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Alcohol and Mental Health

Dialectical Behavior Therapy vs. Cognitive Behavioral Therapy: What Are the Differences?

August 1, 2023
22 min read
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A team of researchers and psychologists who specialize in behavioral health and neuroscience. This group collaborates to produce insightful and evidence-based content.
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Certified recovery coach specialized in helping everyone redefine their relationship with alcohol. His approach in coaching focuses on habit formation and addressing the stress in our lives.
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Recognized by Fortune and Fast Company as a top innovator shaping the future of health and known for his pivotal role in helping individuals change their relationship with alcohol.
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Reframe Content Team
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In the world of psychological therapies, two standout approaches have emerged over the years: Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Tracing their origins back to the mid-20th century, CBT was born from the marriage of cognitive and behavioral therapies, aimed at addressing maladaptive thoughts and behaviors. DBT, which blossomed a few decades later, sought to enhance the CBT framework by integrating elements of mindfulness and acceptance. As these therapies evolved over time, they each forged unique paths to address emotional and behavioral challenges. 

Both have been buzzing around the wellness world, especially when it comes to cutting down on alcohol. But what are they? And which one might be your best companion on the journey to a healthier you?

Spot the Differences

Embarking on a journey to quit or cut back on alcohol can feel daunting, and it's essential to have the right tools by your side. Both Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) have proven effective for many. However, understanding their nuances can guide you toward the most fitting approach for your unique circumstances.

Here’s the difference in a nutshell:

CBT: The Brain Trainer. Imagine CBT as a personal coach for your thoughts, helping you gear up for the championship game (your life!). CBT is all about identifying negative thought patterns and replacing them with more positive, constructive ones. When it comes to reducing alcohol intake, CBT focuses on understanding the thought patterns that trigger the desire for a drink. Then, with the help of this therapy, you can retrain your brain to replace that urge with healthier coping mechanisms.

DBT: Your Balancing Buddy. DBT builds upon the foundations of CBT, but takes a different approach. It’s all about finding balance. DBT combines acceptance (it's okay to have these feelings) with change (let's work on handling them better).

In the realm of alcohol moderation, DBT focuses on addressing the intense emotions or situations that make us reach for the bottle. By learning to accept our feelings without judgment and then applying strategies to manage them, we’re less likely to turn to alcohol as a crutch.

Now, let’s explore the differences in more detail.

1. Origins and Intentions 

CBT was created as a therapy to treat depression, while DBT was initially designed for people with borderline personality disorder (who often experience intense swings in emotions).

As far as intentions, CBT aims to identify and challenge maladaptive thought patterns that influence our emotions and behaviors and replace them with more constructive ones. While it started primarily as a treatment for depression, it proved to be a useful tool for tackling other disorders, including anxiety, PTSD, and substance misuse.

DBT blends cognitive-behavioral approaches with mindfulness principles. Its core intention is to balance acceptance and change. While CBT emphasizes change through cognitive restructuring, DBT adds an additional layer of accepting and validating one's experiences. This dual approach helps individuals regulate emotions, tolerate distress, master mindfulness, and improve interpersonal effectiveness. Initially crafted for BPD, DBT's has also expanded to other areas, including eating disorders, substance misuse, and mood disorders.

While both CBT and DBT have their unique origins and intentions, they share the overarching goal of improving individual well-being. The choice between them—or a blend of both—hinges on personal needs, the specific challenges at hand, and our therapeutic goals. Either way, both therapies have proven to be powerful allies in the journey toward mental and emotional health!

2. Core Focus

Diving deep into therapy methods means more than just understanding techniques and origins. It’s also about appreciating the underlying values that drive these approaches. While CBT is rooted in the present and zeroes in on identifying and rectifying maladaptive thought patterns, the hallmark of DBT is its broader emphasis on acceptance and change, emotional regulation, and interpersonal effectiveness.

Here's a spotlight on these core values to help you decipher which therapy aligns best with your needs.

CBT’s Foundational Pillars

  • Thought-emotion-behavior link. CBT is based on the belief that our thoughts, emotions, and behaviors are interconnected. By changing our thoughts, we can influence our emotions and modify our behaviors.
  • Active participation. CBT emphasizes the collaborative nature of therapy. Both the therapist and client are active participants, working together to identify and address maladaptive patterns.
  • Present-focused. CBT is primarily concerned with current thought patterns and behaviors, even though it acknowledges that past experiences might have shaped them.
  • Skills over insight. While gaining insight into one's behaviors and thought patterns is valuable, CBT places a stronger emphasis on equipping individuals with practical skills to manage their challenges.
  • Empowerment. CBT empowers clients to recognize and change negative thought patterns and behaviors, promoting self-reliance and resilience.

DBT’s Guiding Principles

  • Dialectics. The very name of this therapy encapsulates its key value: the balance and integration of opposites, especially the values of acceptance of the situation the way it is and the recognition that change might be necessary.
  • Mindfulness. Borrowed from Buddhist practices, mindfulness encourages us to be fully present in the moment, observing our emotions, thoughts, and surroundings without judgment.
  • Validation. DBT places a strong emphasis on validating clients' experiences, affirming that their feelings and behaviors have understandable origins.
  • Behavioral science. Much like CBT, DBT recognizes the importance of understanding and changing maladaptive behaviors, incorporating behavioral techniques in its approach.
  • Holistic approach. While CBT often focuses on the present, DBT integrates the past, present, and future, understanding that past traumas and experiences can significantly influence current behaviors.

While some of their principles overlap, CBT and DBT are driven by unique sets of core values. CBT leans heavily on the interplay of thoughts, emotions, and behaviors, while DBT, although recognizing this interplay, weaves in acceptance, mindfulness, and validation to create a more comprehensive approach. Your alignment with these values can play a role in determining which therapy resonates most with your journey.

3. Structure, Intensity, and Duration

When choosing between Cognitive Behavioral Therapy and Dialectical Behavior Therapy, getting a feel for how each therapy unfolds in a structured setting is essential. Think of it like picking out a new workout routine; both yoga and Pilates might aim to strengthen and stretch, but they each have their own distinct flow. Let's decode the structure of CBT and DBT to get a clearer picture.

CBT: A Structured Individual Blueprint

  • Initial assessment followed by individual therapy. The therapist and client begin by pinpointing specific challenges and set goals for the therapy. Often, CBT is then delivered in individual therapy sessions, focusing on the unique thought patterns of the client.
  • Homework assignments. Yes, there's homework! But don’t worry; it’s designed to help practice and solidify the skills learned in sessions.
  • Skill development. Sessions typically revolve around learning skills to recognize and challenge maladaptive thoughts and behaviors.
  • Session structure. CBT sessions usually have a consistent structure. They begin with a review of the previous week (including homework), followed by the introduction of a new skill or concept and conclude with a new homework assignment.
  • Duration. CBT is often short-term, ranging from 5 to 20 sessions, though this can vary based on individual needs. 

DBT: A Layered Interactive Approach

  • Group skills training. DBT is unique in its emphasis on group sessions. Participants learn and practice skills together, focusing on four main modules: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
  • Individual therapy to complement group training. This approach involves one-on-one sessions for individuals to work on personal challenges by utilizing the skills they learn in the group sessions.
  • Phone coaching as additional support. Some DBT therapists offer phone coaching, providing clients with real-time strategies to handle difficult situations as they arise.
  • Therapist consultation team. This is more for the therapists than the clients. DBT therapists often meet in groups to support and learn from each other, ensuring they provide the best care.
  • Duration. DBT can be more intensive than CBT, often spanning several months. It's designed to provide comprehensive support, particularly for those with more severe or complex challenges.

Whether you're leaning toward the individual focus and cognitive restructuring of CBT or the group dynamic and emotional balance of DBT, understanding their structures can help you make a more informed choice. Remember, it's all about finding the right fit for your journey, and there's no one-size-fits-all!

4. Strategy Approach

When embarking on a journey of personal growth and change, the strategy (or the roadmap) you choose can make all the difference. While both CBT and DBT offer robust roadmaps, they navigate different terrains and use distinct signposts. 

The primary aim of CBT is to challenge and change negative thought patterns, instilling more adaptive beliefs and behaviors. DBT, on the other hand, prioritizes a balance between acceptance and change. It uses mindfulness and distress tolerance techniques, teaching individuals to sit with their emotions without necessarily acting on them.

Let's unravel the strategic approaches of both to help guide your therapeutic adventure.

CBT: The Analytical Mapmaker

  • Insight through analysis. CBT's main strategy revolves around understanding and dissecting thoughts. It's about breaking down the cognitive processes to understand how they affect our emotions and behaviors.
  • Active problem-solving. Once challenges are identified, CBT equips individuals with tools to address them head-on, fostering a proactive approach.
  • Feedback loop. CBT incorporates a continuous feedback mechanism between the therapist and the client. Together, they review progress, tackle challenges, and set new goals, ensuring the journey stays on track.
  • Goal-oriented. The approach is typically targeted and time-limited, focusing on specific challenges and working systematically to address them.
  • Empowerment through knowledge. CBT strives to equip clients with a deep understanding of their challenges, believing that knowledge is the key to fostering change.

DBT: The Holistic Navigator

  • Multi-modal approach. DBT doesn't just stick to one format. With individual therapy, group skills training, and even phone coaching, it’s about providing a well-rounded support system.
  • Emphasis on relationships. A significant portion of DBT is dedicated to improving interpersonal effectiveness, ensuring clients not only improve internally but also in relation to others.
  • Continuous skill building. DBT is like a continuous skill-building workshop. Whether it's mindfulness, distress tolerance, or emotion regulation, the focus is on equipping individuals with a wide range of tools for different situations.

In the grand scheme of personal growth, both CBT and DBT offer strategic approaches tailored to diverse needs. Think of them as two different GPS systems: both get you to your destination, but they might suggest different routes. No matter the choice, you're in the driver's seat, traveling toward a brighter future!

5. Techniques

While both therapies teach coping skills, CBT is more about challenging and changing negative thought patterns. DBT, on the other hand, focuses on accepting those thoughts and feelings, and then finding ways to balance and manage them.

While the origins, values, and structures of Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) help shape our understanding, it's the techniques that provide the practical tools for change. Imagine being in a toolkit store: while both CBT and DBT offer valuable tools, each has a distinct set. 

Let’s see what’s inside these toolboxes:

CBT: Precision Tools for Thought Work

  • Cognitive restructuring. At the heart of CBT, this technique involves identifying and challenging negative thoughts, then replacing them with more realistic or positive ones. (It's like cleaning out a cluttered closet and reorganizing it).
  • Behavioral experiments. By testing out new behaviors in real-life situations and observing the outcomes, we can confront and change our beliefs. (It's like trying out a new recipe to see how it turns out).
  • Exposure therapy. This practice involves gradually and safely confronting feared situations or memories, reducing the power they hold over us.
  • Activity scheduling. CBT emphasizes the need to combat low mood or avoidance by planning and engaging in pleasurable or meaningful activities.
  • Problem solving. CBT aims to equip us with a systematic approach to handle challenges or stressful situations.

DBT: A Mixed Bag for Emotional Balance

Mindfulness. DBT encourages clients to stay present and experience each moment without judgment. (Think of it as tuning into a radio station that's just about the “now”).

Distress tolerance. Rather than escaping from emotional pain, this technique equips individuals to tolerate and accept distressing moments and ways to soothe themselves.

Interpersonal effectiveness. Improving communication and relationship-building skills is meant to help us advocate for our needs and set boundaries.

Emotion regulation. This set of techniques is about understanding and managing intense emotions, ensuring they don’t lead to impulsive or harmful behaviors.

Validation. While it’s a technique, validation is also a core part of the DBT toolkit. Therapists validate clients' experiences while also helping them learn and grow.

So, Which One Is Right for My Journey?

Both CBT and DBT offer unique pathways to understanding and managing thoughts, behaviors, and emotions. It's like having different workout routines in your regimen; each serves a purpose, and the best one for you depends on your specific goals and needs.

When it comes to alcohol in particular, both can be fantastic tools. Your choice might hinge on whether you feel the need to address deep emotional challenges (the realm of DBT) or if you're looking to switch out specific negative thought patterns that trigger drinking (the specialty of CBT).

CBT might be better suited for you if: 

  • You notice specific triggers or thought patterns leading you to drink.
  • You want to challenge particular beliefs about alcohol.
  • You want a more targeted approach.

DBT might work better if:

  • Emotional intensity, impulsivity, or interpersonal challenges contribute significantly to your alcohol misuse.
  • You want to learn to balance different areas of your life, including alcohol.
  • You prefer a more holistic approach.

The decision between DBT and CBT is a deeply personal one, and there's no one-size-fits-all. Some people benefit from a combination of both, while others find one to be the perfect fit. Consulting with a therapist or counselor can provide further clarity. They can assess your unique challenges, strengths, and goals, guiding you toward the most effective approach for your alcohol journey.

Taking Action 

  • Evaluate your triggers. Make a list of situations or emotions that make you want to drink. Recognizing these can help you decide between CBT or DBT.
  • Seek professional guidance. Chat with a therapist or counselor familiar with both methods. They can help guide your decision based on your personal needs.
  • Journal. Document your feelings and experiences. This can help you recognize patterns in your behavior, which is beneficial in both CBT and DBT.
  • Educate yourself. Dive into some resources. Books, articles, or online courses can provide a deeper understanding of both therapies.
  • Join a group. If you lean towards DBT, consider joining a skills training group. The shared experiences can be invaluable.
  • Practice mindfulness. Both therapies emphasize mindfulness. Take 5 minutes daily to meditate or simply be present in the moment.

Remember, whether it's CBT or DBT, the journey to cutting back or quitting alcohol is deeply personal. Find what resonates with you, seek support, and here’s to a brighter, clearer tomorrow! 

Summary FAQs

1. What's the primary focus of CBT and DBT?

CBT zeroes in on the interconnectedness of thoughts, emotions, and behaviors. DBT, while acknowledging this, incorporates a balance between acceptance and change, emphasizing mindfulness and emotional regulation.

2. How do the origins of the two differ?

CBT emerged from a blend of cognitive and behavioral therapies, focusing on changing negative thought patterns. DBT was initially designed for individuals with borderline personality disorder, integrating CBT principles with mindfulness and acceptance strategies.

3. Which therapy places emphasis on group sessions?

DBT is unique in its emphasis on group skills training sessions, where participants learn and practice skills together.

4. What are cognitive distortions, and how does CBT address them?

Cognitive distortions are skewed perceptions or thoughts that can distort reality. CBT helps individuals identify, challenge, and replace these distortions with more accurate and constructive thoughts.

5. What are the differences between the core values of CBT and DBT?

CBT values the thought-emotion-behavior link, active participation, being present-focused, skill-building, and empowerment. DBT emphasizes dialectics, mindfulness, validation, behavioral science, and a holistic approach.

6. How does each therapy approach alcohol misuse?

CBT helps individuals recognize and challenge thoughts that contribute to alcohol misuse, providing tools to reshape these patterns. DBT, on the other hand, equips individuals with skills to regulate intense emotions and distress, often underlying triggers for alcohol misuse.

7. Is there a typical structure to how CBT and DBT sessions progress?

CBT usually involves an initial assessment, skill development, homework assignments, and is often short-term. DBT has a multi-faceted approach with individual therapy, group skills training, phone coaching, and therapist consultation teams, spanning several months.

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