Cognitive Behavioral Therapy and Dialectical Behavioral Therapy: What’s the Difference?


Cognitive Behavioral Therapy and Dialectical Behavioral Therapy: What’s the Difference?

If you are exploring getting help for an addiction for you or someone else, you may be wondering what the treatment entails. Two popular forms of psychotherapy used to treat substance use disorder are cognitive behavioral therapy and dialectical behavioral therapy. Both are types of talk therapy and are evidence-based – meaning there has been rigorous research testing the effectiveness of each approach. Read on to learn more about cognitive behavior therapy and dialectical behavioral therapy and the differences between the two.

What is Cognitive Behavioral Therapy?

Developed by psychologist Aaron Beck, cognitive behavioral therapy has been around for several decades. Known for his work in treating depression, Beck noticed that his patients frequently experienced negative thoughts about themselves, the world in general, and about others. This type of ‘distorted thinking’ as it is often referred to, can negatively impact a person’s mental and emotional health. Helping patients identify those negative thinking patterns and replacing them with realistic thoughts is central to the cognitive behavioral approach.

In addition to helping to treat depression, cognitive behavioral therapy has also been shown effective in treating addictions. Key features of cognitive behavioral therapy include:

  • Recognizing negative thoughts. This can be time-consuming, especially for individuals with limited self-awareness. However, learning to spot the false narratives that are driving unhealthy behaviors is a critical part of the healing journey.
  • Practice. Part of cognitive behavioral therapy involves learning new skills that will take the place of old thought patterns and behaviors. For instance, those healing from substance abuse might practice how to cope with common triggers.
  • Becoming a better problem solver. Whether big or small, problems are a common part of life. Learning how to address problems in a functional, healthy way is an important aspect of cognitive behavioral therapy. Patients are taught how to recognize problems and find potential solutions, as well as selecting and implementing the solution.
  • Observation. Also known as self-monitoring, observation involves tracking your symptoms over a period of time. Individuals with anxiety might observe what situations make them feel more anxious, while those with addictions might track triggers. The information can be used by a therapist to help develop coping strategies specific to each patient’s area of need.


What is Dialectical Behavioral Therapy?

A type of cognitive behavioral therapy, dialectical behavioral therapy was developed by Dr. Marsha Linehan in the late 1980s. Dr. Linehan recognized that individuals with borderline personality disorder did not respond to cognitive behavioral therapy as well as she thought they could. She and her colleagues sought to address the unique needs of patients with borderline personality disorder, which typically include trouble controlling negative emotions and conflict in relationships.

In addition to treating individuals with borderline personality disorder, dialectical behavioral therapy has also proven effective in helping individuals with substance use disorder. Drawing from philosophy, dialectical behavioral therapy involves the balancing of opposites. During therapy patients learn how to hold two opposite truths at once, which requires a shift from an either-or to a both-and perspective. Key features of dialectical behavioral therapy include teaching the following skills:

  • Mindfulness. Learning to tune into what is happening around you and be accepting of your thoughts and feelings without judgement.
  • Distress tolerance. Helps to replace negative coping skills (i.e. substance use) with strategies that are more supportive and healthy.
  • Interpersonal effectiveness. Combines social and listening skills with assertiveness training to help individuals communicate more effectively and foster healthier relationships with others and themselves.
  • Emotional regulation. Teaches individuals how to manage their emotions before they become overwhelming and cause negative behaviors.

What are the Differences Between Cognitive Behavioral Therapy and Dialectical Behavioral Therapy?

While both cognitive behavioral therapy and dialectical behavioral therapy share many similarities, there are some key differences. Cognitive behavioral therapy seeks to address the underlying negative thoughts that cause maladaptive behaviors. Based on the cognitive behavioral approach, dialectical behavioral therapy also targets the psychosocial factors that influence behaviors (i.e. relationships).

Another difference is how therapy is delivered. Cognitive behavioral therapy is usually face-to-face – either in person or via a video platform. Dialectical behavioral therapy can include one-on-one sessions with a trained therapist, skills training within a group setting, and phone coaching to offer support in between sessions.


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