CBT vs. DBT: When Is Each Type of Therapy Most Effective?

October 15, 2019 Mark Wilhelm

When someone is struggling with a behavioral health issue, there are a variety of therapeutic models that can be used to treat it. Each type of therapy approaches the treatment process from a unique perspective, and they have strengths and weaknesses based on the individual being treated.

Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two popular models for treating mental health disorders. You might notice that these models have very similar names, which sheds some light into how they’re related. DBT is a modified form of CBT, but its approach to treatment is distinct enough from CBT that the two models are usually considered unique.

Both CBT and DBT are supported by research that proves their effectiveness, and they can each be used to treat a variety of mental health issues. However, several important factors may influence which model a therapist uses to treat a client.

Dr. Aarika V. White is a staff psychologist at Cummins who has experience using both CBT and DBT in therapy. She points out that a person’s specific mental health condition as well as their personal factors can determine which model will be most effective in treatment.

What the Research Says

The most noteworthy difference between CBT and DBT is the kind of change they create for the client. CBT primarily helps clients recognize and change problematic patterns of thinking and behaving. By contrast, DBT primarily helps clients regulate intense emotions and improve interpersonal relationships through validation, acceptance and behavior change.

Because different mental health disorders affect cognition and behavior differently, the type of treatment that’s most effective for a given disorder also varies. This means that neither CBT nor DBT is the best option in all cases, as Dr. White explains with an anecdote. “For a long time, I thought DBT worked great for anxiety. Then I attended a conference on DBT, and the speaker shared that the research doesn’t support DBT for generalized anxiety disorder, at least not above and beyond anything else.”

For depression, anxiety, OCD, phobias and PTSD, research has shown that CBT tends to be the more effective treatment. For borderline personality disorder, self-harm behaviors and chronic suicidal ideation, DBT tends to be the better choice.

According to Dr. White, these differences are largely caused by the way each model creates change:

“In DBT, there’s not a heavy reliance on changing thoughts. There’s an implicit process that happens, so that as the client is mindful, as they’re more accepting, as they validate themselves and ask for validation, they start to change any resistance they may have. They start to be kinder to themselves, catastrophize less, ground themselves in reality and accept reality, but it’s not the active challenging process that happens with CBT.”

What the Client Says

Even when we know which therapeutic model is most effective for treating a disorder, it’s important to remember that every client is unique. Each individual who enters therapy brings with them “personal factors” like childhood experiences, education, personality, values, world views and cognitive biases.

Dr. White believes that every therapist should have a theoretical orientation (such as CBT, DBT, or another therapeutic model) from which they approach treatment. However, she also stresses that the interventions used with a particular client must be appropriate for their mental health condition and personal factors. “A therapist’s personal worldview should influence their theoretical orientation. That should influence what interventions they choose, but they also have to take into account the factors that the client brings into the room. For example, I always approach treatment from a DBT perspective, but I may not always apply DBT skills,” she says.

As an expert in behavioral health, the therapist’s job is to determine the best method of treating their client. This doesn’t mean the client should have no input in the process, though. In fact, research by the American Psychological Association found that clients are more successful in therapy if they can collaborate with their therapist and provide feedback about their treatment.

For this reason, client feedback should be used to inform treatment whenever possible. This might influence the therapist’s decision about which treatment model to use, or it could convince them to try a different model if their first choice isn’t yielding results. “I’ll always approach treatment from a DBT lens, but there might be a case where the individual hasn’t been responding to DBT or they tell me they don’t want DBT. Again, it kind of depends on what the client is bringing into therapy,” Dr. White says.

As a recipient of behavioral health care, you always have the right to discuss your treatment with your therapist or counselor. You can ask about the strengths and weaknesses of different therapeutic models, express your treatment preferences, and provide feedback about your treatment experience.

If you’re currently receiving treatment or are thinking about seeking treatment, ask your therapist if CBT, DBT, or another therapeutic model could be the best option for you!

Want to learn about other behavioral health services provided by Cummins BHS? Read our articles on peer recovery services and dialectial behavior therapy below!

How Avon Community School Corporation and Cummins BHS Are Supporting Students’ Mental Health

October 14, 2019 Mark Wilhelm

The school years are an exciting period of learning and growth for children and teens. It’s a time for young people to develop the personal, academic and social skills they’ll need to be successful in life. However, it can also be a challenging time in terms of mental and emotional wellness.

As students progress through the grades, they’re faced with many new responsibilities, societal expectations and relationships to navigate. These environmental stressors can be overwhelming for some youth, commonly resulting in feelings of anxiety or depression. Additionally, roughly half of all mental disorders manifest by a person’s mid-teens, making the school-age years rife with potential mental health concerns.

For these reasons, it’s vital that children and teens have access to comprehensive behavioral health care. This includes education about important mental health topics, training in preventative coping skills, and one-on-one therapy and counseling. Interventions like these help youth build resiliency and lesson their risk for serious mental health conditions later in life.

Fortunately, some school systems are taking steps to provide these services in their curriculums and on their school grounds. One such case is Avon Community School Corporation (ACSC), which has partnered with Cummins Behavioral Health Systems to provide support for all its students. We spoke with Krista Fay, Mental Wellness Coordinator at ACSC, to learn more.

Social-Emotional Learning: A Foundation for Wellness

Take a moment to think about everything children learn in school. You’ll probably think first about the various subjects they study in their classes: reading, writing, mathematics, history, world languages and the sciences, to name a few. However, the school environment also provides an opportunity for youth to learn many important “soft skills” that they’ll need to be successful in life.

“Those skills look like self-management, emotion regulation, social awareness, responsible decision making and time management,” Fay says. These all fall under the umbrella of social-emotional learning (or SEL), defined by The Collaborative for Academic, Social, and Emotional Learning (CASEL) as “the process through which children and adults understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions.”

Social-emotional learning is often an informal, unguided process, but research has shown that teaching SEL alongside academics increases students’ potential to succeed in school and throughout their lives. That’s why Avon Community School Corporation is working to integrate Universal Social-Emotional Learning Curriculums into its schools. Starting this year, students are receiving instruction on essential SEL concepts, as Fay explains:

“We’re teaching students conflict resolution skills and some basic emotional regulation strategies. For example, we’re doing a lot of work with kindergartners on identifying emotions like anger. What’s the difference between annoyance, anger and rage? The size of your feeling. You can show a child three different sizes of blocks, and now they have context to represent how big their anger is. If it’s a little anger, they can do these things, and if it’s a medium or big anger, they can do these other things. It gives them a framework for identifying their feelings and recognizing the cues they produce in the body.”

Small Group and Individual Counseling: Additional Help for Those Who Need It

Even with knowledge of social-emotional learning concepts and skills, there will always be children and teens who need additional support. ACSC partners with Cummins BHS to provide one-on-one counseling and therapy for students who have the greatest needs. This level of service allows for diagnosis and treatment of mental health issues within the school environment.

However, there’s a large divide between youth who need simple SEL lessons in the classroom and youth who need the support of individual therapy. ACSC is addressing this gap with its new Mental Wellness Team. “We hired four social workers, and they are providing small group services for kids. As counselors start to see mental health needs, they can refer to the social workers, and the social workers can put in a bumper level of support. For some kids, that may be enough to address their needs,” Fay says.

She continues,

“To be clear, we’re not diagnosing mental health needs through this program. We’re looking for how students are presenting in the learning environment. For example, a teacher or staff member may notice that a student appears upset or has expressed feeling worried about a particular subject or social situation. If we provide small group support with other kids who are experiencing the same thing, we have a better chance of getting them to recognize their emotions, regulate their behavior and apply wellness principles, which will help them be successful over a longer term.”

The benefit of providing all three tiers of service is a smoother transition from level to level. This is helpful when youth are moving up levels of service as much as when they’re moving down. “In the past, a student might have been very successful with Cummins—so successful that they discharged—and then when that support was gone, they struggled and had to immediately return to a high level of support. Now we have a way to walk-down services so that kids can not only maintain success, but also transfer those skills across lighter and lighter levels,” Fay says.

Although Avon Community School Corporation’s new mental health services program is still in its infancy, Fay is excited and optimistic about the impact it will have on students’ well-being. Cummins BHS is proud to be a community mental health partner with Avon schools in this initiative!

To learn more about how Cummins BHS is supporting mental health in schools and the community at large, read some of our other posts below!

Acceptance and Change: Dr. Aarika V. White on the Role of Validation in DBT

October 4, 2019 Mark Wilhelm

Taking action to improve our mental health can be difficult. On top of the emotional work needed to change our thoughts and behaviors, we might also struggle with the feeling that other people don’t understand us. We might feel like our family, our friends, and even our therapists only want to make us change and don’t actually accept us for who we are.

Dialectical behavior therapy, or DBT, is a type of psychological therapy that aims to counteract these feelings. Created by psychologist Dr. Marsha Linehan in the 1980s, DBT is a modified form of cognitive behavioral therapy that emphasizes the importance of both acceptance and change in the therapy process. In DBT sessions, clients work not only to change harmful thoughts and behaviors they may have, but also to accept the benefits of doing so.

Of course, it’s easier for someone to accept that they must change their behaviors if they feel accepted by others in turn. This is why validation is an important part of DBT. Early in her development of the model, Dr. Linehan discovered that her clients who were most resistant to therapy were also raised in environments that were highly invalidating.

To better understand the role that validation plays in DBT, we spoke with Dr. Aarika V. White, a psychologist at Cummins who uses DBT as her theoretical framework. She breaks validation into two main categories: validation from the therapist and self-validation from the client.

Accepting the Value of Therapy

One of the core tenets of DBT is that the client must accept that they need help. Uncooperative clients are unlikely to put in the emotional work that’s asked of them, which diminishes the effectiveness of treatment. The client must believe that therapy is the best option for them, and this is best achieved through validation.

According to Dr. White, validation is extremely important but sometimes misunderstood. “Sometimes people think giving validation means they have to tell the other person that they’re right,” she says. “That’s not what validation is. Validation is saying, ‘I can understand where you’re coming from. I can look at it from your point of view and see why you might have responded the way you responded, or why you might have had the interpretation you had.’ “

DBT aims to make the therapist an ally in the client’s treatment rather than an adversary. Using validation as a tool, the therapist builds trust with the client by acknowledging their thoughts and behaviors, but they also point out how changing these thoughts and behaviors can be beneficial. This dynamic can ultimately convince a resistant client to buy into treatment, as Dr. White explains:

“When you’re working with a client in a therapy setting, validation is one of the most important ways to ‘soften’ their attitude and get them in a headspace where they can hear what you’re trying to teach them. If a client comes in and they’re upset, angry or hurt because they’re not feeling validated, either by someone else or by the therapist, the skills work is not going to be effective because they’re not going to be able to hear what the therapist or the skills trainer is saying to them.”

Accepting the Value of Our Disorder

Validation is crucial not only for convincing the client to engage with therapy—it’s also necessary for helping them accept their mental disorder or condition.

Due to the stigma surrounding mental illness, people who have mental health issues may believe something is wrong with them. Therapy models that focus solely on changing behaviors can inadvertently increase feelings of shame and guilt among some clients. “This is why Dr. Linehan created DBT,” Dr. White says. “People were getting the message that they were flawed, because they were being told, ‘Change your thinking, change your behavior, and your life will get better.’ She realized she needed to help them understand that they are the way they are for a reason, and that’s not wrong. They have to be able to accept who they are and why they are that way, otherwise they’re going to spend all their energy fighting it.”

If the therapist validates a client’s experience about their mental health and also helps them reframe these thoughts more positively, they can begin to erode the stigma the client feels. This can counteract feelings of denial or self-pity that prevent clients from making therapeutic progress, ultimately increasing the chances that they will embrace change.

As Dr. White says, “That’s where validation turns to self-validation. When you can remove that layer of worry, shame, embarrassment, or whatever comes with the client’s condition, then you can start to see more effective change.”

DBT skills training is one of the many services provided by Cummins Behavioral Health Systems. Our licensed therapists can help you with a variety of mental health needs, from psychiatric assessment to substance use treatment and crisis intervention. Please visit our services page to learn all the ways we can help!

Want to learn more coping skills for managing your mental health? Check out a few of our other posts below!

What Do Food Critics Know About Savoring Life?

October 1, 2019 Mark Wilhelm

On first thought, professional food critics don’t necessarily strike us as experts in mental health. While there’s no denying that eating makes us feel good, this wouldn’t lead us to believe food critics know something about mental wellness that the rest of us don’t.

The average food critic probably doesn’t possess any special knowledge about psychology, but they are exceptionally skilled at the art of savoring. Consider everything they pay attention to when tasting a dish, as summarized by one food blog:

The visual appearance of the dish, such as the colors, shapes, and arrangement of the food
The smell of the dish, including how many individual aromas can be detected and how enticing they are
The complexity and balance of all the flavors present in the dish
The texture and temperature of the food, and how these enhance or detract from the eating experience

As you can see, a food critic approaches the task of eating differently than most people. When they eat, they are living entirely in the moment. They’re focused on appreciating every element of their food and getting as much enjoyment from it as possible. In this way, food critics are masters at savoring—a coping skill you can use to increase your own appreciation of life.

Finding More “Spice” in Everyday Life

We’ve all heard the adage that “variety is the spice of life,” and yes, psychological research has shown that people are happiest when they experience a wide variety of positive situations. But we can also increase our enjoyment of things that we do on a daily basis. Just like food critics, savoring helps us detect the “spices” that are already present in the “food” that is our lives.

Savoring is closely related to mindfulness, but it takes the idea of living in the present an extra step. When we savor an experience, we focus our attention on what makes it pleasurable. We pay attention to everything that’s happening in the moment, and then we take the time to relish all the ways it gives us satisfaction.

In his book Enjoy Life! Healing with Happiness, psychologist Dr. Lynn Johnson refers to a person’s ability to enjoy life as their level of “zestfulness.” Someone who’s high in zestfulness is naturally good at savoring life’s pleasant events. Although people typically operate at their baseline level of zestfulness, Dr. Johnson argues that we can raise our zest for life by practicing the skill of savoring.

So, how can we begin to develop our savoring abilities? It’s not difficult—all you’ll need is a pen and paper.

An Exercise for Increasing Zest

Here’s an exercise that Dr. Johnson recommends to help attune your savoring skills.

First, choose a simple, everyday pleasure that you enjoy. This could be anything you like to do as long as it allows for quiet contemplation. Some examples might be going for a walk, sitting outside on a nice day, reading a book, practicing an art or craft, or eating your favorite meal.

Next, as you are experiencing this pleasant activity or situation, focus your attention on everything that’s happening around you. What sights, sounds, smells and sensations do you notice? Concentrate also on what you’re thinking and feeling. Do you feel content? Relaxed? Amused? Inspired? Grateful? Let your mind linger on the positive sensations and emotions you experience.

After the experience is over, take out a journal or diary and write down what you noticed. Write about your thoughts, feelings and sensations as vividly as possible so that you almost relive them as you write, and notice how you feel while doing so. Does reimagining the experience that you’re savoring make you feel happier?

If we practice savoring and writing about one pleasant experience every day, we’ll find that there are many small things in our lives that we appreciate. Over time, we can increase our zestfulness and enjoyment of life for what it is, not what it could or might be—and we’ll learn a thing or two about how to be a good food critic in the process!

Looking for more information to help you improve your mood and enjoy life? You might find these posts useful!