CBT v. DBT

CBT vs. DBT: What are the Key Differences in Substance Use Treatment? 

When it comes to treating addiction, there’s no one-size-fits-all solution. Two of the most evidence-based and widely used therapeutic approaches are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). While some clinicians specialize in one modality, many blend both to tailor treatment to each client’s individual needs. What’s exciting about CBT and DBT is their versatility—they’re not just for addiction; the skills gained often support long-term emotional well-being and can be applied across life’s many challenges. 

Before diving deeper into the differences, let’s explore what makes each approach unique and beneficial:

Cognitive Behavioral Therapy (CBT)

CBT is often considered the foundational framework for modern talk therapy. Developed by Dr. Aaron Beck, CBT is based on the idea that our thoughts influence our feelings and behaviors. By identifying and challenging negative or unhelpful thought patterns, individuals can begin to change behaviors that no longer serve them—such as substance use.

One of the core techniques in CBT is cognitive restructuring—the process of reframing negative or distorted thoughts into more realistic and helpful ones. This helps clients respond to stressors in more balanced, empowered ways. Change doesn’t happen overnight, but with practice, new thought patterns become second nature or automatic. 

CBT tools commonly used in addiction treatment include:

• Identifying and avoiding triggers

• Journaling to track thoughts and behaviors

• Learning alternative coping strategies (e.g., mindfulness, relaxation techniques)

• Building out problem solving skills

• Practicing assertiveness and boundary-setting

• Building a support system of friends, sponsors, or peer mentors

CBT in Action: (thinking I can make up a canva diagram for this)
Trigger → Thought → Emotion → Behavior
Understanding this chain helps interrupt destructive patterns and create room for healthier responses.

Dialectical Behavior Therapy (DBT)

Originally developed by Dr. Marsha Linehan for borderline personality disorder, DBT has since been adapted to support individuals with a wide range of struggles, including substance use, emotional dysregulation, and self-harming behaviors. DBT is particularly effective for individuals who experience intense emotions and difficulty managing impulses. I also love that DBT is skill-based. You are bound to learn an acronym of a tool you have learned that you can easily remember to self-soothe in a time of crisis.

What sets DBT apart is its dialectical philosophy: the idea that two seemingly opposite things can be true at the same time. For example, “I’m doing the best I can” and “I need to do better” can both coexist. This balance between acceptance and change is at the heart of DBT (Which is so reflective of experiences in our daily life!)

Key DBT skill areas include:

• Distress Tolerance – Learning how to “ride out” uncomfortable thoughts, emotions and feelings without resorting to harmful behaviors or using 

• Emotional Regulation – Building new skills to properly manage uncomfortable emotions to manage responses

• Interpersonal Effectiveness – Focuses on improving relationships with others. Skills here include identifying/communicating boundaries. This is where group therapy comes in! 

• Mindfulness – A wonderful skill around awareness. This looks like checking in with ourselves, noting what feelings are coming up in the present moment. It’s meant to identify, self-soothe, and de-escalate ourselves in stressful situations with no judgment.

Group therapy is often a component of DBT, offering a supportive environment to practice these skills in real time.

Which Approach Is Right for You?

Both CBT and DBT are highly effective in the treatment of addiction—but your personal history, goals, and emotional experiences can guide which modality (or combination of both) is best for you. CBT tends to work well with those who also experience anxiety, depression, obsessive compulsive disorder (OCD), or post-traumatic stress disorder (PTSD). DBT may be more effective for those struggling with impulse control, emotional volatility, setting boundaries, or interpersonal challenges.

At Health in Tandem, our therapists are trained in both CBT and DBT. Whether you're just starting your healing journey or looking to deepen the work you’ve already begun, we’re here to support you in creating lasting change.

Want to learn more? Check out more information on the different types of therapy for substance use.