November 19th, 2025
Cognitive Behavioral therapy and Dialectical behavior therapy are two of the most requested therapies by clients seeking mental health treatment. In this blog, we will review each of these therapy modalities. We’ll talk about each approach of CBT and DBT and discuss similarities and key differences.
I’d like to start by sharing a brief history or how these therapies were developed. In recent history, cognitive behavioral therapy has been considered the gold standard in psychotherapy, due to its empirical veracity and its clinical effectiveness with a wide range of mental health disorders.
CBT is recognized as an effective treatment for conditions such as depression, anxiety, OCD, ADHD and Insomnia. As a form of talk therapy, CBT has an evidence-based and structured approach. Developed in the 1960s by psychiatrist Aaron Beck, CBT changed psychotherapy by shifting the focus in the therapy room, from deep exploration of the past to recognizing and modifying unhealthy thoughts and behaviors in the current.
As a form of CBT, Dialectical Behavior Therapy was developed in the late 1970s by psychologist Marsha Linehan. The purpose of DBT, at its inception, was to treat borderline personality disorder. Over time, DBT adapted to be applicable to treat a variety of psychiatric conditions, particularly effective for individuals who experience emotions intensely and for people who might engage in destructive behaviors, such as self-harm.
Today, DBT therapy is considered to have many clinical applications, and it's recognized as an effective treatment for personality disorders, eating disorders, substance use disorders, trauma related conditions, as well as more common conditions, such as depression and anxiety.
Let’s spend some time defining each therapy modality. Cognitive behavioral therapy is a form of psychological treatment that works by restructuring thinking patterns. CBT is a form of talk therapy that was designed to be goal-oriented and relatively short-term. The mechanism through which CBT works is to change negative or unhealthy thought patterns.
At its core, CBT operates on the premise that our thoughts shape beliefs; beliefs influence behavior, and this sequence of events extends to affect our feelings and emotions. Techniques employed in CBT include identifying and modifying automatic negative thoughts, understanding core beliefs, recognizing cognitive distortions, reality testing, reevaluating negative thoughts, relaxation exercises, confronting fears through prolonged exposure and behavioral activation.
To take a deeper dive into CBT therapy, head to our blog “Cognitive Behavioral Therapy: What it is & How it Works”.
Dialectical behavior therapy is a psychotherapy modality that is particularly effective for helping people manage intense emotions and/or destructive behaviors. DBT is technically a form of CBT, and it builds upon CBT principles and adds an emphasis on emotional and social dimensions.
DBT may provide more validation to a person’s emotions than CBT. DBT therapy teaches a specific set of skills related to distress tolerance, emotional regulation, mindfulness, and interpersonal communication. DBT and DBT skills are intended to create behavioral change.
The main purpose of DBT is to accept emotions and learn to regulate them and for an individual to make healthier choices. Research shows that DBT strengthens a person’s ability to handle distress without an individual losing control.
Cognitive behavioral therapy and dialectical behavior therapy are both evidenced based therapeutic approaches. While DBT was developed from CBT and these approaches share similarities in supporting healthy change, there are also key differences that might be helpful to understand.
CBT focuses on how your thoughts, feelings, and behavior influence each other. While DBT also does this, more emphasis is given towards regulating emotions, being mindful, and learning to accept pain. Due to CBT’s emphasis on changing negative thought patterns and DBT’s emphasis on accepting emotions, DBT may provide more emotional validation for some people.
CBT tends to examine an individual’s thoughts more intensely and directly than DBT, while DBT acknowledges the role of thoughts but focuses on skill development to manage emotions and the impact of one’s thoughts.
Another difference is that CBT is generally short term and is intended to produce results in 12-20 sessions. DBT can be a longer commitment and can be a more multifaceted approach, including individual and group therapy sessions.
Another key difference is that CBT can be more personalized to a client’s unique needs and goals. Tools can be targeted to clients’ problematic thoughts and behaviors, whereas DBT teaches a specific set of coping DBT skills from a set curriculum. In summary, CBT focuses on changing negative thoughts and behaviors, while DBT balances acceptance and change, focusing on emotional regulation and mindfulness.
Let’s talk about the application of these therapies and what you can expect in a therapy session. Both therapies are best when the client and therapist have an effective therapeutic relationship. Both therapies tend to be present focused and rely on therapeutic assignments or exercises to master the skills. Each therapy also requires some mindfulness or practice of bringing awareness to one’s thoughts.
In therapy, CBT looks like a collaborative structured process, where you work with a therapist to directly change unhealthy thought patterns and behaviors that cause distress.
In therapy, DBT can be seen to have stages, starting with practices to stabilize the client and then working through the skill building to develop the coping skills that will support a client to manage their emotions without impulsively acting in the heat of their feelings. It’s important to note that all therapies require practice to master the skills and apply it in a way that works for an individual.
Although pursuing therapy is a personal journey, you don’t have to navigate it alone. Talking to a mental health professional, such as a therapist, psychologist, or psychiatrist, can be helpful in deciding if CBT, DBT, or any other type of therapy is best for you. Therapy usually starts with an assessment, and that assessment can provide insight into your challenges, as well as treatment recommendations.
When deciding on mental health treatment, you should also consider your symptoms, or if you have a diagnosis, to understand which therapy might be best for treating your condition. There is an overlap in which mental health conditions can be treated by CBT and/or DBT, but research suggests there may be situations where one is better suited than the other.
An individual may want to choose CBT if the primary issue is negative thought patterns that affect one’s mood and behaviors. Whereas DBT might be better suited for people who experience intense emotions that affect one’s relationships and daily life. I want to end by reiterating that regardless of which therapy is right for a person, you will have to apply and practice the therapy skills to see benefits in therapy.
Understanding the difference between Cognitive Behavioral Therapy and Dialectical Behavior Therapy is the first step—working with the right clinician is the next. Clarity Clinic offers specialized CBT, DBT, and integrative psychotherapy with licensed experts who can help you build the tools you need to improve your mental health. Whether you prefer in-office visits or online therapy, we make it easy to get started.
Explore our mental health clinic locations (Loop, River North, Lakeview Belmont, Lakeview Broadway, Evanston, or Arlington Heights) to find one near you! Schedule your appointment with the best mental health therapist near you today.
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How does DBT differ from CBT?
DBT (Dialectical Behavior Therapy) is a specialized form of CBT designed for people who struggle with intense emotions, impulsivity, or chronic patterns of self-defeating behaviors. While CBT focuses on identifying and changing unhelpful thoughts to improve behaviors and emotions, DBT adds structured skills training in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. In short: CBT focuses on changing negative thoughts and behaviors, while DBT balances acceptance and change, focusing on emotional regulation and mindfulness.
Who is DBT not recommended for?
DBT can be extremely effective for many people, but it isn’t the best fit for everyone. It may be less helpful for individuals with severe psychotic disorders or those with significant cognitive impairments, as the structured, skills-based nature of DBT can be difficult to engage with in these situations.
Is DBT more intense than CBT?
Yes — DBT is considered more intensive than traditional CBT. It often includes weekly individual therapy, weekly group skills training, homework, and sometimes phone coaching. The structure is designed to support people with higher-risk symptoms or more complex emotional needs. CBT, on the other hand, is typically shorter-term, more flexible, and focused on shifting specific thought patterns and behaviors.
Who is CBT not recommended for?
CBT isn’t recommended for everyone. It may be less effective for people with complex unresolved trauma, severe depression with psychosis, certain cognitive impairments, or conditions like schizophrenia. It can also fall short when someone’s struggles are tied to larger systemic issues (like racism or poverty) or when they need a therapy style that focuses more on the relationship itself rather than structured skills and homework.
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