DBT vs CBT

Both Dialectical Behaviour Therapy (DBT) and Cognitive Behaviour Therapy (CBT) have extensive and robust evidence bases. While they share common roots, there are some important differences between traditional CBT and DBT approaches.

Put simply, CBT focuses on the relationship between thoughts, behaviours, and feelings. By identifying and changing unhelpful patterns in thinking and behaviour, the aim is to influence how a person feels in a given situation.

DBT also works with change, but places greater emphasis on the connection between emotions and the body. In DBT, we change our bodies to change our mind, using behavioural and physiological strategies to regulate emotional intensity. While DBT does include cognitive approaches, it gives more attention to emotions themselves and the messages they may carry.

At times, emotions can feel so intense that they overwhelm our ability to think. We may recognise that what we are feeling is “too much,” but struggle to know what to do in the moment. We may also know 'facts' about ourselves but these facts fail to change what we feel. DBT addresses this by teaching skills to manage emotional intensity as it arises—helping individuals tolerate distress without making the situation worse or shutting the emotion down completely. Once the intensity has reduced, there is space to reflect on what happened and what the emotion may have been communicating.

Another key feature of DBT is its focus on layers of emotional experience, often described as primary and secondary emotions. A primary emotion might be sadness, for example, which is then quickly followed by a secondary emotion such as anxiety (“Why do I feel like this?”). DBT encourages people to tune into the message of the primary emotion, while also validating the understandable secondary response.

Overall, DBT can be particularly helpful for people who find that knowing things logically—for example, knowing that others care about them— does not translate into feeling things emotionally. In contrast, traditional CBT focuses more directly on identifying and restructuring unhelpful thought patterns about the self, others, and the world in order to shift emotional experience.

Both approaches are effective. The key is finding the one that best fits your needs and experiences.