Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are two prominent therapeutic approaches widely used in mental health treatment. Both CBT and DBT aim to help individuals manage emotions, improve relationships, and cope with challenging situations. However, they differ in their focus, techniques, and target populations.
If you are unsure of which modality will be best for you, or if you want to implement either PLEASE speak with your treatment team. This blog post is more an explanation of the modality’s history, key aspects, general criticisms, and their applicability to bipolar disorder. Neither this blog post nor my blog in general should be seen as medical advice and your treatment/care team is where you should go for particular questions about your treatment.
Cognitive Behavioral Therapy
CBT is a goal-oriented therapeutic approach that explores the relationship between thoughts, feelings, and behaviors. It emphasizes identifying negative thought patterns and beliefs and challenging them to change negative behaviors and emotions. The core principles include recognizing cognitive distortions, developing coping strategies, and modifying behaviors through gradual exposure and practice.
Key Aspects of CBT:
- Focuses on present-day issues and problem-solving.
- Involves structured sessions with homework assignments.
- Encourages clients to challenge and reframe negative thoughts.
- Widely used for various mental health conditions like depression, anxiety, and PTSD.
- Focuses on cognition and the links between thoughts, emotions, and behaviors
Critiques of CBT:
- Overemphasis on cognitive aspects may overlook emotions or interpersonal issues.
- The focus on challenging thoughts might not suit everyone’s needs.
- Some individuals might find the structured nature restrictive or too demanding.
CBT for Bipolar Disorder
CBT has a decent amount of evidence for showing that it can help improve bipolar symptoms.
A 2017 meta-analysis stated the following:
“CBT is effective in decreasing the relapse rate and improving depressive symptoms, mania severity, and psychosocial functioning, with a mild-to-moderate effect size.”
Kai-Jo Chiang, et al. Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials
Personally, I’ve found that the theory of CBT (the idea of Behaviors, Thoughts, and Emotions being all interconnected and forming a chain reaction) can be helpful in preventing some of the most destructive impulses I have. CBT was used in the first psych hospital I was in and was helpful at the time for me to process my feelings. That being said, CBT doesn’t always work. Sometimes when we’re in an elevated (or even a depressed state) our tools and coping skills seem out of reach.
Dialectical Behavioral Therapy
DBT, developed by Marsha Linehan, primarily targets individuals struggling with emotion dysregulation, particularly those with borderline personality disorder (BPD). It combines cognitive-behavioral techniques with mindfulness and acceptance strategies. DBT aims to teach skills for managing intense emotions, improving interpersonal relationships, and tolerating distress.
Key Aspects of DBT:
- Incorporates mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills.
- Emphasizes balancing acceptance and change-oriented strategies.
- Uses group therapy along with individual sessions.
- Addresses the dialectical tensions between acceptance and change.
Critiques of DBT:
- Not all aspects of DBT might suit individuals without emotion regulation issues or BPD.
- The intensive nature of DBT, with multiple components, can be challenging to implement in some settings (a.k.a. There are a lot of acronyms to remember!)
- The focus on acceptance might be perceived as invalidating or overlooking the need for change.
DBT for Bipolar Disorder
There is growing, but limited, evidence showing that DBT is helpful for people with bipolar disorder, especially for emotional dysregulation which can be caused by bipolar.
According to a 2023 review published in the International Journal of Bipolar Disorders:
“The studies provided preliminary evidence suggesting these interventions (DBT) may be effective for improving several core symptoms of BD….DBT may be an effective treatment for BD; however, the confidence in this conclusion is limited by the small sample sizes, heterogeneity, and high risk of bias in all published trials. Larger well-designed RCTs are now required to establish the effectiveness of DBT in BD.”
A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders, Brett D.M. Jones, et al.,
Personally, I’ve found DBT to be really helpful not for bipolar but for overall emotional regulation and interpersonal effectiveness. I would recommend DBT to anyone, but I’m not sure how well the skills work for bipolar symptoms, if that makes sense.
Final Thoughts
While both CBT and DBT offer valuable tools for mental health, criticisms exist for each approach. It’s essential to understand that no single therapy fits all, and effectiveness depends on individual needs, preferences, and the nature of the mental health condition. Some people might benefit from a combination of approaches or a more tailored therapy regimen.
Ultimately, the criticisms highlight the importance of considering diverse perspectives and individualized treatments in mental health care. It’s crucial for therapists and clients to collaboratively explore and choose the approach that best aligns with the client’s goals and needs, fostering a more effective and supportive therapeutic journey. So, again, please speak with your therapist or care team to help determine which modality is best for you.
Sources
CBT vs DBT Therapy by Charlie Health
Cognitive Behavioral Therapy by Suma P. Chand Published by StatPearls
Dialectical Behavioral Therapy by Psychology Today
Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of
randomized controlled trials by Kai-Jo Chiang
History of DBT: Origins and Foundations by Psychotherapy Academy
The History of Cognitive Behavioral Therapy by The Beck Institute Cares