Dialectical Behavior Therapy vs. Cognitive Behavioral Therapy

CBT was first coined by psychiatrist Aaron Beck in 1964, who theorized that certain negative emotional states are linked with certain types of thinking, namely maladaptive thinking. Dr. Beck, outlined three types of cognition: 

1. Core beliefs, which are deeply held beliefs about the world, the self and others
2. Dysfunctional assumptions, which are rules that we have adapted to guide our decisions and choices. These assumptions can be maladaptive and influence us to make decisions that are not beneficial to us 
3. Negative Automatic Thoughts, which are thoughts that happen automatically and that increase negativity, low self esteem and feelings of inadequacy. 

According to Dr. Beck and later CBT theorists, how we feel and behave is determined by how we construe and perceive a situation through our thoughts.

Change can be achieved through identifying our maladaptive thought patterns and changing how we think, or changing our actions, since thoughts, feelings and behaviors are closely linked and influence one another. 

DBT was developed with the goal to better address emotional regulation and incorporates principles of mindfulness practice of Zen Buddhism and elements of Dialectical philosophy with a strong focus on the social aspects of regulation and functioning. 

Learning to approach life through a dialectical lens involves recognizing that all things are interconnected, and that change is constant and inevitable. 

Dialectical thinking teaches us how to synthesize a truth that can be based on seemingly opposite positions such as “I am doing the best I can AND I can do better” or “ I really want to change AND change intimidates me”. 

Mindfulness practice refers to our ability to increase awareness of our internal and external experiences, in the present moment, without judgements, and to strengthen our ability to direct our attention where we want it to be, rather than letting our emotions take over. 

DBT is founded on the Buddhist tenet that life comes with pain that we have no control over, and that the pain that comes with life doesn’t need to turn into suffering. 

Turning pain into suffering is what we do have control over, and DBT skills training can help in teaching us how to not turn pain into emotional suffering through acceptance, intentional control of our attention, and behavioral skills. 

A Comparative Analysis of Techniques and Strategies 

The key components of CBT treatment are establishing a trustful, collaborative relationship with the CBT therapist, where both client and therapist can identify and set goals to facilitate change, for a limited period of time until the client is able to apply critical thinking, logic and reason to their cognitions on their own. 

Clients are also taught to use somatic management techniques for relaxation as well as behavioral activation techniques to cope with the lack of motivation that sometimes comes with depression. 

Here are some examples of somatic management techniques: 

• Grounding: Look around the room and choose three  items. Notice all details and describe them to yourself, such as texture, color, shadows, shape etc. 
• Relaxation: Try to notice something in the present moment with each of your five senses: sight, sound, smell, taste and touch.
• Sensory awareness: Place a cool cloth on your face, or hold something cool such as an ice pack and notice the sensation of the temperature.

Here are the first steps of behavioral activation: 

• Activity monitoring, to figure out what exactly you are doing in the day and how it links with your mood 
• Think about your values, what is important to you in your life that gives you purpose and meaning, so that you can start identifying activities to start doing that correspond to those values 
• Scheduling  pleasurable and enjoyable activities purposefully in our daily routines 
• Problem solving around potential barriers to activation/motivation 

CBT can be a short-term treatment depending on the individual’s needs, while DBT is often a months-long process and it typically involves learning skills in a group context. 

The group component is often an important part of the process, as it offers people the opportunity to learn DBT skills with others and deepen their knowledge from others’ experiences, in a safe and supportive environment. 

Both individual and group components of DBT are structured and involve setting goals, mindfulness practice, engaging with homework outside the sessions, and committing to practicing skills outside the environment where skills are first learned. 

DBT enhances the ability to regulate emotions by focusing on four different sets of skills: 

• Mindfulness: Increasing awareness, in the present moment, without judgments.
• Distress tolerance: Dealing effectively with crisis, accepting reality and tolerating intense emotions without making things worse. 
• Emotion regulation: Understanding what our emotions communicate and do for us, and increasing feelings of pleasure and mastery in daily life.
• Interpersonal effectiveness: Becoming effective in getting our needs met in relationships, setting healthy boundaries, strengthening supportive relationships and ending destructive ones.