Updated January 2026
Dialectical behavior therapy (DBT) and cognitive-behavioral therapy (CBT) are both evidence-based talk therapies. DBT teaches skills for balancing emotions, being more present, and improving relationships. CBT focuses on helping people change unhelpful thoughts and behaviors. Which one would be the best fit, and do you even need to choose? This article will help you decide.
Table of Contents
- CBT vs. DBT at a glance
- What is CBT?
- What is DBT?
- The difference between CBT and DBT
- Can CBT and DBT be used together?
- CBT or DBT: Which is better?
- CBT vs. DBT for anxiety
- CBT vs. DBT for depression
- CBT vs. DBT for borderline personality disorder (BPD)
- Starting DBT in Massachusetts
CBT vs. DBT at a glance
| CBT | DBT | |
| Primary focus | Focuses on changing negative thought patterns and behaviors. | More emphasis on the acceptance and validation of emotions. |
| Techniques used | Cognitive restructuring and exposure therapy are commonly used. | Mindfulness practices, such as meditation and breathing exercises, are often incorporated. |
| Typical duration | Often structured as a shorter-term approach. | Typically more intensive and may take place over a longer period of time. |
| How it’s delivered | May be delivered in individual or group settings. | Often includes structured skills groups focused on coping and emotional regulation. |
| Practice between sessions | Emphasizes tracking thoughts and testing new behaviors. | Focuses on applying coping skills during moments of emotional distress. |
What it means for you:
- CBT might be a better choice if you need help reframing negative thoughts
- DBT may be right if you have a harder time balancing your moods and emotions
- A combination can also work well to find new ways to cope that actually stick
What is DBT?
Dialectical behavior therapy is a type of CBT originally developed to help people with borderline personality disorder. It’s been adapted to treat a range of other mental health issues, including trauma-related conditions.
DBT teaches four main skills:
- Mindfulness
- Distress tolerance
- Emotional regulation
- Interpersonal effectiveness
What is CBT?
CBT is a skills-based therapy that focuses on the relationship between thoughts, feelings, and behaviors. The goal is to identify and change negative thought patterns and behaviors that may be contributing to mental health issues. CBT is commonly used for a range of mental health conditions, including anxiety, depression, and PTSD.
A CBT session might include:
- Reviewing current challenges and progress since the last session
- Identifying thoughts, patterns, or behaviors and noticing unhelpful ones
- Learning and practicing coping or problem-solving skills
- Setting small, achievable goals to work on before the next session
The difference between CBT and DBT
If you start DBT or CBT, you can expect some differences in how therapists guide you during sessions. While you may not notice a change in how they show up or their outlook, you will notice some differences in their focus, the techniques they use, and how therapy is delivered.
- Focus: CBT focuses on changing negative thought patterns and behaviors. DBT, on the other hand, puts more emphasis on the acceptance and validation of emotions.
- Techniques: CBT uses techniques such as cognitive restructuring and exposure therapy. In DBT, mindfulness practices, such as meditation and breathing exercises, are often incorporated.
- Format: CBT may be delivered in individual or group sessions, and both can be effective. DBT skills, since they include interpersonal effectiveness, are often practiced in group sessions.
Can CBT and DBT be used together?
Yes. CBT and DBT can be complementary, especially because your mental health is complex. Your therapist may recommend some CBT and DBT sessions and suggest joining skills groups between individual meetings. You might work with more than one therapist, but they should collaborate to review your challenges and progress.
CBT or DBT: Which is better?
There is no one-size-fits-all answer. CBT may be a good fit if you are looking for a structured, goal-oriented approach that focuses on changing unhelpful thoughts and behaviors. DBT may feel more supportive if emotional intensity, stress tolerance, or relationship challenges are a primary concern.
Talking with a professional is the best way to determine the right approach for your specific needs. During an initial evaluation, a therapist can assess your concerns and help you decide which therapy may be most beneficial.
CBT vs. DBT for anxiety
CBT for anxiety is often considered a first-line approach because it helps people identify and change unhelpful thought patterns and avoidance behaviors that can keep anxiety going over time. By learning to challenge anxious thinking and gradually face feared situations, many people experience meaningful relief.
DBT skills can also be helpful for anxiety, particularly when anxiety feels overwhelming or difficult to regulate from moment to moment. Mindfulness and distress tolerance skills may help with physical symptoms or emotional surges related to anxiety.
CBT vs. DBT for depression
Since CBT focuses on identifying negative thought patterns and increasing engagement in meaningful activities, it can be especially helpful for depression. Depression leads to withdrawal, low motivation, and persistent feelings of hopelessness, and CBT can interrupt the cycle of thoughts that can leave someone feeling stuck.
DBT for depression may be beneficial when low mood is accompanied by intense emotional reactions, difficulty coping with stress, or challenges in managing relationships. Emotion regulation and distress tolerance skills can help people navigate moods more effectively.
DBT for borderline personality disorder (BPD)
DBT was originally developed to treat borderline personality disorder and has strong evidence supporting its effectiveness for emotion dysregulation, interpersonal difficulties, and impulsive behaviors.
CBT can still play an important role by helping people with BPD identify and challenge unhelpful thought patterns that contribute to distress, particularly when used alongside DBT skills.
Remember, only a healthcare professional can provide a diagnosis. Working with a mental health specialist can give you a more accurate diagnosis, which means your treatment plan can be better tailored to your unique needs.
Start DBT therapy today at Rockland Recovery Behavioral Health
Our team knows that seeking mental health treatment can be a difficult decision. Whether dialectical behavior therapy or cognitive-behavioral therapy is right for you, we offer intensive care without needing to break from work or other commitments.
Whether you’re a healthcare provider, first responder, nurse, teacher, or simply a busy adult seeking mental health treatment, Rockland Recovery Behavioral Health can help. We provide a non-judgmental, evidence-based approach that is tailored to your individual needs.