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Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two evidence-based therapeutic modalities commonly used in substance use and co-occurring mental health disorder treatment programs. While they share some principles, they have different areas of emphasis.
Understanding the difference between CBT and DBT can enable you to better understand what to expect from therapy and why a clinician may recommend one approach, the other, or a combination of both.
At Skyline Recovery Center, treatment is personalized to each person’s symptoms, goals, history, and recovery needs. CBT and DBT may both be incorporated into your treatment for substance use and co-occurring mental health concerns.
What Is CBT?
Cognitive behavioral therapy, or CBT, is a structured therapeutic approach that focuses on the connection among thinking, feeling, and behavioral patterns.
The basic notion is that patterns of thinking can impact emotions and behavior. When certain thinking patterns become inaccurate or unhelpful, they can contribute to behaviors that make a person’s circumstances more difficult.
In CBT, a therapist may help you:
- Identify unhelpful thought patterns
- Recognize events or circumstances that trigger difficult emotions or behaviors
- Examine whether certain thoughts are accurate or helpful
- Develop healthier ways of responding to stress
- Practice new behaviors and coping strategies
- Build skills that can support long-term recovery
CBT is widely used for conditions such as anxiety, depression, and substance use disorders. It can also be incorporated into treatment when substance use and mental health symptoms occur together.
What Is DBT?
Dialectical behavior therapy, or DBT, is an approach that developed from cognitive behavioral therapy. It combines behavioral strategies with acceptance-based techniques and emphasizes managing intense emotions and difficult situations.
DBT commonly teaches four core skill areas:
- Mindfulness: Learning to remain aware of thoughts, feelings, and experiences in the present moment
- Distress Tolerance: Developing ways to cope with difficult situations without responding in harmful or destructive ways
- Emotion Regulation: Understanding and managing intense emotional responses
- Interpersonal Effectiveness: Building healthier communication and relationship skills
A full, or “comprehensive,” DBT program at Skyline Recovery Center typically has four components: individual therapy, a weekly skills-training group, in-between-session phone coaching, and a consultation team that coordinates with the clinicians delivering treatment. Not every program that uses DBT delivers all four parts. For instance, some offer DBT-informed skills groups rather than the complete model.
DBT was originally developed for severe emotional difficulties that come with borderline personality disorder. It has since been adapted for a range of mental and behavioral health concerns. It can also have a role in substance use treatment, particularly when emotional distress, impulsive behaviors, or difficulty coping with strong emotions contribute to substance use.
Wish To Find Out What Care Can Look Like For You?
Whether you are managing a substance use or mental health concern, the right level of care can enable you to manage your thoughts, choices, and daily life.
Therapies like CBT and DBT offer tools to develop healthier coping skills - but no one plan works for everyone. This is why we begin with a confidential clinical assessment at Skyline - personalized to your needs and goals.
What Is the Difference Between CBT and DBT?
The main difference between CBT and DBT is the emphasis of each approach.
CBT generally focuses on identifying and changing unhelpful patterns of thinking and behavior. DBT uses many of these behavioral principles but emphasizes accepting difficult experiences, regulating emotions, tolerating distress, and improving relationships.
| CBT | DBT |
|---|---|
| Focuses on thoughts, feelings, and behaviors | Focuses on emotions, behaviors, relationships, and acceptance |
| Identifies and challenges unhelpful thoughts | Teaches skills for managing intense emotions and distress |
| Often uses cognitive restructuring and behavioral techniques | Uses mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness |
| Commonly used for anxiety, depression, and substance use | Commonly used when emotional dysregulation and difficult behaviors are prominent |
| Often structured around specific treatment goals | Often involves structured skills training and ongoing practice |
The two approaches are not mutually exclusive. A person’s treatment plan may include techniques from both, depending on their clinical needs and goals. Skyline Recovery personalizes care to your symptoms and circumstances, and may integrate multiple evidence-based therapies into a coordinated treatment plan.
How Can DBT and CBT For Addiction Help?
DBT for addiction focuses on helping you develop healthier ways to respond to difficult cravings, emotions, stress, interpersonal conflict, and other events that may contribute to substance use.
For some, substance use becomes a way to temporarily escape overwhelming emotions or distress. DBT can provide practical skills for managing those moments without turning to alcohol or drugs.
DBT has also been specifically adapted for substance use disorders (DBT-SUD), developed by Marsha Linehan and colleagues. It includes “dialectical abstinence” – a commitment to abstinence that is combined with acceptance of any lapse as part of the recovery journey, rather than treating a single slip as a full relapse.
For instance, DBT skills may help a person:
- Recognize emotional triggers before they escalate
- Tolerate distress without immediately acting on an urge
- Manage intense emotions
- Communicate more effectively in relationships
- Identify patterns that contribute to impulsive behavior
- Develop healthier coping strategies
CBT can also play an important role in addiction treatment by enabling a person to identify thoughts, triggers, and behaviors linked with substance use and develop healthier alternative responses. This mirrors Marlatt and Gordon’s relapse prevention model, which focuses on identifying high-risk circumstances and developing coping skills so a lapse does not turn into a full relapse.
As substance use can involve both behavioral patterns and underlying emotional or mental health concerns, clinicians may use CBT, DBT, or other therapies as part of a broader treatment plan. Skyline Recovery Center uses both CBT and DBT in its substance use and dual diagnosis programs.
CBT vs DBT for Anxiety
When considering DBT vs CBT for anxiety, the right approach depends on the person’s symptoms and overall treatment needs.
CBT is widely used for anxiety, as it directly targets anxious thought patterns and behaviors such as avoidance. Therapy may involve identifying anxious predictions, examining the evidence behind them, and gradually developing healthier responses, often through exposure-based work – slowly and safely facing feared situations to reduce avoidance over time.
DBT can also be useful when anxiety occurs alongside significant emotional dysregulation, impulsive behaviors, interpersonal difficulties, or problems tolerating distress. Its skills can enable a person to manage overwhelming emotions and respond to stressful situations more effectively.
This does not mean that one therapy is automatically the right modality for everyone with anxiety. A clinician can assess the person’s symptoms and determine which therapeutic approaches fit their needs.
CBT or DBT for Depression
Those exploring CBT or DBT for depression may find that both can help, because each can focus on different aspects of emotional and behavioral difficulties.
CBT can identify patterns of negative thinking and behaviors that may reinforce depressive symptoms. It may also involve behavioral activation – behavioral strategies designed to help a person gradually become more active and engaged in meaningful activities.
DBT may be considered when depression occurs alongside severe emotional dysregulation, self-destructive behaviors, interpersonal difficulties, or difficulty tolerating distress.
The presence of depression alone does not determine which therapy should be used. A comprehensive assessment can help identify the symptoms, contributing factors, and treatment goals that should inform therapy.
What Is a Treatment Plan in Therapy?
A treatment plan is a structured outline that identifies the concerns being addressed, treatment goals, therapeutic approaches, and ways to monitor progress. It gives the therapist and client a shared framework for treatment while allowing the plan to change as needs evolve.
A treatment plan may address:
- Symptoms and concerns
- Treatment goals
- Specific objectives
- Therapeutic approaches
- Coping and behavioral skills
- Progress toward goals
- Medication or psychiatric care when appropriate
- Relapse prevention
- Aftercare and continuing support
Treatment planning is especially crucial when someone has both a substance use disorder and a mental health condition. Rather than treating each concern separately, integrated care can address the relationship between mental health symptoms and substance use.
At Skyline Recovery Center, treatment begins with a clinical assessment, following which you will be recommended the right level of structured outpatient care – a partial hospitalization program, an intensive outpatient program, or a standard outpatient therapy program that fits in with your needs and goals.
CBT and DBT are delivered through these programs. Our emphasis is on meeting you where you are and providing you with a structured yet flexible path to recovery that fits in seamlessly with your life.
Other therapies may also be incorporated when appropriate. Skyline Recovery Center’s therapy approach includes CBT, DBT, trauma-informed care, individual and group therapy, family therapy, and other evidence-based or whole person approaches, depending on the person’s needs.
What CBT and DBT Look Like at Skyline Recovery Center?
In PHP, DBT skills groups typically meet 5 times a week, focusing on mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. In IOP, these groups typically meet 2-3 times a week as clients step down from higher levels of care.
Individual sessions draw from both CBT and DBT, depending on the client’s treatment plan, generally held once or twice weekly.
Diary cards and between-session homework that track cravings, emotions, and skills used are a standard part of measuring progress for both CBT and DBT.
Your first week will typically focus on intake and assessment, orientation to group norms, and a first individual session to set treatment goals. You will likely spend that first week getting acquainted with the schedule and developing a rapport with your therapist before diving deeper into therapy work.
Choosing Between CBT and DBT Is Not Something You Need to Figure Out On Your Own
If you are exploring CBT and DBT for substance use, anxiety, depression, or other concerns, you do not have to figure this out on your own.
A licensed and qualified clinician at the Skyline Recovery Center can evaluate your symptoms, substance use history, mental health concerns, treatment goals, relationships, coping patterns, and other relevant factors.
For someone experiencing substance use and/or a mental health condition, this personalized path to recovery is particularly important. Treating the substance use disorder while also addressing underlying mental health concerns can provide a more coordinated approach to recovery.
Get Clarity On Your Options
When you take the first step to your recovery, you do not have to figure out whether CBT or DBT is the right therapeutic modality for you. A licensed and trained clinician will sit with you in safe and confidential settings to understand your needs and goals and recommend a personalized program for you.
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Frequently Asked Questions
Is DBT a type of CBT?
DBT developed from CBT and retains many cognitive and behavioral principles, but it also emphasizes acceptance, mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Which is better for substance use disorders - CBT or DBT?
Neither therapy is universally better for substance use. CBT can help address thoughts, triggers, and behaviors linked with substance use. DBT can be particularly useful when intense emotions, impulsive behaviors, or difficulty tolerating distress contribute to substance use. A comprehensive treatment plan may incorporate either or both approaches.
How long does CBT or DBT take?
The length of therapy varies based on the person's needs, goals, symptoms, and treatment setting. CBT is often delivered as a structured therapy, while comprehensive DBT programs may involve longer-term treatment and skills training.
Do I have to choose between CBT and DBT?
Depending on your needs, a treatment plan may incorporate CBT, DBT, or techniques from both approaches. Other therapies may also be appropriate.
Is DBT better than CBT or vice-versa?
There is no single answer, as the two therapies serve different purposes and emphasize different areas. CBT may be particularly useful when treatment focuses on changing unhelpful thought patterns and behaviors. DBT may be particularly useful when intense emotions, distress tolerance, impulsive behaviors, or interpersonal difficulties are central concerns.
Can CBT and DBT be used together?
CBT and DBT can be incorporated into the same treatment plan when clinically appropriate. For instance, CBT techniques may help a person examine thoughts and behaviors associated with substance use, while DBT skills may help them manage the intense emotions or stressful situations that make those behaviors more difficult to control.
Are CBT and DBT covered by insurance?
Skyline Recovery Center works with many major insurance plans. Coverage for CBT and DBT delivered in PHP, IOP, or outpatient therapy depends on your plan and medical necessity - our admissions team can verify your benefits before you start.
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