So what is CBT and DBT anyways? Whether you are new or go to therapy frequently, CBT and DBT are important treatment options to understand because they might impact your overall therapeutic results. Understanding various theoretical orientations may align you with a mental health professional best suited to help you achieve your therapeutic goals. As a client, you should be encouraged to advocate for the best possible treatment.
What is CBT and DBT as Types of Therapy?
Cognitive behavioral therapy (CBT) is a form of evidence-based psychotherapy, or talk therapy, that treats a wide range of mental health disorders, such as depression, anxiety, PTSD, eating disorders, substance use disorder, and numerous other conditions. Moreover, CBT has proven to be an effective adjunct treatment alongside medication for more serious mental disorders such as bipolar disorder and schizophrenia. CBT has also been adapted to fit clients of all age ranges and settings, including individual, couples, and group therapy.
CBT dates back to the 1960s when Aaron Beck, American psychiatrist, noted when working with clinically depressed clients that they often lacked insight into their cognitive distortions. This led Beck to believe therapy sessions could help clients better reflect on their cognitive functioning and change their negative thoughts. As a psychiatrist, Beck firmly thought that unhelpful thoughts and behaviors weren’t the only causes of psychological distress; genetics and neurobiology were also contributing factors.
However, one of Beck’s earliest contributions to CBT was the idea that regardless of the cause of depression, when someone is in psychological distress, their thinking reflects what he called the negative cognitive triad. The negative cognitive triad is seen when the individual struggling with depression has thought patterns that are reflective of a distorted self-view (self-criticism), a negative view of the world (pessimism), and a lack of future goals (hopelessness). Beck believed that regardless of the cause of the depressive episode, the negative cognitive triad maintained depression.
Since the 1960s, CBT has been thoroughly researched and adapted to fit the current CBT models, which are more often seen today. Currently, there are several different models of CBT that clinicians will use depending on the client’s symptoms. One of the most commonly practiced forms of CBT is a treatment modality called dialectical behavior therapy (DBT).
DBT was created in the 1970s by Marsha Linehan, an American psychologist, and suicide researcher. Through her research, Linehan found individuals with borderline personality disorder (BPD), which is often characterized by intensity of emotions and lacking tools to self-regulate. Thus, DBT focuses on distress tolerance that aims to help individuals with self-acceptance, improve interpersonal relationships, and increase emotional regulation.
Even though DBT started as a treatment for personality disorders, it has now expanded to help individuals with various mental health concerns, including eating disorders, substance use disorders, depression, and others experiencing self-destructive behaviors. Moreover, DBT has been heavily researched in the treatment of BPD. One study found that out of 47 participants with BPD who underwent DBT treatment, 77% of participants no longer met the DSM-5 criteria for BPD. DBT therapy can also be conducted in group (often called DBT skills) and individual settings with people ages seven and up.
How CBT Can Help Improve Mental Health Issues
CBT is a highly structured, pragmatic, and goal-oriented cognitive model of psychotherapy. The main objective of CBT is changing current thoughts, feelings, and behaviors rather than just verbally processing previous traumatic events. Unlike other forms of therapy, CBT focuses on the here and now to improve the client’s current state of mind. Typical CBT sessions will range between 10-20 weekly one hour sessions.
CBT requires the client and therapist to build a strong therapeutic relationship, as the therapist will challenge the client’s cognitive distortions and negative core beliefs. CBT therapists will often assign clients homework outside the therapy setting to test their new skillset in everyday life. CBT helps improve mental health because it teaches the client how to be their own therapist by providing the client with the tools to change maladaptive thinking.
When in therapy, psychotherapist will often ask you about your therapeutic goals. The therapist will collaborate with the client on the most prevalent goals and structure sessions to provide the client with supportive interventions to help the client achieve those goals. When working in the context of CBT, therapeutic goals should be ‘SMART’ (specific, measurable, achievable, realistic, and time-limited).
CBT interventions address automatic thoughts, cognitive distortions, and core beliefs. Automatic thoughts are interpretations of life events. An example of this is if you don’t get a text back immediately from your partner, an automatic thought would be, “my partner is angry at me.” That thought then depicts your mood and future behaviors.
A common CBT intervention is Socratic questioning, where the therapist will help you question your automatic thoughts and have you point out evidence that does and does not support your current thought process. Ultimately, the goal is to challenge those thoughts into something that is more accurate as to what is happening. Instead of “my partner is angry with me,” maybe a more accurate way of interpreting the event is “they must be busy at the moment.”
Another CBT intervention is looking at one’s cognitive distortions or irrational thoughts that can influence your emotions. By labeling and understanding what cognitive distortions you engage in, you are more likely to recognize when you might be having an anxious thought rather than a logical one.
Lastly, CBT will focus on a person’s core beliefs which are the individual’s most central ideas about themselves and the world around them. Core beliefs are formed through life experiences but can also be inherited from our caretakers. A therapist will help you understand some of your core beliefs and identify any harmful beliefs that might feel true but impair your view of yourself and others.
How DBT Can Improve Mental Health
DBT can improve your mental health by equipping you with the tools to improve inner and intrapersonal skills. DBT, like CBT, consists of highly structured sessions that are goal oriented. DBT is also highly collaborative between the client and therapist. DBT is often a one-year requirement, with sessions lasting once a week for 40-60 minutes.
DBT builds comprehensive skills focusing on four main areas: distress tolerance, mindfulness, emotional regulation skills, and interpersonal effectiveness. Each area is to equip individuals with the tools to help self-regulate and improve interpersonal relationships. Distress tolerance assists clients in dealing with tidal wave emotions when they arise.
DBT interventions focusing on distress tolerance include distraction skills such as ‘REST’ (relax, evaluate, set intentions, and take action). Distraction skills are essential because they help you temporarily stop thinking about your pain and allow time to implement a healthy coping strategy.
Mindfulness is a core component of DBT which helps you focus on the present moment and thus learn how to self-soothe. Mindfulness also helps to develop what DBT therapists call a “wise mind,” which is the ability to make healthy decisions based on rational thoughts. Mindfulness-based interventions include meditation, somatic exercises, and body mapping.
DBT therapists will walk you through emotional regulation skills to help you better identify your emotions and have productive ways of handling your feelings. DBT breaks emotional responses into primary emotions (strong emotions that come on quickly) and secondary emotions (emotional reactions to your primary emotions). The therapist will help you to identify your primary emotion before secondary or ambivalent emotions overwhelm you. DBT interventions include analyzing your daily routine and how it may impact your life. Other interventions involve implementing coping thoughts that remind you of your strength and progress.
Lastly, interpersonal effectiveness or social skills training helps you to maintain healthy relationships. Through interpersonal effectiveness, DBT interventions will teach you to be an assertive communicator, identify personal values, and cope with conflict. A therapist can help you with role-playing exercises to help you build confidence in your interpersonal skills.
Concluding CBT vs. DBT
Entering therapy can feel overwhelming. By aligning yourself with a therapist who can help you achieve your goals, you are more likely to have a successful outcome. The more you know about treatment options, the more you can help yourself, and others have a positive therapy experience.