Practice Management

Cognitive-Behavioral Therapy vs Dialectical Behavior Therapy

Jeff Bauer
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cbt vs dbt
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Both CBT and DBT focus on teaching practical skills you can use to deal with emotional distress. However, CBT mainly focuses on identifying and changing negative thoughts, while DBT is based on learning how to better handle emotions.

Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers.

Psychotherapy (“talk therapy”) is an effective way to treat many mental health disorders. Cognitive-behavioral therapy (CBT) is a type of psychotherapy that focuses on the connections between your thoughts, feelings, and behaviors.1,2 It teaches you how changing how you think can change how you feel and act.1,2 Dialectical behavior therapy (DBT) focuses on ways to improve how you control your emotions and cope with distress.1,3 This fact sheet explains the similarities and differences between CBT and DBT.

Cognitive-Behavioral Therapy

All forms of CBT are based on understanding that the way you think affects how you feel and act, and that certain thinking patterns can cause emotional problems.1,4,5 Cognitive-behavioral therapy shows you how changing your thoughts — or how you respond to your thoughts — can reduce emotional distress.1

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Cognitive-behavioral therapy teaches you ways to identity and change thoughts that cause problems.5,6 This usually includes some combination of the following3,4:

  • Relaxation techniques (such as deep breathing and mindfulness);
  • Psychoeducation (learning how thoughts, feelings, and actions are connected);
  • Behavioral therapy skills (learning how to participate in positive activities); and 
  • Cognitive restructuring.

Cognitive restructuring means identifying your negative automatic thoughts and cognitive distortions, and recognizing that they are not necessarily true.4 Negative automatic thoughts are your immediate, unfavorable interpretations of events, such as thinking someone doesn’t like you because they didn’t say hello.7 Cognitive distortions are patterns of negative thinking that lead to incorrect conclusions. Examples of cognitive distortions include catastrophizing, overgeneralizing, and “black and white” thinking, such as “I never do anything right” or “If I lose my job, no one will ever hire me again.” 2,7 Your therapist will help you evaluate the accuracy and usefulness of such thoughts, and encourage you to change thoughts that are not helpful.1

Cognitive-behavioral therapy can be conducted one-on-one with a therapist, in group sessions, or virtually over the Internet or via an app.4 The number and length of sessions varies but generally is short-term. A common format is therapy sessions that last 45 minutes to 1 hour and take place once a week for 12 to 16 weeks.2-4 These sessions usually are supplemented with “homework” assignments to complete between sessions.

Dialectical Behavior Therapy

In DBT, “dialectical” means recognizing that 2 seemingly opposite things or ideas can be true at the same time. Part of DBT includes being taught to accept yourself, your situations, and your emotions as they are, while at the same time working to make positive changes.8

The main goals of DBT are to teach you ways to better manage intense emotions, improve your relationships, tolerate distress, and reduce unhelpful behaviors.4 This is accomplished by a program that includes the following4,9,10:

  • Individual therapy;
  • Group skills training;
  • Telephone coaching; and 
  • Consultation meetings by therapists and others who are part of your care. 

The precise format, length, and duration of each of these can vary depending on the specific patient and disorder.9

In DBT, individual therapy focuses on identifying and addressing unhelpful behaviors, and using the skills taught in the group skills training. These sessions typically take place once a week for 50 minutes.9

Group skills training is provided in a classroom setting, typically once a week for approximately 2 hours.9 In this training, you are taught the 4 core DBT skills4,11:

  • Mindfulness;
  • Distress tolerance;
  • Interpersonal effectiveness; and
  • Emotion regulation.

Mindfulness means focusing on the present moment and accepting whatever is happening in that moment, including your thoughts and feelings, without judgment.2,4 Distress tolerance involves learning ways to handle emotional pain and difficult situations without resorting to harmful behaviors. Examples include self-soothing techniques, intense exercise, controlled breathing, and progressive muscle relaxation.4 Interpersonal effectiveness skills are strategies for dealing with social situations, such as asserting yourself and negotiating conflict. Emotion regulation skills are ways of understanding, identifying, and controlling your emotions.4 Examples include accurately labeling your emotions, understanding how emotions work, and using techniques to make your emotions less intense.4

With telephone coaching, you are able to call a therapist as needed between sessions.9 This allows you to receive immediate help with applying DBT skills when you are in the middle of a crisis. 

The consultation meetings support the therapists and make sure the treatment remains consistent with the principles of DBT.9

CBT vs DBT: Similarities and Differences

Both CBT and DBT focus on teaching practical skills you can use to deal with emotional distress.5 Some techniques, such as mindfulness and social skills, are part of both therapies. One-on-one therapy and homework assignments typically are part of both CBT and DBT. One important difference is that CBT mainly focuses on identifying and changing negative thoughts, while DBT is based learning how to better handle emotions and distress.11 Also, CBT typically is a short-term treatment (12 to 16 weeks) while DBT usually is longer (1 year to 18 months).1,2

CBT vs DBT: Which Is Right for You?

Which type of psychotherapy is best for you is a decision to make after consulting with a therapist. It depends on several factors, including which disorder you have, your willingness to meet the requirements of the type of therapy, and the availability of a therapist with appropriate expertise. Both CBT and DBT are effective for a range of mental health disorders. The evidence for CBT is strongest for the following conditions1,2:

  • Depression;
  • Panic disorder;
  • Generalized anxiety disorder;
  • PTSD;
  • Obsessive-compulsive disorder, and 
  • Social phobia.1,2 

Dialectical behavioral therapy has been effective for borderline personality disorder and other disorders in which people have trouble regulating their emotions, including PTSD, substance abuse, depression, and eating disorders.1,12,13 

CBT vs DBT: Frequently Asked Patient Questions

Who created CBT?

Psychoanalyst Aaron Beck often is credited with being the first to notice (in the late 1960s) that negative thoughts were often the root of the problem in his patients with depression. He also noticed that when he helped these patients change their thinking, they felt better and were able to change their behavior.14 This led Beck to develop what he called cognitive therapy, which eventually evolved into CBT.14

What is the ABC model of CBT?

The ABC model was developed by Albert Ellis, who created rational emotive behavior therapy, an early form of CBT. The ABC model is as follows15:

  • A (Activating event): The negative situation a person encounters;
  • B (Beliefs): How the person interprets the event; and 
  • C (Consequences): The person’s emotional or behavioral response to the situation.

The ABC model helps people understand that it is not the event that determines how they feel or act, but their beliefs about the event.15 The ABC model is commonly used in CBT.

Who created DBT?

Dialectical behavioral therapy was created in the early 1980s by Marsha Linehan, PhD. She developed it as a treatment for people with borderline personality disorder who had suicidal thoughts and engaged in behaviors to harm themselves.4

What are the 4 core skills of dialectical behavior therapy?

The 4 main skills of DBT are as follows4,11:

  • Mindfulness;
  • Distress tolerance;
  • Interpersonal effectiveness; and
  • Emotion regulation.

References

  1. Saju PJ. Cognitive behavioural therapy and dialectical behavioural therapy: An introduction. In: Gibbons R, O’Reilly J, eds. Seminars in the Psychotherapies. 2nd edition. Cambridge University Press; 2021:79-96.
  2. Curtiss JE, Levine DS, Ander I, Baker AW. Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus (Am Psychiatr Publ). 2021;19(2):184-189. doi:10.1176/appi.focus.20200045
  3. Afshari B, Jafarian Dehkordi F, Asgharnejad Farid AA, et al. Study of the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder. Trends Psychiatry Psychother. 2022;44:e20200156. doi:10.47626/2237-6089-2020-0156
  4. Rostamzadeh M, Husseini AA, Mosier W. Evaluating the efficacy of dialectical and cognitive behavioral therapies in reducing impulsive behaviors. Journal of Public Health and Primary Care. 2024;5(3):153-161. doi:10.4103/jphpc.jphpc_10_24
  5. Fruzzetti AE. Dialectical thinking. Cognitive and Behavioral Practice. 2022;29(3):567-570. doi:10.1016/j.cbpra.2022.02.011
  6. Nakao M, Shirotsuki K, Sugaya N. Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosoc Med. 2021;15(1):16. doi:10.1186/s13030-021-00219-w
  7. Chand SP, Kuckel DP, Huecker MR. Cognitive behavior therapy. StatPearls. Updated May 23, 2023. Accessed August 26, 2025. https://www.ncbi.nlm.nih.gov/books/NBK470241/
  8. Vijayapriya CV, Tamarana R. Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: A systematic review. Res Psychother. 2023;26(2):662. doi:10.4081/ripppo.2023.662
  9. Rizvi SL, Bitran AM, Oshin LA, Yin Q, Ruork AK. The state of the science: Dialectical behavior therapy. Behav Ther. 2024;55(6):1233-1248. doi:10.1016/j.beth.2024.02.006
  10. Michałowska SN, Chęć M. Dialectical behavior therapy in the treatment of trauma. Archives of Psychiatry and Psychotherapy. 2024;26(1):26-32. doi:10.12740/APP/172133
  11. Dong C, Zhao J, Wei Y, Wu D, Cai Z. Comparative analysis of cognitive behavioral therapy and dialectical behavior therapy in enhancing psychological capital among medical students: A randomized controlled trial. Front Psychol. 2024;15:1479310. doi:10.3389/fpsyg.2024.1479310
  12. Bohus M, Kleindienst N, Hahn C, et al. Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: A randomized clinical trial. JAMA Psychiatry. 2020;77(12):1235-1245. doi:10.1001/jamapsychiatry.2020.2148
  13. Lammers MW, Vroling MS, Crosby RD, van Strien T. Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up. Int J Eat Disord. 2022;55(7):902-913. doi:10.1002/eat.23750
  14. Beck JS, Fleming S. A brief history of Aaron T. Beck, MD, and cognitive behavior therapy. Clin Psychol Eur. 2021;3(2):e6701. doi:10.32872/cpe.6701
  15. Selva J. What is Albert Ellis’ ABC model in CBT theory? PositivePsychology.com. Published March 8, 2018. Accessed August 26, 2025. https://positivepsychology.com/albert-ellis-abc-model-rebt-cbt/