Dialectical vs. Cognitive Behavioral Therapy for BPD

group therapy session
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If you have borderline personality disorder, you have probably heard of both cognitive-behavioral therapy and dialectical behavior therapy. Are these modes of treatment different or simply variations of each other? Let's take a closer look at these types of behavioral therapies and how they are related.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy, or CBT, is a form of therapy that aims to restructure and change the way a person thinks and behaves. Whether or not this therapy is beneficial depends strongly on the relationship between the individual and their therapist. The individual's willingness to make a change is also a crucial factor.

Examples of techniques used by a cognitive-behavioral therapist include cognitive restructuring and behavioral changes, like reducing self-defeating behaviors and learning how to respond to problems in a healthy, adaptive manner. In cognitive restructuring, a patient is taught to identify negative reactive thoughts and modify them.

Dialectical Behavior Therapy

Dialectical behavioral therapy, or DBT, is a modified type of CBT that was uniquely developed to treat borderline personality disorder. This approach is called "dialectical" because it involves the interaction of two conflicting ideas, which are that improving the symptoms of BPD involves both acceptance and change.

It focuses on skills like mindfulness or living in the present, regulating emotions, tolerating distress, and effectively managing relationships with others. DBT is the only empirically supported treatment for borderline personality disorder. 

DBT is composed of four elements that the individual and therapist usually work on over a year or more:

  • Individual DBT therapy, which uses techniques like cognitive restructure and exposure to change behavior and improve quality of life.
  • Group therapy, which uses skills training to teach patients how to respond well to difficult problems or situations.
  • Phone calls, which focus on applying learned skills to life outside of therapy.
  • Weekly consultation meetings among the DBT therapists, which offer a means of support for the therapists and to ensure they are following the DBT treatment model.

This type of therapy focuses on some of the common symptoms of BPD including impulsivity, exaggerated mood changes, unstable relationships, poor sense of self, and the fear of abandonment. DBT also helps people with BPD work on skills such as being able to tolerate distress, regulating emotions, and effective interpersonal behavior. 

One major focus on DBT is to help people learn how to deal with powerful emotions and learn new ways of coping with strong feelings without resorting to unhealthy coping mechanisms. Distress tolerance, for example, centers on helping people recognize and accept painful feelings without engaging in harmful behaviors like self-harm. 

How to Decide Which BPD Treatment Is Right for You

If you have borderline personality disorder, there are treatments that can help you manage your condition. Please speak with your doctor about finding the right therapist and treatment model for you so you can feel better and improve your quality of life.

Borderline Personality Disorder Discussion Guide

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Differences Between Dialectical Behavioral Therapy and Cognitive Behavioral Therapy

DBT is simply a modified form of CBT that uses traditional cognitive-behavioral techniques, but also implements other skills like mindfulness, acceptance, and tolerating distress.

  • Helps patients change how they think/behave

  • Patients learn how to manage negative emotions

  • Can be used in the treatment of many disorders

  • A type of cognitive-behavioral therapy

  • Incorporates other skills (e.g., mindfulness)

  • Specifically treats borderline personality disorder

The good news is that DBT has been found to be considerably more effective in treating people with borderline personality disorder.

Dialectical behavioral therapy is recommended as a first-line treatment for borderline personality disorder and has been shown to reduce the need for medical care and medications by as much as 90%.

It's interesting to note that some cognitive-behavioral therapists incorporate certain elements of the DBT model into their treatment sessions. Also, other forms of CBT have developed that use the elements of DBT. For instance, mindfulness-based cognitive therapy utilizes traditional cognitive-behavioral techniques with mindfulness to treat depression.

3 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Psychotherapy. National Alliance on Mental Health.

  2. Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW. The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatr Clin North Am. 2010;33(3):657-85. doi:10.1016/j.psc.2010.04.007

  3. May JM, Richardi TM, Barth KS. Dialectical behavior therapy as treatment for borderline personality disorder. Ment Health Clin. 2016;6(2):62-67. doi:10.9740/mhc.2016.03.62

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.