Understanding DBT: How It Grew Out of CBT and Why It Matters
“Balance is not something you find, it’s something you create.” – Jana Kingsford
Introduction
Dialectical Behavior Therapy (DBT) is one of the most influential therapies developed in the past few decades. While it shares a foundation with Cognitive Behavioral Therapy (CBT), DBT was created to address challenges that traditional CBT didn’t fully meet. Over time, DBT has become a powerful approach for helping people manage intense emotions, build resilience, and create lives worth living.
How DBT Began
DBT was developed in the late 1980s by psychologist Marsha Linehan. Originally, it was designed to treat individuals with borderline personality disorder (BPD), a condition marked by severe emotional dysregulation, frequent crises, and chronic suicidal thoughts (Linehan, 2015).
Traditional CBT, with its focus on identifying and challenging distorted thoughts, wasn’t always enough for clients who experienced overwhelming emotions. DBT built on CBT’s foundation but added new elements — particularly mindfulness practices, distress tolerance strategies, and a focus on acceptance (Chapman, 2006).
This is where the “dialectical” part comes in. Dialectics means holding two opposing truths at once. DBT balances:
Acceptance (“I am doing the best I can”)
Change (“I can also work on doing better”)
Over time, CBT itself has begun to integrate more mindfulness and acceptance-based strategies, showing how these two approaches continue to influence one another.
The Core Skills of DBT
DBT organizes its work around four main skill areas:
Mindfulness – staying grounded and present in the moment.
Distress Tolerance – coping with crises and stress without making things worse.
Emotion Regulation – recognizing, labeling, and managing intense emotions.
Interpersonal Effectiveness – building healthier and more stable relationships.
These skills go beyond thought-challenging; they provide a toolkit for living with emotions in a healthier way.
How CBT and DBT Are Similar
Both are structured, skills-based therapies.
Both emphasize the connection between thoughts, emotions, and behaviors.
Both give clients practical tools to use in daily life.
Both are strongly supported by research.
How CBT and DBT Are Different
CBT focuses on identifying and reframing unhelpful thoughts and beliefs.
DBT emphasizes acceptance and regulation of emotions, even when thoughts can’t be changed.
CBT often asks: “How can I see this differently and respond more effectively?”
DBT often asks: “How can I accept this moment and manage my emotions while still working toward change?”
How DBT Has Expanded
Although DBT started as a treatment for borderline personality disorder, research has since shown its effectiveness for many other conditions, including:
Posttraumatic Stress Disorder (PTSD)
Substance use disorders
Depression
Eating disorders
Suicidal ideation and self-harm
Today, DBT is used in individual therapy, group skills training, hospital programs, and community-based care. It continues to evolve as new research supports its flexibility and power.
Why I Integrate DBT
In my own practice, I draw on DBT because it adds something vital to CBT: the reminder that not every thought can be challenged. Sometimes the most healing step is to accept emotions, sit with them, and learn how to regulate them.
That’s why I view DBT skills — especially emotional regulation and distress tolerance — as essential for long-term mental wellness. Combined with the structure of CBT, they create a pathway not only for clearer thinking but also for greater emotional balance, resilience, and self-acceptance.
If you’re curious about how CBT and DBT could support your own journey, therapy can provide a space to explore these skills in a way that fits your life.
—
Joseph Mounts M.Ed., AADC, LPC
References
Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry, 3(9), 62–68.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). The Guilford Press.
