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CBT vs DBT: Explanations and Criticisms


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#1 eldorado

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Posted 03 February 2013 - 02:02 AM

Okay, I'm curious.  I'm familiar and a probationer of CBT, what's the big difference and difference in out look.  (Sorry, don't mean to hijack, but if this stuff is working for so many of you, maybe I can get something out of it also.)


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#2 vondick

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Posted 03 February 2013 - 07:40 AM

I will tell you what goes through my brain when I look at worksheets that I found myself or were very briefly shown to me by my counselor. I will invite people who have ACTUALLY been properly led through the therapy to enlighten us both..

 

CBT: Look at a situation/problem/event. Explain the core beliefs you hold that you see this situation through. How are you thinking? how are you feeling? How does your body feel? Tell me something good about yourself. Are you enlightened? You're just thinking bad. ( eg. http://www.psycholog...orksheets.html/)

 

DBT: You're going to be in situations. And sometimes you are going to be distressed or upset or sad or angry or any range of extreme emotions. Because that's what happens in life, and to some people, quite often. Here are a set of skills to help you get through that. Instead of telling yourself positive things about yourself that you don't really believe, practice self respect in small easy ways daily. When you have a super negative thought, practice doing  _________, __________, or ___________ instead. Take care of yourself. (Eg. http://www.dbtselfhe...kills_list.html)

 

CBT made my brain hurt. DBT I am just starting to learn about, but seems straightforward, practical, and awesome.


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#3 Wooster

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Posted 03 February 2013 - 12:31 PM

The developer of DBT, Marsha Linehan, was a protege of Aaron Beck, "the guy" for CBT.

 

CBT focuses more on recognizing thinking patterns to identify "errors", challenging automatic negative thoughts, and developing awareness of how thought patterns influence our emotional states. It's very formulaic in the sense that CBT views a linear progression from antecedent event/activating event--->beliefs (including automatic negative thoughts, rational or irrational thouthts)--->consequences (emotions whether they be pleasant/unpleasant or healthy/unhealthy, other thoughts, behaviors).

 

DBT is a highly skill-oriented curriculum. A lot of people will just teach DBT skills without doing the full DBT protocol developed for treatment of BPD. The full protocol consists of individual therapist (who helps implement the skills, its not "talk therapy" + group skills class + med management + treatment team meetings.

 

DBT helps people learn how to develop skills they might have missed out on so they can regulate emotions, tolerate distress, and have increased interpersonal effectiveness in increasingly healthier ways. Those three skill sets are taught, alternating with a chunk of mindfulness skills between each of the other skills: mindfulness, emotion regulation, mindfulness, distress tolerance, mindfulness, interpersonal effectiveness. It takes about 6 months to cycle through one full rotation like that. 

 

DBT also focuses more on validating current distressed emotional states while not reinforcing them. This is the "dialectic" part of dialectical behavioral therapy. Or one of the "dialectics" that emerges in DBT. Another one idea prevalent in DBT is that the patient can't fail the therapy... only the therapy can fail the patient. As it is currently practiced out in clinical settings, though, I hear a lot of people forgetting that idea.

 

I think both approaches are incredibly useful for different situations.


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#4 vondick

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Posted 03 February 2013 - 01:33 PM

Thanks for elaborating Wooster!

 

I have become increasingly interested in DBT after reading this thread and doing some research. I love how it is extremely strategy based and used in the moment, and includes some zen concepts which I have benefited from in the past. I've only just looked over some of the skills, but I have already been able to successfully apply them, and I am looking for a tdoc that uses a more mindful, skills based approach. I feel like it is somewhere I could go in therapy that could make up an actual plan, which is promising.

 

I can see how CBT could be extremely useful for some situations- I know it is frequently used in depression, what other types of things is it good at addressing? I can see  it's usefulness, my brain just doesn't work like that.


Really quite very sure I'm on the spectrum. Awaiting report back from assessment.
Recently quit Wellbutrin XL 150, taking Dexedrine spansules when I can afford it.
A little slow with social interaction- if I offend you do not hesitate to let me know, chances are I really didn't mean it.


#5 saveyoursanity

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Posted 03 February 2013 - 11:45 PM

In my experience, CBT was about changing your core beliefs and thoughts in the assumption that thoughts lead to feelings lead to actions.
 
DBT is focussed on the action part of that equation.  Feelings may not be under control, they may not even be controllable for that person, and trying to act on thought change is often like trying to redirect a fucking flood.   Whereas actions are generally assumed to be under conscious control by everyone, so people generally acknowledge that their actions are much easier to act on.  I mean, look at the verb!
 
My personal criticism of DBT is that it's great a t getting people to stop acting "badly" (or self-destructively or whichever way the "bad" actions come out) and not very good at getting people to understand why they act this way and how to fix that why.   Applying DBT can quiet the waters but does not remove the cause of the flood itself, in other words.  However, you can't figure out what's causing a flood if you're getting overwhelmed and drowned by it anyway, so...  there's a place for DBT, absolutely.
 
I went through the full DBT thing (individual + group etc) and also "just" intensive group DBT at a separate, earlier time.  Both helped, group DBT helped more (STEPPS, if anyone's wondering) but that may be because my rapport with my individual therapist was crap and at that point I was not so symptomatic and therefore wanted to focus on the "why" and examine root causes and how to change those.  Regardless of my criticism, I still use DBT skills every day and would recommend it to anyone who feels they need to "quiet the waters".

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#6 Titania

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Posted 04 February 2013 - 03:54 AM

I had DBT and psychoanalysis side by side, which other than being fucking exhausting, meant I could drdge the depths and skill survive what came up. I find DBT more accessible than CBT because my brain isn't very logically oriented, my inner life doesn't feel that ordered. I found CBT useful, but my mind has been chaos for such a long time, the chain model doesn't always easily apply.


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#7 Phoenix_Rising

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Posted 04 February 2013 - 07:16 AM

Thank you vondick and wooster for providing explanations for CBT and DBT.  I am struggling to take in all that CBT encompasses and I think it will help to have the worksheets that are provided on the website you referenced, vondick.


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#8 tryp

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Posted 04 February 2013 - 10:10 AM

My first therapist (an MEd) way back before I was diagnosed was really into CBT and wanted me to try it.  I really hated it - it's hard to describe why I found it so loathesome - I think it just wasn't giving me what I needed.

 

Last year I was doing group DBT combined with supportive individual psychotherapy which is good because I don't think I would have tolerated DBT without it.  I don't hate DBT because I find it unhelpful - I find it very helpful - I just also find it deeply upsetting.

 

This year I am going to be doing individual DBT with another therapist and supportive therapy with my current therapist.  I suppose I will find out how well I tolerate it, but I don't expect it to be pretty.

 

Still, what I appreciate about DBT is that it does give me the opportunity to address what feels like "core issues".  I always somehow felt that CBT was not well matched to my pathology and really didn't address the core of my issues.


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#9 WinglessFaery

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Posted 04 February 2013 - 01:35 PM

Is DBT somthing too bring up with my current pdoc or would I need one that specializes?
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#10 tryp

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Posted 04 February 2013 - 02:17 PM

You can definitely bring it up and see what they say. Since it is a specialized therapy, some level of special training is required to do it, but your therapist might be able to refer you. Or work through a workbook with you. Some therapists feel comfortable doing it without much training but to really get the full benefit you need someone formally trained IMO.

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#11 vondick

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Posted 05 February 2013 - 11:36 PM

Personally- I don't really think in emotions. I mean- I have them (obviously), but when I'm looking at any given situation, it's usually behind a very objective lens. Not %100 of the time- I mean I'm not a robot, but for the most part this is true. So when CBT worksheets ask me to describe my core beliefs of a situation, it just isn't a question I can answer. Which doesn't mean I don't occasionally have ideas that are warped about a given situation, it just- isn't a question I can answer. So given that it is a question frequently asked in CBT, that's problematic for me.

 

That being said, emotions sneak up on me and sometimes hit me like sensory overload. So the lack of emotional control + ability to step back and see things really objectively would make DBT really useful and fairly accessible to me.


Really quite very sure I'm on the spectrum. Awaiting report back from assessment.
Recently quit Wellbutrin XL 150, taking Dexedrine spansules when I can afford it.
A little slow with social interaction- if I offend you do not hesitate to let me know, chances are I really didn't mean it.


#12 saveyoursanity

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Posted 06 February 2013 - 11:30 AM

I think it's a shame that DBT is kind of "relegated" to people with borderline personality disorder.  It seems like it would also be helpful for ANYONE who has ANY intense emotions that they can't deal with easily, like people with anger problems or even, as vondick suggested, the sensory overload and emotional overload that anyone could experience.


CAPS LOCK IS HOW I FEEL INSIDE ALL THE TIME.

"There will be coffee and cookies in the Gandhi Room after the revolution."

 

Dx and Psych Rx in profile.

I am NOT a medical professional, merely experienced from a consumer perspective.
I strongly urge fact checking with your own research and consulting an actual medical professional.


#13 Wooster

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Posted 06 February 2013 - 11:59 AM

Vondick, CBT expressly asks you NOT to "think in emotions"... but to examine the underlying THOUGHT STRUCTURES... beliefs, opinions, and such that lead to emotions.

 

ETA... not how you feel about something, but what you think.

Basic example found here: http://www.basic-cou...al-therapy.html

 

SYS, I think the skills of DBT (with fewer annoying mnemonics) should be taught in grade school.


Edited by Wooster, 06 February 2013 - 12:03 PM.

Boards I mod on: self harm, panic/anxiety, ptsd, ocd, dissociative, sleep, not otherwise specified, benzos, lifestyle alternatives, therapy, health care system

Current meds: 60# golden retriever service dog, (swellbutrin, light box, vitamin D for the impending lack of sunlight blahs)

*disclaimer--Nothing I write should be construed as professional advice or creating a therapeutic relationship.*

Hurray! I *finally* figured out how to correct my starting weight on MFP!
21850981.png
Created by MyFitnessPal.com - Nutrition Facts For Foods






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