What’s the Difference Between CBT and DBT? A Chicago Therapist Explains

The Short Answer: CBT vs DBT

Here’s the simplest way to understand the difference:

CBT (Cognitive Behavioral Therapy) focuses on changing unhelpful thought patterns and behaviors. It’s like learning to catch your negative thinking and replace it with more balanced, realistic thoughts.

DBT (Dialectical Behavior Therapy) focuses on accepting and managing intense emotions while also learning to change problematic behaviors. It’s like learning to ride the waves of difficult emotions without getting swept away by them.

Think of it this way: CBT says “let’s examine and change that thought,” while DBT says “let’s first accept that you’re having this feeling, then learn skills to manage it.”

Both are types of therapy that have been proven to work. But they take different approaches and work best for different challenges.

What Is CBT? (Cognitive Behavioral Therapy)

Cognitive Behavioral Therapy was developed in the 1960s by Dr. Aaron Beck, who noticed that his patients’ negative thoughts were making their depression worse. CBT is built on a simple but powerful idea: your thoughts, feelings, and behaviors are all connected, and changing one can change the others.

How CBT Works

In our Chicago CBT therapy, you work with your therapist to:

• Identify negative thought patterns (called “cognitive distortions”) like catastrophizing, black-and-white thinking, or mind-reading
• Challenge those thoughts with evidence and logic—asking “Is this thought actually true? What’s the evidence?”
• Replace unhelpful thoughts with more balanced, realistic ones
• Change behaviors that keep you stuck in anxiety or depression
• Practice new skills through homework and real-world experiments

What CBT Treats Best

CBT is the gold-standard treatment for:

• Generalized Anxiety Disorder (GAD)
• Panic Disorder and panic attacks
• Social Anxiety
• Specific phobias (flying, heights, public speaking)
• Depression
• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)
• Insomnia
• Health anxiety

What CBT Sessions Look Like

CBT is typically structured and goal-focused. In a typical session, you might:

• Review what happened during the week and any homework you practiced
• Identify a specific problem or situation causing distress
• Work through it using CBT techniques (thought records, behavioral experiments, etc.)
• Learn a new skill or concept
• Get homework to practice before your next session

CBT is usually short-term, with many people seeing significant improvement in 12-20 sessions. It’s practical and skills-focused—you’re learning tools you can use for the rest of your life.

CBT Example: Anxiety About a Work Presentation

Let’s say you’re anxious about giving a presentation at work. Here’s how CBT would approach it:

Automatic Thought: “I’m going to mess this up and everyone will think I’m incompetent.”

CBT Process:

• Identify the cognitive distortion (fortune-telling, catastrophizing)
• Challenge it with evidence: “What evidence do I have that this will happen? What evidence contradicts this thought?”
• Generate a more balanced thought: “I’m prepared, and even if I’m nervous, I can get through this. One presentation doesn’t define my entire competence.”
• Behavioral experiment: Give the presentation and observe what actually happens (usually it goes better than the anxiety predicted)

What Is DBT? (Dialectical Behavior Therapy)

Dialectical Behavior Therapy was developed in the late 1980s by Dr. Marsha Linehan, originally to treat Borderline Personality Disorder. DBT is built on the concept of “dialectics”—holding two seemingly opposite ideas at the same time. The core dialectic in DBT is: You need to accept yourself as you are AND work to change.

How DBT Works

DBT teaches four main skill sets:

1. Mindfulness

Learning to be present in the moment without judgment. This is the foundation of all other DBT skills.

2. Distress Tolerance

Getting through crises without making things worse. Think of this as your “emergency toolkit” for when emotions feel overwhelming.

3. Emotion Regulation

Understanding and managing intense emotions. Learning to decrease emotional vulnerability and change unwanted emotions.

4. Interpersonal Effectiveness

Communicating your needs, setting boundaries, and maintaining relationships while respecting yourself and others.

What DBT Treats Best

DBT was originally designed for Borderline Personality Disorder but has proven effective for:

• Borderline Personality Disorder (BPD)
• Chronic suicidal thoughts or self-harm behaviors
• Intense emotional reactions (emotional dysregulation)
• Eating disorders
• Substance abuse
• PTSD and trauma (especially complex trauma)
• Depression that hasn’t responded to other treatments
• Relationship problems involving intense emotions

What DBT Sessions Look Like

DBT is more intensive than CBT and typically includes:

• Individual therapy (once a week) – working on personal goals and applying skills to your life
• Skills group (once a week, 2-2.5 hours) – learning the four skill modules with other people
• Phone coaching (as needed) – brief calls to your therapist between sessions when you need help using skills in real-time
• Consultation team (for therapists) – DBT therapists meet regularly to support each other in providing good treatment

DBT programs typically last 6-12 months, though some people continue longer.

DBT Example: Intense Anger After an Argument

Let’s say you had a fight with your partner and you’re feeling intense anger—the kind that makes you want to say something you’ll regret or leave the relationship entirely.

DBT Approach:

• Mindfulness: Notice that you’re feeling intense anger without judging yourself for it (“I’m so angry right now, and that’s what’s happening”)
• Distress Tolerance: Use a skill like TIPP (Temperature change, Intense exercise, Paced breathing, Paired muscle relaxation) to bring down the intensity before acting
• Emotion Regulation: Identify what triggered the anger and what you need—maybe you feel dismissed or unheard
• Interpersonal Effectiveness: Once calm, communicate your needs using DEAR MAN (Describe, Express, Assert, Reinforce, be Mindful, Appear confident, Negotiate)

The goal isn’t to eliminate the anger but to manage it skillfully so you don’t damage the relationship or yourself.

Key Differences Between CBT and DBT

Which One Is Right for You?

Here’s how to think about whether CBT or DBT might be a better fit:

CBT Might Be Right for You If:

• Your main struggle is anxiety, worry, or panic
• You tend to get stuck in negative thinking patterns
• You want focused, short-term treatment for a specific issue
• You’re dealing with depression or low mood
• You have phobias or OCD
• You prefer individual therapy without group components
• Your emotions feel manageable most of the time, even if they’re unpleasant

DBT Might Be Right for You If:

• Your emotions feel overwhelming and out of control
• You struggle with impulsive behaviors (self-harm, substance use, binge eating, reckless driving)
• Your relationships are intense and chaotic
• You’ve been told you have Borderline Personality Disorder
• You experience chronic suicidal thoughts
• CBT alone hasn’t been enough in the past
• You need help with severe emotional reactions that interfere with daily life
• You’re open to a group format for learning skills

Can You Do Both?

Yes! Many therapists integrate techniques from both CBT and DBT. At Calm Anxiety Therapy Clinic, we often use:

• CBT as the primary approach with DBT skills sprinkled in (like mindfulness or distress tolerance techniques)
• DBT skills groups alongside individual CBT therapy
• Sequential treatment – starting with DBT to build emotion regulation skills, then moving to CBT to address specific anxiety or depression

The best approach depends on your unique situation, and your therapist will help figure out what makes sense.

Common Misconceptions About CBT and DBT

“CBT is just positive thinking”

Not true. CBT isn’t about replacing negative thoughts with artificially positive ones. It’s about examining your thoughts for accuracy and balance. If your thought is “I might not get this job,” CBT doesn’t say “think positive—you’ll definitely get it!” Instead, it helps you recognize that “I might not get this job” is different from “I’ll never get any job” or “I’m worthless.”

“DBT is only for people with Borderline Personality Disorder”

Not true. While DBT was originally developed for BPD, it’s now used for many conditions involving emotional dysregulation. You don’t need a BPD diagnosis to benefit from DBT skills.

“DBT means your emotions are ‘wrong'”

Not true. DBT is actually one of the most validating therapies out there. It teaches that all emotions are valid and make sense given your biology and life experiences. The focus is on managing them skillfully, not eliminating or judging them.

“You have to choose one or the other”

Not necessarily. Many therapists are trained in both and will use elements of each depending on what you need in the moment.

CBT and DBT in Chicago: What to Expect

If you’re looking for CBT or DBT in Chicago, here’s what to know:

Finding a CBT Therapist

CBT is widely available throughout Chicago—in Lakeview, Lincoln Park, Loop, River North, West Loop, and beyond. Most therapists have at least some CBT training because it’s such a foundational approach.

At Calm Anxiety Therapy Clinic, we specialize in CBT for anxiety disorders and can see you in person at our Lakeview office or via telehealth anywhere in Illinois.

Finding a DBT Therapist

DBT requires more specialized training, so there are fewer DBT providers than CBT providers. Look for therapists who:

• Have completed intensive DBT training
• Are part of a DBT consultation team
• Offer comprehensive DBT (individual therapy + skills group + phone coaching)

Some programs in Chicago offer DBT groups, which can be attended alongside your individual therapy with a non-DBT therapist.

Insurance Coverage

Both CBT and DBT are typically covered by insurance, but coverage details vary:

• CBT: Usually covered like any other individual therapy
• DBT: Individual sessions typically covered; group sessions may or may not be covered depending on your plan

Always check with your insurance and the therapist’s office to understand your coverage.

The Bottom Line: Which Therapy Should You Choose?

Here’s the honest truth: the best therapy is the one you’ll actually do.

Both CBT and DBT are evidence-based, effective treatments. The “right” choice depends on:

• What you’re struggling with most
• What approach resonates with you
• What’s available in your area
• Your schedule and commitment level
• Your relationship with your therapist (this matters more than the specific modality)

If you’re not sure which would be better, start with a consultation. A good therapist will assess your needs and recommend the best approach—and if they’re not the right fit, they’ll refer you to someone who is.

Ready to Get Started with CBT or DBT in Chicago?

At Calm Anxiety Therapy Clinic in Lakeview, we specialize in Cognitive Behavioral Therapy for anxiety, depression, OCD, and related conditions. We incorporate elements of DBT when helpful, particularly mindfulness and distress tolerance skills.

Whether you’re dealing with constant worry, panic attacks, social anxiety, or overwhelming emotions, we’re here to help you find relief.

Calm Anxiety CBT Therapy Clinic
3354 N. Paulina St, Suite 209
Chicago, IL 60657
Phone: 773.234.1350

Schedule Your Consultation

We serve clients throughout Lakeview, Lincoln Park, Roscoe Village, Southport Corridor, Andersonville, Uptown, Lincoln Square, and all Chicago neighborhoods. Virtual therapy available throughout Illinois.

You don’t have to figure this out alone. Let’s talk about which approach is right for you.