Understanding the Therapy Alphabet: CBT and DBT

What is the Difference Between CBT and DBT?

If you have ever googled therapy (usually at 1:00am after a stressful day), you have probably run into a sea of acronyms. Two of the most common are CBT and DBT. They sound similar, they both involve skills, and yet they are not exactly the same thing.

So what is the difference?

In plain English:

CBT (Cognitive Behavioral Therapy) helps you change unhelpful thoughts and behaviors.

DBT (Dialectical Behavior Therapy) helps you manage big emotions, ride out distress, and not blow up your life when feelings get loud.

Both are evidence-based. Both are highly effective. Neither involves lying on a couch talking about your childhood for ten years (unless you really want to).

A Quick Backstory (Because Context Matters)

CBT came first. It was developed by psychiatrist Aaron Beck in the 1960s. Beck noticed that many people struggling with depression and anxiety were dealing with thought patterns that were… let’s say, not doing them any favors.

Things like:

“I always mess everything up.”
“Everyone thinks I’m an idiot.”
“This one awkward moment will haunt me forever.”

CBT was designed to help people identify those thoughts, challenge them, and replace them with something more realistic and less catastrophic.

Then came DBT.

DBT was developed by psychologist Marsha Linehan in the late 1980s. And here is a detail many people do not realize:

Marsha Linehan was originally trained as a CBT therapist.

DBT is not anti-CBT. It is actually built on CBT.

While working with clients who experienced intense emotions, chronic crises, and self-destructive behaviors, Linehan discovered that change strategies alone were not always enough. Clients also needed:

• Validation
• Acceptance
• Tools for surviving emotional storms
• Skills for when logic goes completely offline

So DBT expanded the CBT model by adding mindfulness, distress tolerance, and emotion regulation strategies.

Wait… So CBT Is Inside DBT?

Yes. Very much so.

CBT is woven directly into DBT, especially in the Emotion Regulation skills. Clients still learn to:

• Identify thinking patterns
• Notice cognitive distortions
• Examine interpretations
• Shift beliefs
• Change behaviors

DBT just acknowledges a very human truth:

When you are flooded with emotion, your brain is not always interested in a neat cognitive worksheet.

Sometimes you first need to calm your nervous system before you can “think differently.”

Different Focus, Different Feel

CBT often asks:

“Is this thought accurate?”
“What is the evidence?”
“What happens if we test this belief?”

DBT often asks:

“How do we help you get through this moment without making things worse?”
“How do we regulate the intensity?”
“How do we accept reality while still working toward change?”

CBT = change the pattern
DBT = survive the wave + change the pattern

Skills You Might Learn

In CBT:

• How to challenge your inner catastrophizer
• How to stop avoidance cycles
• How to test fears in real life
• How thoughts, feelings, and behaviors interact
• How to break stuck patterns

In DBT:

• How to not act on every emotional impulse
• How to tolerate distress without self-destructing
• How to regulate intense emotions
• How to be mindful instead of reactive
• How to navigate relationships without burning bridges

When CBT Often Shines

CBT is incredibly effective for:

• Anxiety
• Depression
• OCD
• Phobias
• Panic
• Rumination
• Negative self-talk
• Perfectionism

If your brain is running unhelpful commentary on a loop, CBT is often a great fit.

When DBT Often Shines

DBT is especially helpful for:

• Emotional dysregulation
• Intense mood swings
• Impulsivity
• Self-harm behaviors
• Chronic relationship conflict
• Feeling emotionally “hijacked”

If your emotions tend to grab the steering wheel and floor it, DBT can be life-changing.

The Plot Twist: You Do Not Actually Have to Choose

Many therapists (including us) integrate both.

Because humans are complicated.

You might need CBT tools for anxious thinking and DBT tools for emotional overwhelm. Good therapy is not about loyalty to a single acronym. It is about finding what genuinely helps.

Bottom Line:

CBT helps you change unhelpful thoughts and behaviors.

DBT helps you manage intense emotions, tolerate distress, and build stability, while still using CBT-based strategies for change.

Both work.
Both are backed by research.
Both require practice (sorry, there is no “just talk once and be cured” option).

Selected References

Beck, A. T. (1979). Cognitive Therapy of Depression. Guilford Press.

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy. Clinical Psychology Review, 26(1), 17–31.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.

Linehan, M. M., et al. (2006). Two-year randomized controlled trial of DBT vs therapy by experts. Archives of General Psychiatry.

Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). DBT skills use and treatment outcomes. Behaviour Research and Therapy, 48(9), 832–839.

Hofmann, S. G., et al. (2012). The efficacy of CBT: A review of meta-analyses. Cognitive Therapy and Research.