DBT vs. CBT: Exploring Two Trusted Approaches to Mental Health Support
Clinically reviewed by: Hailey Perez, LMFT
Dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) are two of the most widely researched and recommended approaches in psychotherapy today. Both are recognized by organizations like the American Psychological Association as gold-standard, evidence-based treatments for supporting emotional well-being and addressing a wide range of mental health conditions. While these therapies share a common foundation, they differ in their goals, structure, and focus.
DBT, originally developed as a variation of CBT, was designed to support people experiencing intense emotions or behavior patterns that feel difficult to manage, particularly those associated with borderline personality disorder. It blends cognitive behavioral strategies with mindfulness, skills training, and emotion regulation to strengthen emotional resilience and build healthier interpersonal relationships.
CBT focuses on helping individuals recognize and shift unhelpful thought patterns that may impact feelings, behaviors, and overall mental health. As one of the most established forms of talk therapy, CBT works especially well for anxiety disorders, depression, phobias, and obsessive-compulsive disorder (OCD).
Both approaches offer valuable treatment options, and understanding the differences between them can help individuals find the type of therapy that best fits their needs, goals, and experiences. At Octave, we work closely with clients to explore options like DBT and CBT, designing customized care plans for individual therapy that support long-term emotional health and resilience. We are also proud to offer a Center of Excellence for DBT practitioners, providing specialized care for individuals seeking deeper support with emotional regulation, relationships, and lasting growth.
DBT vs. CBT: Distinct paths toward lasting change
While DBT and CBT are both trusted, evidence-based talk therapy modalities, they take different paths in what they target, how they create change, and the outcomes they prioritize. Understanding these key differences can help you choose which approach best aligns with your personal needs, preferences, and goals.
Just remember that therapy isn’t about fitting yourself into a specific model. It's about finding what works best for you, with support from a skilled mental health professional who can meet you where you are and help you move forward with care and intention.
| DBT | CBT | |
|---|---|---|
| Main focus | Managing intense emotions and strengthening emotional regulation | Recognizing and reshaping unhelpful thought patterns |
| Therapy approach | Combining acceptance with practical change strategies to build emotional stability | Using cognitive restructuring techniques to encourage healthier thinking and behaviors |
| Goal of therapy | Supporting individuals in building a meaningful and connected life through emotional resilience and relational skills | Supporting emotional well-being and daily functioning by fostering helpful thought patterns |
| Core skills | Mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness | Cognitive restructuring, guided discovery, behavioral activation, exposure techniques, problem-solving |
| Best for | Borderline personality disorder, post-traumatic stress disorder, bipolar disorder, eating disorders, substance use disorder, suicidal thoughts | Anxiety disorders, depression, obsessive-compulsive disorder, phobias, post-traumatic stress disorder |
| Structure | Long-term; combination of individual therapy and skills training | Short-term; structured individual therapy sessions with defined goals |
Main focus
When you’re choosing a therapy approach, it helps to understand what your sessions will focus on day-to-day during sessions. Some approaches center on thoughts, others on emotions, and that main focus can shape your whole experience.
DBT - Navigating emotional intensity and building regulation skills
DBT therapy centers daily work around helping individuals recognize, understand, and manage strong emotional reactions. Sessions often focus on identifying emotional triggers, understanding the connection between emotions and behaviors, and practicing specific coping mechanisms to tolerate distress without reacting impulsively. This work supports individuals in building emotional resilience moment by moment through greater awareness, intentional responses, and skillful action.
At Octave, we offer a Center of Excellence for DBT practitioners, connecting clients with highly trained specialists who provide deep support for emotional regulation, relationship challenges, and lasting growth.
CBT - Reframing unhelpful thoughts and building balanced perspectives
CBT sessions primarily explore patterns of thinking that fuel emotional distress. Individuals learn to identify cognitive distortions like catastrophizing, overgeneralizing, or all-or-nothing thinking, and practice reshaping those thoughts into more balanced, realistic interpretations. This shift in perspective often leads to greater emotional ease, more effective problem-solving, and improved day-to-day functioning in relationships, work, and life.
Therapy approach
Different therapies use different strategies to create change. Some emphasize acceptance alongside change, while others focus more directly on shifting thoughts and behaviors. Understanding the approach behind each therapy can help you find the support that feels most validating and empowering.
DBT - Balancing acceptance and change to support emotional growth
DBT balances acceptance and change. It acknowledges that while making positive changes is important, healing often starts with accepting emotions and experiences without judgment. A DBT therapist will use validation to actively affirm clients’ feelings and experiences while also guiding them toward healthier coping strategies and new skills. For example, a client might learn to observe intense anger without judgment (mindfulness) while also practicing ways to express it skillfully within a relationship (interpersonal effectiveness). This balance between acceptance and action is intentional and central to how DBT supports long-term growth.
CBT - Emphasis on cognitive change to shift thought and behavior patterns
CBT primarily emphasizes cognitive change. It’s built around the idea that shifting unhelpful thought patterns can lead to healthier emotions and behavior patterns. CBT focuses on helping clients challenge the accuracy of their thoughts through structured exercises. For instance, someone experiencing social anxiety might gradually test their beliefs about public speaking by engaging in small, manageable exposures. These shifts in thinking often lead to more confidence, emotional stability, and real-world change.
Goal of therapy
Therapy isn’t just about what happens session to session, it’s also about where you’re headed. Approaches like DBT and CBT offer different long-term goals for emotional growth, resilience, and change. While these are two of the most well-established and widely used modalities, they’re also just two of many that can support your mental health and overall well-being.
DBT - Fostering emotional resilience and strengthening relationships
The big-picture goal of DBT is to support individuals in building a meaningful and connected life through emotional resilience and relational skills. Success looks like navigating intense emotions without destructive behaviors, maintaining healthier relationships, setting boundaries, and finding meaning beyond moment-to-moment survival. With time, many clients come to feel more emotionally stable and better equipped to stay present and engaged, especially during difficult moments.
CBT - Encouraging healthier perspectives and emotional well-being
CBT’s long-term goal is to equip individuals with skills to manage stressors and respond to challenges with more adaptive thinking. Success means feeling more emotionally balanced day-to-day, having effective strategies to counter anxiety or depression, and facing future difficulties with greater confidence. Many clients find that CBT helps them feel more in control of their thinking, leading to greater calm, clarity, and self-trust.
Core skills
A big part of therapy is building practical skills you can carry into everyday life. Different approaches emphasize different sets of tools to support emotional resilience and help you respond more effectively to challenges.
DBT - Building mindfulness, emotional regulation, and relationship skills
DBT helps clients build a stronger foundation for emotional and relational well-being by systematically working through four skills modules:
Mindfulness: Staying present and aware without judgment
Distress tolerance: Managing crisis situations without impulsive reactions
Emotion regulation: Understanding and balancing emotional responses
Interpersonal effectiveness: Communicating needs clearly and building healthier relationships
These skills are often practiced in individual therapy, with the goal of applying them to real-life situations as they arise.
CBT - Developing thought restructuring and problem-solving tools
CBT equips individuals with a wide range of techniques to manage distress, challenge negative thoughts, and build emotional resilience. These often include:
Cognitive restructuring: Recognize and challenge distorted or automatic thoughts
Guided discovery: Explore new perspectives by asking thoughtful questions that uncover unhelpful thinking patterns
Behavioral activation: Re-engage with meaningful activities that align with values and goals
Exposure techniques: Face fears gradually and systematically to reduce avoidance and build confidence
Relaxation and stress reduction: Practice calming techniques like deep breathing and progressive muscle relaxation to ease emotional and physical tension
Problem-solving: Break down challenges into manageable steps to find effective, realistic solutions (also referred to as successive approximation)
By practicing these skills inside and outside of therapy, clients often develop greater emotional clarity, confidence, and a stronger sense of agency in their lives.
Conditions best supported
Different therapies often align best with different emotional needs, experiences, and goals. Understanding where DBT and CBT tend to be most effective can help you make thoughtful, informed choices about the kind of support that’s right for you.
DBT - Supporting emotional intensity and complexity
DBT is often a strong fit for individuals who want support in managing intense emotions or building healthier coping strategies.
It’s especially effective for experiences like:
Emotion dysregulation
Suicidal ideation and self-harm behaviors
Borderline personality disorder
Eating disorders
Bipolar disorder
Substance use recovery
Post-traumatic stress disorder
DBT provides structure and skills for managing intense feelings and helps individuals create a more balanced, connected life.
CBT - Supporting cognitive distortions and related behavior patterns
CBT is often a good match for individuals looking to shift unhelpful thought patterns and strengthen day-to-day coping.
It’s widely used to support:
Anxiety disorders
Depression
Obsessive-compulsive disorder
Post-traumatic stress disorder
Attention deficit hyperactivity disorder
Addiction
Eating disorders
CBT offers clear, actionable strategies for interrupting patterns of worry, avoidance, or hopelessness, building stronger emotional foundations over time.
Structure
The way therapy is organized, including the number of sessions, the kinds of support offered, and how skills are practiced, can shape the rhythm and depth of the therapeutic process. Knowing what to expect from the structure can help individuals feel more prepared, supported, and engaged from the start.
DBT - Layered support through individual therapy and skills training
DBT typically offers a more comprehensive structure. It often lasts between six months and a year, giving individuals time and space to practice and integrate new ways of responding to challenges. It includes weekly individual therapy and skills training for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, where you’ll also work on applying these skills to real-life situations. This layered approach helps individuals not only build new skills but also apply them consistently in everyday life.
CBT - Structured, short-term sessions with clear, actionable goals
CBT is typically a shorter-term approach that focuses on helping individuals reach clearly defined goals within a specific timeframe. Treatment often lasts between six and 20 weeks, depending on the individual’s needs and the focus of therapy. Each session follows a structured agenda that revolves around current experiences and practical skill-building. Progress in CBT is measured in small, achievable steps, which helps build a sense of momentum and confidence over time. For many, this clear and efficient structure provides the direction and focus they need to feel empowered in their growth.
Bridging DBT and CBT: How both therapies build resilience
While DBT and CBT take different paths, they share a common foundation. In fact, DBT was originally developed as an adaptation of CBT, designed to better meet the needs of individuals navigating intense emotional experiences. Despite DBT and CBT’s differences, both therapies are grounded in the belief that practical skills can help individuals build resilience, strengthen relationships, and move toward lasting emotional well-being.
Both therapies:
Are built on the idea that our thoughts, emotions, and behaviors are connected, and that building awareness of these patterns can lead to positive change.
Offer structured, skills-based approaches that focus on learning practical strategies to navigate challenges.
Encourage active participation both inside and outside of therapy sessions, helping individuals strengthen their skills in real life.
Are backed by strong research showing their effectiveness across a wide range of mental health needs.
Whether someone is learning to manage intense emotions, reframe unhelpful thoughts, or strengthen coping skills, both therapies offer powerful tools for healing, growth, and long-term mental health.
What studies reveal about DBT and CBT
When exploring therapy options, you may wonder if one approach is more effective than the other. The truth is, both DBT and CBT are highly effective, but each shines in different ways. Research highlights how each modality supports emotional growth, skill development, and long-term mental well-being, depending on a person’s needs and goals.
Dialectical behavior therapy (DBT) is backed by strong research showing its impact on emotional well-being.
One meta-analysis found that DBT skills-training groups significantly improve emotional regulation across a range of common mental health conditions.
In a separate 2022 study, individuals who had completed DBT treatment were asked to reflect on their experiences years later. Many described ongoing improvements in how they manage emotions, navigate relationships, and use coping strategies during difficult times.
These findings show that DBT doesn’t just offer short-term support, it helps individuals build emotional resilience that can continue to strengthen over time.
Research continues to show that cognitive behavioral therapy (CBT) is a powerful tool for emotional growth and mental well-being.
A 2022 study found that CBT strengthens important emotional skills, giving individuals healthier ways to manage difficult feelings and thoughts.
Broader reviews confirm that CBT is one of the most effective treatments for conditions like depression, anxiety disorders, and OCD.
When it comes to depression specifically, a meta-analysis found that CBT is just as effective as medication in the short-term, but it’s even more effective than medication in the long-term.
Both DBT and CBT offer real, lasting ways to support emotional growth. Each approach is rooted in evidence, yet flexible enough to be tailored to the individual. And while research can provide important insights, therapy is still a deeply personal journey. A licensed mental health professional can help you explore which approach—or combination of approaches—best supports your path forward.
Combining DBT and CBT for customized support
Therapy isn’t about fitting people into a rigid model, it’s about finding the right tools to meet each individual’s needs and goals. That’s why, in some cases, therapists may thoughtfully combine elements of DBT and CBT to offer a more customized and flexible treatment plan.
An integrated approach may be helpful when:
A person is navigating both unhelpful thought patterns and strong emotional experiences.
Someone benefits from CBT’s structured focus on reframing thoughts, while also building DBT skills for managing emotions and coping with distress.
A patient needs to address multiple mental health needs, such as supporting anxiety symptoms alongside strengthening emotion regulation for conditions like borderline personality disorder (BPD) or post-traumatic stress disorder (PTSD).
For example, a therapist might use CBT techniques to help a client shift patterns of catastrophized thinking, while also drawing on DBT strategies to support emotional resilience during stressful situations. This flexible approach ensures that therapy addresses both how a person thinks and how they experience emotions, offering a well-rounded path to greater well-being.
At Octave, our providers blend evidence-based modalities like DBT and CBT to create care plans that are both structured and adaptable. This thoughtful integration helps clients build the skills, confidence, and emotional strength they need to move forward with lasting change.
Moving toward lasting change with trusted care
We believe that finding the right therapy approach is an important part of building a life that feels more connected, resilient, and fulfilling. Whether you’re navigating intense emotions or working to shift unhelpful thought patterns, DBT and CBT each offer powerful tools for growth and healing.
For some, the structured, goal-oriented nature of CBT feels like the right fit. Others are drawn to DBT’s focus on emotion regulation, mindfulness, and building stronger relationships. And in many cases, blending elements of both approaches can create a meaningful path forward.
No two journeys look exactly alike, and that’s a good thing. What matters most is finding support that feels aligned with your experiences, your goals, and the life you’re working to create. If you’re exploring individual therapy options and wondering whether DBT, CBT, or a combination of approaches could support your goals, Octave’s therapists are here to help. Together, we can find the approach that feels right for you and the life you’re building.