Which Therapy Is Right
for You – CBT, DBT, or ACT?
Syed Hammad Ali, VIMHANS Hospital, Delhi
Navigating Your Mental Health Journey
Introduction: Your
Therapy, Your Choice
Mental health isn’t
one-size-fits-all—just as a fever and a fracture needs different treatments,
anxiety, depression,
and trauma require tailored therapeutic approaches. At VIMHANS Delhi, we understand
that choosing between Cognitive Behavioural Therapy (CBT), Dialectical
Behaviour Therapy (DBT), and Acceptance and Commitment Therapy (ACT) can feel
overwhelming. This guide simplifies these options, helping you take the first
step toward healing. While stigma around mental health persists in Indian
society—where seeking help is sometimes mislabeled as
"weakness"—remember that prioritizing your well-being is an act of
courage. Delhi/NCR residents have unique resources like VIMHANS, ensuring
expert care is within reach.
What Is Cognitive
Behavioural Therapy (CBT)? Rewiring Your Thoughts How it works:
CBT helps you identify unhelpful thought patterns
that may be deepening your struggles. By examining how your thoughts, emotions,
and actions interact, you'll see difficult situations with new clarity and
respond in healthier ways. Imagine your mind is a garden. Negative thoughts
(e.g. “I’ll fail this exam”) are weeds. CBT helps you identify these weeds, replace them with healthy plants (e.g. “I can
prepare well”), and tend your garden regularly. It targets to solve current problems by changing
unhelpful thought patterns that worsen anxiety, depression, or other challenges to mental health.
What to expect:
● Session structure:
○ A typical cognitive therapy schedule consists of
about 15 visits over a three-month period.
● Tools used:
○ Cognitive techniques such as recognising and
correcting negative automatic thoughts,
○ Teaching reattribution techniques - recognizing
that multiple factors contribute to an event, not just personal responsibility,
○ Decentering - recognizing that thoughts and
feelings are not facts, but rather subjective experiences that can be observed and
processed without being immediately acted upon.
○ Identifying and testing maladaptive assumptions,
○ Behavioural techniques such as activity
scheduling, homework assignments, graded task assignment, behavioural rehearsal, role
playing, and diversion techniques.
Best for: Those struggling with negative thought
patterns seen in anxiety disorders, depression, phobias, or obsessive thoughts. People who prefer
practical, goal-oriented strategies gel well with CBT.
What Is Dialectical Behaviour Therapy (DBT)? Mastering
Emotional Storms
How it differs: While CBT focuses on challenging
unhelpful thought patterns, DBT teaches you to accept intense emotions while learning to control
reactions through mindfulness, distress tolerance and acceptance, and interpersonal skills.
Think of emotions as weather: You can’t stop a monsoon, but DBT gives you an umbrella
(coping skills) to walk through it without drowning. Originally designed for Borderline
Personality Disorder (BPD), it now helps those with self-harm urges, chronic suicidal thoughts, eating
disorders, or trauma.
What to expect:
● Session structure:
○ DBT sessions typically last 50-90 minutes.
However, the duration may vary depending on the program and individual needs.
● Core skills:
○ Mindfulness: Staying present during distress, just
observing your thoughts and feelings without judgement.
○ Distress tolerance: Learning healthy ways to cope
with intense emotions and urges without resorting to self-harm or other
destructive behaviors. (e.g., using ice on wrists to “shock” the nervous system).
○ Emotion regulation: Developing skills to manage
difficult emotions like anger, sadness, and fear in a healthy way.
○ Interpersonal effectiveness: Building stronger,
more fulfilling relationships by learning assertive communication and conflict
resolution skills.
Best for: Individuals with overwhelming emotions,
impulsive behaviour, or unstable relationships.
What Is Acceptance and Commitment Therapy (ACT)?
Finding Your Compass
How it works: ACT is an action-oriented approach to
psychotherapy that stems from traditional behavior therapy. Clients learn to stop avoiding,
denying, and struggling with their inner emotions and, instead, accept that these deeper
feelings are appropriate responses to certain situations that should not prevent them from moving
forward in their lives. With this understanding, clients begin to accept their
hardships and commit to making necessary changes in their behavior, regardless of what is
going on in their lives and how they feel about it. Picture yourself carrying a heavy backpack (painful
thoughts). ACT teaches you to unpack it, accept its weight, and still hike toward your goals
(e.g., family, career). It uses mindfulness and self-compassion to treat anxiety, depression,
substance use, chronic stress and pain, or trauma.
What to expect:
● Session structure: Weekly 50-minute sessions for
8–16 weeks.
● Tools used:
○ Acceptance: Rather than avoiding, denying, or
altering them, acceptance involves acknowledging and embracing the full range
of our thoughts and emotions.
○ Cognitive defusion: Distancing yourself from and
changing the way you react to distressing thoughts and feelings. This involves,
seeing thoughts as passing clouds, observing it without judgment, singing the
thought, and labeling the automatic response that you have.
○ Committed Action: Taking concrete steps to
incorporate changes that will align with our values and lead to positive change. This
may involve goal setting, exposure to difficult thoughts or experiences, and skill
development.
Best for: Those seeking purpose despite chronic
pain, stress, or low self-worth.
CBT vs DBT vs ACT: Which Fits You?
Core Philosophies:
Therapy Primary Goal View of Distress Key Metaphor CBT Restructure Thinking "Distorted thoughts create suffering."
Repairing a misaligned lens – Adjust how you see the world.
DBT Balance Acceptance and Change
"Inability to manage intense emotions causes chaos."
Building a lifeboat – Stay afloat in emotional storms.
ACT Live Fully Despite Pain
"Struggling against pain worsens it."
Carrying luggage lightly
– Keep walking towards your destination.
Key Differences:
● Relationship with Thoughts/Emotions:
○ CBT: Challenges Thoughts (“Is this worry
realistic?”)
○ DBT: Accepts emotions while changing reactions
(“My anger is valid but I won’t yell”)
○ ACT: Observes thoughts without fighting them (“I
notice that I’m having self-critical thoughts”)
● Focus Area:
○ CBT: Behavior (avoidance patterns) + Cognition
(self-critical thoughts).
○ DBT: Emotions (regulation) + Relationships
(interpersonal effectiveness).
○ ACT: Values (meaningful action) + Present-moment
awareness (mindfulness).
● Tools and Techniques:
○ CBT: Homework sheets, Socratic questioning.
○ DBT: Crisis survival skills (TIPP: Temperature, Intense
exercise, Paced breathing).
○ ACT: Metaphors ("Thoughts are like cars on a
highway - they come and go"), values compass exercises.
Where they overlap:
● Mindfulness: All three use it.
○ CBT: For detaching from thoughts.
○ DBT: For tolerating distress.
○ ACT: For connecting to the present.
● Behavioural Activation: CBT (scheduling
pleasurable activities) and ACT (committed action towards intrinsic values and goals).
● Cognitive Awareness: CBT (identifying distortions)
and ACT (cognitive defusion).
Matching Therapy to Symptoms & Personality:
Your Profile Likely Best Fit Why?
"I overthink everything." CBT Targets
rumination & catastrophic thinking directly.
"My emotions control me." DBT Builds
concrete skills for emotional tsunamis & impulsive urges.
"I feel stuck/lost." ACT Focuses on
purpose & action even when motivation is low.
"I need quick tools." CBT or ACT Both
offer practical strategies within weeks (vs. DBT’s longer skills training).
"I self-harm or have suicidal thoughts."
DBT Only therapy with specific protocols for life-threatening behaviors.
How VIMHANS Guides Your Therapy Choice in Delhi/NCR
Our specialists use structured assessments to map
your symptoms, goals, and lifestyle:
1. Expert evaluation: We utilize clinical interviews
and standardized tools to identify your needs.
2. Personalized plans: Tailored CBT/DBT/ACT
combinations aligned with your priorities.
3. Specialist access: We have a panel of highly
trained and qualified psychologists and psychiatrists trained across all three modalities.
Take the First Step Today
Choosing therapy is deeply personal—like finding
shoes that fit only your feet. At VIMHANS, we walk alongside you. Early intervention prevents
years of struggle; a single session can illuminate paths hidden by pain. Reach out: Your
mental health journey begins with one brave conversation. "You don’t have to see the whole staircase.
Just take the first step." — Martin Luther King Jr.
References
Beck, J. S. (2011). Cognitive behavior therapy:
Basics and beyond (2nd ed.). Guilford Press.
Carpenter, J. K., et al. (2018). Cognitive
behavioral therapy for anxiety disorders: A meta-analysis. Behaviour Research and Therapy, 104,
29–40.
https://doi.org/10.1016/j.brat.2018.02.002
Hayes, S. C., Strosahl, K. D., & Wilson, K. G.
(2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.).
Guilford Press.
Kelson, J., et al. (2023). Acceptance and commitment
therapy for anxiety and depression: An updated review. Clinical Psychology Review, 101,
102272. https://doi.org/10.1016/j.cpr.2023.102272
Linehan, M. M. (2014). DBT skills training manual
(2nd ed.). Guilford Press.
Ruiz, F. J. (2022). Acceptance and commitment
therapy versus cognitive behavioral therapy in the treatment of anxiety disorders: A systematic
review. Current Psychology. https://doi.org/10.1007/s12144-022-03706-7
Stoffers-Winterling, J. M., et al. (2022).
Dialectical behaviour therapy for borderline personality disorder. Cochrane Database of Systematic Reviews,
9(9), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2