If you’re exploring outpatient mental health care, you are likely to encounter two major forms of talk therapy, CBT and DBT.
Both methods provide tools for processing and changing thoughts, emotions, and behaviors. They’re different in the tools they provide and how they engage challenges.
Some people respond better to one or the other, depending on their mental health condition, personality and other factors.
What’s the Difference Between CBT and DBT?
The main difference between CBT vs. DBT is in how each handles problem solving and achieving more balanced mental health.
- Cognitive behavioral therapy (CBT) focuses on identifying and changing unhelpful, automatic thought patterns and behaviors by recognizing how your thoughts directly affect your current feelings, actions, and perspectives.
- Dialectical behavior therapy (DBT) is a special form of CBT that focuses on managing intense, complex emotions by balancing change with acceptance through mindfulness, distress tolerance, and coping tools.
These therapies also approach change somewhat differently. CBT often asks you to examine whether a thought is accurate or helpful and consider a different response.
DBT combines acceptance with change, helping you recognize your current experience and while building new ways to respond.
| Focus | CBT | DBT |
| Main goal | Change unhelpful thoughts and behaviors | Manage intense emotions and distress |
| Core skills | Thought challenging, exposure, problem solving | Mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness |
| Common uses | Anxiety, depression, phobias, OCD | Instense emotional distress, self-harm, suicidal thoughts, BPD |
When Is CBT a Good Fit?
CBT may help when certain thoughts or behaviors contribute to your symptoms.
It’s commonly used for:
- Anxiety
- Depression
- Phobias
- Obsessive-Compulsive Disorder (OCD)
For example, someone with social anxiety may assume other people are judging them, even when there is little evidence to support that belief.
CBT can help them examine that belief and consider whether the evidence supports it. The person can practice responding differently when the same thought comes up.
CBT can also use exposure for phobias and OCD. This involves gradually facing feared situations instead of continuing to avoid them.
For more examples of how these techniques work, see CBT skills for anxiety and depression.
When Is DBT a Good Fit?
DBT may help when intense emotions or difficulty tolerating stressful situations interfere with daily life.
It’s commonly used for:
- Borderline Personality Disorder (BPD)
- Complex Trauma and PTSD
- Emotional Dysregulation
- Substance Use Disorders with emotional triggers
- Bipolar Depression with impulsivity and risk-taking
DBT focuses on four core skill areas:
- Mindfulness: Notice thoughts, emotions, and surroundings.
- Distress tolerance: Get through difficult situations without making them worse.
- Emotional regulation: Understand and manage strong emotions.
- Interpersonal effectiveness: Communicate needs and maintain healthier relationships.
These skills can be useful when emotional reactions feel difficult to control or create problems at home, at work, or in relationships.
DBT can also address behaviors such as self-harm and suicidal behavior as part of a comprehensive treatment plan.
How Are CBT and DBT Similar?
CBT and DBT both connect thoughts, emotions, and behaviors.
Both use structured exercises. Both also involved practicing therapeutic skills outside of sessions.
Another similarity is their practical focus. Rather than only discussing problems, therapy can give you specific strategies to apply between appointments.
DBT developed from cognitive and behavioral therapy traditions. It adds more structure and a stronger focus on acceptance, emotional regulation, and distress tolerance.
Can You Use CBT and DBT Together?
Yes. CBT and DBT can be used together when different techniques address different treatment needs.
For example:
- CBT can address unhelpful thinking patterns.
- DBT can provide strategies for managing intense distress.
A treatment program may also use different approaches at different points in care. The techniques used can change as your needs change.
New Mind Wellness offers CBT and DBT through outpatient programs in Pennsylvania, including PHP and IOP services.
Choosing Between CBT and DBT
The right approach depends on what treatment needs to address.
CBT may be discussed when:
Persistent thought patterns, avoidance, or specific fears are central concerns.
DBT may be discussed when:
Intense emotions, difficulty tolerating distress, self-harm, or relationship difficulties are more prominent.
It can also help to ask what you want to accomplish in therapy. You might want to reduce avoidance, change a recurring thought pattern, improve emotional control, or develop healthier ways to handle conflict.
A clinical evaluation can help identify appropriate treatment approaches. Schedule a free mental health evaluation to discuss your options.
Frequently Asked Questions
What happens during a CBT session?
CBT sessions typically involve discussing current concerns, identifying patterns that affect how you think or behave, and practicing strategies related to those patterns. Your therapist may also recommend exercises to practice between sessions.
What happens during a DBT session?
DBT sessions can involve learning and practicing specific skills related to mindfulness, distress tolerance, emotional regulation, or interpersonal effectiveness. The format may vary depending on the type of DBT care you receive.
Do you have to talk about past experiences in CBT or DBT?
Not necessarily. Both approaches can focus on current thoughts, behaviors, emotions, and situations. Your therapist can determine how past experiences fit into treatment based on your individual circumstances and the approach being used.
Sources:
- Cognitive–behavioral therapy for management of mental health and stress-related disorders – PubMed: National Library of Medicine
- Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis – PubMed: National Library of Medicine
- Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study – PubMed: National Library of Medicine
- Psychotherapies – National Institute of Mental Health (NIMH)