you is to speak with an experienced therapist about your needs and goals.
That said, there is scientific research that backs up each approach for specific conditions.
CBT has been demonstrated to be effective in treating:
- Eating disorders
DBT has been demonstrated to be effective in treating:
- Bipolar disorder
- Borderline personality disorder
- Generalized anxiety disorder
- Substance use disorder
- Suicidal behaviour
- Non-suicidal self-harm
- Eating disorders
- Obsessive-compulsive disorder
Again, it’s important to be aware that the best way to determine the best approach for your unique situations is by talking to a skilled therapist. Remember that there is no “right” approach to therapy. The best method is the one that works for you, and a therapist can help you figure that out.
At Trillium Counselling, we offer both CBT and DBT, and our experienced and compassionate therapists can help you choose the approach that would serve you best. For more information or to make an appointment, contact us today.