CBT and DBT are both practical, skills based talk therapies. Cognitive behavioral therapy (CBT) focuses on how your thoughts shape your feelings and actions. Dialectical behavior therapy (DBT) grew out of CBT and adds acceptance and skills for intense emotions. CBT often fits anxiety and depression; DBT often fits emotions that feel too big to manage.
Key takeaways
- Cognitive behavioral therapy (CBT) helps you notice unhelpful thoughts, test them, and change the patterns they drive.
- Dialectical behavior therapy (DBT) is built on CBT and adds acceptance, or validation, plus four skill sets for big emotions.
- Neither one is "better." The right fit depends on what you are struggling with and how intense your emotions get.
- Some readers will be best served by a comprehensive DBT program, which Foundations does not offer. This guide says when.
- Foundations offers CBT and individual counseling that draws on DBT skills.
CBT vs DBT at a glance
| CBT | DBT skills in individual counseling | Comprehensive DBT program | |
|---|---|---|---|
| Core idea | Change unhelpful thoughts and behaviors | Balance acceptance with change, using DBT skills | Balance acceptance with change, using every part of standard DBT |
| Often used for | Anxiety, depression, PTSD, OCD, eating disorders, insomnia (Cleveland Clinic) | Intense emotions, regretted urges, recurring conflict | Originally developed for chronically suicidal people with borderline personality disorder (NAMI) |
| Typical length | Many people attend 8 to 12 visits (Cleveland Clinic) | No fixed length; depends on your goals | At least six months to a year (Cleveland Clinic) |
| Between sessions | Practice exercises | Practice skills | Practice skills, plus phone coaching |
| Format | Individual sessions | Individual sessions | Weekly individual therapy, skills training, phone coaching, therapist team (Behavioral Tech) |
| At Foundations? | Yes | Yes | No; offered by specialty DBT programs |
What is CBT?
Cognitive behavioral therapy (CBT) is, in the words of Cleveland Clinic, "a goal-focused talk therapy." Cleveland Clinic explains that "It focuses on how your thoughts influence how you feel and behave." The National Institute of Mental Health (NIMH) describes CBT as helping a person "become aware of automatic ways of thinking that are inaccurate or harmful," then question those thoughts and "change self-defeating behavior patterns."
The National Alliance on Mental Illness (NAMI) puts the method simply: "The core principles of CBT are identifying negative or false beliefs and testing or restructuring them." In practice, that might mean catching the thought "I always mess this up" and checking it against what actually happened.
CBT has a deep evidence base. NAMI notes that "Cognitive behavioral therapy has a considerable amount of scientific data supporting its use," and Cleveland Clinic says "CBT commonly helps manage mental health conditions like anxiety and depression." Our guide to cognitive behavioral therapy and emotional baggage goes deeper on how CBT works.
What is DBT?
Dialectical behavior therapy (DBT) is, per Cleveland Clinic, "a type of talk therapy (psychotherapy)." It is based on CBT, "but it's specially adapted for people who experience emotions very intensely." It was developed by psychologist Marsha Linehan. According to NAMI, "Dialectical behavior therapy (DBT) was originally developed to treat chronically suicidal individuals with borderline personality disorder (BPD)," and it has since been adapted for other concerns.
Behavioral Tech, which trains clinicians in DBT, describes four skill sets: mindfulness ("the practice of being fully aware and present in this one moment"), distress tolerance ("how to tolerate pain in difficult situations, not change it"), emotion regulation ("how to change emotions that you want to change"), and interpersonal effectiveness (how to ask for what you want and say no while keeping your self respect and relationships). Our explainer What Is DBT? Skills for Big Emotions walks through each skill.
If you are thinking about suicide or harming yourself, call or text 988, the Suicide and Crisis Lifeline. If you are in immediate danger, call 911.
How are CBT and DBT different?
Change first, or acceptance and change together?
CBT leans toward change: spot the thought, test it, replace it. DBT keeps that change work and adds acceptance. NAMI explains that "DBT is heavily based on CBT with one big exception: it emphasizes validation, or accepting uncomfortable thoughts, feelings and behaviors instead of struggling with them." Behavioral Tech says the same thing from the other side: in DBT, "acceptance strategies are added to the behavioral change strategies in CBT."
How intense are the emotions?
CBT works well when you can slow down enough to examine a thought. When emotions surge so fast that there is no room to think, DBT skills such as distress tolerance give you something to do first, so you can get through the moment without making it worse.
How long is each, and what is included?
Cleveland Clinic notes that "Many people attend therapy for eight to 12 visits" of CBT. It says comprehensive DBT "usually takes at least six months to a year," and Behavioral Tech lists its four modes: individual therapy, skills training, phone coaching, and a consultation team for therapists.
How are CBT and DBT alike?
Both are skills based, present focused, and ask you to practice outside the session. Cleveland Clinic says "CBT works best when you practice skills between sessions," and NAMI notes that "Similar to CBT, individuals undergoing DBT are usually instructed to practice these new methods of thinking and behaving as homework between sessions." Both are also used for borderline personality disorder: NIMH lists DBT and CBT among the therapies used for it.
When might CBT be the better fit?
CBT may be a good first choice if:
- Worry, low mood, or fear is the main problem, and you can usually notice your thoughts when it happens.
- You want a focused, time limited approach with clear goals.
- A specific pattern keeps tripping you up, such as avoidance or harsh self talk.
If anxiety is your main concern, our anxiety counseling page explains how counselors approach it.
When might DBT skills be the better fit?
Individual counseling that draws on DBT skills may fit if:
- Your emotions feel too intense or change too fast to manage.
- You act on urges you later regret.
- Relationships keep ending in conflict.
- You understood CBT ideas, but in the heat of the moment they were out of reach.
If anger is the emotion that takes over, our post on not letting anger turn you inside out is a good next read.
When is a comprehensive DBT program the better choice?
This is where we may point you elsewhere. Foundations does not run a comprehensive DBT program, skills groups, or phone coaching. We offer individual counseling that teaches and practices DBT skills. A comprehensive program, offered by specialty DBT programs, may serve you better if:
- Self harm or suicidal behavior is ongoing.
- You want the full model, including weekly skills training and between session phone coaching.
- A clinician who knows you has recommended comprehensive DBT.
If that sounds like you, a counselor can help you look for a program. For questions about medication, talk with your physician; Foundations offers talk therapy only. Only a qualified mental health professional can assess what is going on for you, so treat these lists as a reason to ask, not a diagnosis.
What should I ask a therapist about CBT or DBT?
NIMH notes that "The approach a therapist uses depends on their training and experience and the disorder being treated." Questions worth asking, adapted from NIMH:
- What is your training and experience with CBT or DBT?
- Which approach would you use with me, and why?
- What are the goals, and is there a time frame or number of sessions?
- How will we know it is working, and what happens if it is not?
How can counseling at Foundations help?
More than a dozen Foundations counselors list Cognitive Behavioral Therapy (CBT), and more than a dozen list Dialectical Behavior Therapy (DBT). Training and experience with each model vary, so ask about a counselor's background when you reach out.
You do not have to choose on your own. We will match you with a counselor who fits, and your first meeting with that counselor is a free consultation, a good time to talk through which approach fits you best. Sessions are in person in Fort Collins, Loveland, and Windsor, or online in Colorado. If your first counselor is not the right fit, our Counselor Match Guarantee means we will find another counselor who is.
Frequently asked questions
What is the main difference between CBT and DBT?
CBT focuses on noticing and changing unhelpful thoughts and the behaviors they drive. DBT is built on CBT but adds acceptance, or validation, and four skill sets for intense emotions: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. In short, CBT leans toward change, and DBT balances acceptance with change.
Is DBT better than CBT?
Neither is better overall. They fit different needs. CBT has a large evidence base for concerns like anxiety and depression. DBT was built for people whose emotions feel very intense, and its research is strongest for chronic suicidal behavior and borderline personality disorder. A counselor can help you decide which fits you.
Which is better for anxiety, CBT or DBT?
Cleveland Clinic says CBT commonly helps manage anxiety and depression, so it is often a natural place to start. DBT is also used for anxiety, and its skills can help when anxious feelings surge too fast to think through. Your counselor can blend the two or recommend one based on what you notice.
Can you do CBT and DBT at the same time?
Yes, in a sense. DBT already includes CBT methods, and many counselors draw on both, using CBT to examine thoughts and DBT skills for moments of high emotion. What you would not usually do is attend two separate full treatment programs at once without your clinicians coordinating.
How long do CBT and DBT take?
Cleveland Clinic notes that many people attend eight to 12 CBT visits, sometimes more. It says a comprehensive DBT program usually takes at least six months to a year. Individual counseling that draws on DBT skills has no fixed length; it depends on your goals and how quickly the skills start working in daily life.
Does Foundations offer a full DBT program?
No. Foundations offers individual counseling that teaches and practices DBT skills, not a comprehensive DBT program with skills groups or phone coaching. If a full program would serve you better, your counselor can help you look for one. If you are in crisis, call or text 988.
About this guide
Written by Chris Berger, M.A., LPC, NCC, founder of Foundations Counseling. Comparison claims come from Cleveland Clinic, NAMI, NIMH, and Behavioral Tech, each checked against the live source in October 2026.
Clinically reviewed by Chris Berger, M.A., LPC, NCC. Updated October 2026.
More on how counseling works: browse our Therapy Approaches guides.
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If you are thinking about suicide or harming yourself, call or text 988, the Suicide and Crisis Lifeline. If you are in immediate danger, call 911.