Mood disorders like depression and bipolar affect millions of Americans every year[1] and can be debilitating[3] . As mental health awareness grows so does the need for treatment options[2] . Two popular therapies have gotten a lot of attention: Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Both have been shown to work for mood disorders[4] but how do they compare?

What is CBT?

Cognitive Behavioral Therapy (CBT) is a structured, time-limited, goal oriented form of therapy. Developed by Dr. Aaron Beck in the 1960s as a treatment for depression, CBT has since been used to treat many mood disorders including anxiety, post-traumatic stress disorder (PTSD) and bipolar disorder[3][4].

At its core, CBT is based on the idea that thoughts, emotions and behaviors are connected. By identifying and challenging negative thinking patterns individuals can change their emotional responses and behaviors and improve their mood[3].

CBT Components

1. Identifying cognitive distortions helps you become aware of the automatic, irrational thoughts that can lead to feelings of depression or anxiety. Examples are:
   • Assuming the worst in any situation is catastrophizing.
   • Drawing conclusions from one event is overgeneralizing.
   • Seeing situations in black and white with no middle ground is black and white thinking.
2. Learning to question the negativity of your thoughts and replace them with more balanced, realistic thinking is challenging negative thinking.
3. Doing things that give you pleasure or a sense of achievement even when you don’t feel like it is behavioral activation.
4. I learned to solve problems in real life and did CBT in between sessions with homework.

CBT for Mood Disorders

Many studies show CBT works for mood disorders. For depression, CBT reduces symptoms and relapse[3][7]. A 2023 meta-analysis in The American Journal of Psychiatry found CBT was as effective as medication for mild to moderate depression, with longer-lasting results because it teaches skills for managing future episodes[7].

For example, a person with depression might learn to challenge thoughts like “I’m a total failure” by looking at the evidence for and against that thought and come up with a more balanced thought like “I’ve had setbacks but I’ve also had successes”[3].

CBT also works for managing symptoms of bipolar when used with medication[4]. Bipolar disorder involves complex mood cycles of depression and mania. CBT helps people manage their depressive phases by changing negative thought patterns that make them feel worthless or hopeless[4]. A 2024 study in Psychiatry Research found CBT improves overall functioning in people with bipolar when used with mood-stabilizing medication[4].

The Basics of DBT

Dialectical Behavioral Therapy (DBT) was created in the late ’80s by psychologist Marsha Linehan as a treatment for people with borderline personality disorder (BPD)[5]. However, DBT has since been found to be effective for many other mental health conditions, especially mood disorders, when those disorders involve emotional dysregulation[5].

DBT combines CBT with mindfulness and acceptance strategies[5]. Its core is balancing acceptance of where you are right now with the need to change. The “dialectical” part of DBT means synthesizing opposites—accepting yourself while also working towards growth and change[5].

DBT Skills

DBT is based on four main skill sets:

1. Cultivating present-moment awareness and non-judgmental observation of thoughts and emotions is mindfulness.
2. Learning to handle difficult situations without resorting to harmful behaviors is distress tolerance.
3. Learning to understand, experience and manage intense emotions effectively is emotion regulation.
4. Improving communication skills and maintaining healthy relationships while respecting personal boundaries is interpersonal effectiveness.

These skills are taught in a structured format, often in individual therapy sessions and skills training groups[5]. For example, a patient might learn the “STOP” skill (Stop, Take a step back, Observe, Proceed mindfully) to manage impulsive reactions in crisis[5].

DBT for Mood Disorders

Although DBT was originally developed for BPD, its effectiveness for mood disorders has been proven in recent years[5]. One of the areas where DBT shines is in helping people with severe emotional dysregulation, a common feature in mood disorders like bipolar or depression with co-occurring personality disorders[4][5].

A 2024 study in The Journal of Clinical Psychology looked at DBT for treatment-resistant depression. They found that those who did DBT had a significant reduction in depression symptoms, improved emotional regulation and a decrease in self-harm behaviors[5]. This is because DBT focuses on mindfulness and distress tolerance, which helps people navigate intense emotions without resorting to maladaptive coping mechanisms[5].

For those with bipolar disorder, DBT is most helpful during depressive or mixed episodes when emotions are at an all-time high[4][5]. It teaches skills for managing intense emotions, tolerating distress, and maintaining relationships during tough times[5]. For example, a person might use the “DEAR MAN” technique (Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, Negotiate) to communicate needs and maintain relationships during mood swings[5].

CBT vs DBT for Mood Disorders

Both CBT and DBT work for mood disorders but are suited for different people and conditions[3][5].

Pros of CBT:

1. Structured approach to cognitive reframing[3]
2. Goal-focused with short duration (12-20 sessions)[3]
3. Works well for anxiety disorders which often co-occur with mood disorders[3][4]
4. Focus on changing negative thoughts[3]

Pros of DBT:

1. A comprehensive approach to multiple areas of functioning[5]
2. Best for people with complex or treatment-resistant mood disorders[5]
3. Focus on developing skills for intense emotions[5]
4. The group skills training component provides peer support and real-time practice[5]

CBT’s structured approach to cognitive reframing is helpful for people whose mood disorders are driven by negative thinking[3]. Goal-focused and short-duration make it a quick fix for people looking for immediate practical tools to manage their symptoms[3].

DBT is better for people whose mood disorders involve big emotional dysregulation, impulsivity or co-occurring personality disorders[4][5]. DBT takes longer (often six months to a year). Still, its focus on mindfulness, acceptance and emotional regulation makes it more effective for people who have intense mood swings or chronic suicidality[5].

Factors to Consider Treatment Choice

When choosing between CBT and DBT for mood disorders:

1. The severity and complexity of symptoms determine treatment suitability and DBT is more suitable for severe or complex cases with emotional dysregulation.
2. The presence of comorbid conditions, especially personality disorders, may indicate DBT.
3. History of trauma or abuse may highlight DBT’s focus on emotional regulation and distress tolerance.
4. The ability to do structured therapy may favor CBT for those who like clear goals and homework.
5. Treatment history may indicate DBT as a new approach for those who haven’t responded to traditional CBT.
6. The availability of resources takes into account DBT’s longer commitment time and group therapy requirements, which may not be available to all.
7. Patient preference acknowledges that people may prefer one over the other based on their personal goals and values.

Similarities and Differences of CBT and DBT

Similarities:

• Both CBT and DBT have research backing them up for mood disorders.
• Both focus on the connection between thoughts, emotions and behavior.
• Both teach practical skills for daily life.
• Both involve structured sessions with clear goals.
• Both involve homework assignments between sessions.

Differences:

1. CBT focuses on changing thoughts, whereas DBT focuses on dialectics and balance between acceptance and change.
2. There are different time commitments: CBT (12-20 sessions) vs. DBT (6 months to a year or more).
3. More emphasis on emotional regulation and distress tolerance in DBT vs CBT.
4. Mindfulness is a core component in DBT vs a variable in CBT.
5. Group skills training is a standard component in DBT vs individual therapy in CBT.
6. More focus on crisis management and reducing self-harm in DBT vs CBT.
7. Emphasizing the therapeutic relationship as a model for other relationships more prominently in DBT distinguishes it from CBT’s approach.

Choosing the Right Approach

When considering therapy for mood disorders, the choice between CBT and DBT depends on several things: the nature of your symptoms, your personal preferences and your treatment goals[3][5].

CBT is suitable for:

• Mild to moderate depression or anxiety[3][7]
• Bipolar disorder (with medication)[4]
• You prefer goal-oriented, practical therapy[3]

DBT is suitable for:

• Treatment-resistant depression[5]
• Bipolar disorder with significant emotional dysregulation[4][5]
• Co-occurring personality disorders (e.g., borderline personality disorder)[5]
• History of self-harm or chronic suicidality[5]

Combining CBT and DBT

Recent research is moving towards combining elements of CBT and DBT in treating mood disorders[3][5]. This approach aims to combine the best of both worlds, addressing cognitive restructuring and emotion regulation[3][5]. For some people, a combination of both may be beneficial as each addresses different aspects of emotional and cognitive functioning[4][5].

For example, CBT for challenging negative thoughts[3] and DBT skills for emotion regulation and distress tolerance[5]. This combined approach is good for people with complex mood disorders[4][5].

Conclusion

CBT and DBT are two great therapies for mood disorders, each with its own strengths and ways of working. CBT is about changing negative thought patterns to improve mood and DBT is about mindfulness, acceptance and emotional regulation. Both are helpful for depression, bipolar and other mood disorders.

The choice between CBT and DBT should be based on your individual symptoms, treatment goals and preferences. For some a combination of both may be the best treatment. As mental health treatment evolves these therapies are here to stay to help you feel better and recover.

Authored By

Shebna N Osanmoh I, PMHNP-BC

October 25, 2024

Shebna N Osanmoh is a board-certified Psychiatric Mental Health Nurse Practitioner with extensive experience across the mental health spectrum. Holding a Master’s in Psychiatric/Mental Health Nursing from Walden University, Shebna provides compassionate, culturally sensitive care for a wide range of mental health conditions, emphasizing holistic and individualized treatment approaches to support patients in their wellness journey.