CBT vs. DBT: When Is Each Type of Therapy Most Effective?
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
Aarika V. White, Ph.D.
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!