Yes, you can do CBT and DBT at the same time. Many people combine them, especially when one therapy alone does not cover everything they are working on. The key is making sure your therapist or therapists know about both so the approaches can work together instead of pulling you in two directions.
What do CBT and DBT have in common?
Both Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are structured, skills based talk therapies. They both assume that thoughts, feelings, and behaviors are connected, and that changing one can shift the others. In both, you learn to notice what is happening in your mind and body, then practice responding differently.
They also share a practical, present focused style. You usually leave a session with something to try during the week, such as tracking a thought, completing a worksheet, or practicing a coping skill. Neither approach requires you to spend years exploring your past before anything changes.
Because they share this foundation, they can overlap without feeling like two completely different languages. That is one reason combining them is possible.
How are CBT and DBT different?
CBT tends to focus on identifying and challenging unhelpful thought patterns. For example, if you think “I always ruin everything,” CBT might help you examine the evidence, consider other explanations, and test a more balanced thought. It is widely used for anxiety, depression, and many other concerns. You can read more about how they compare in our guide to CBT vs DBT.
DBT was developed from CBT but places more emphasis on accepting yourself where you are while also working to change. It teaches skills in four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT often includes a group skills component and may involve phone coaching between sessions. It is most commonly associated with intense emotions, relationship difficulties, and patterns of self harm or suicidal thinking.
A simple way to think about it: CBT often asks “Is this thought accurate or helpful?” while DBT often asks “How can I ride out this feeling without making things worse?”
How can CBT and DBT complement each other?
Many people find that the two approaches fill different gaps. You might use CBT to work on a specific worry or belief, while using DBT skills to get through the moments when that worry becomes overwhelming.
Here is an everyday example. Suppose you are afraid of conflict. In CBT, you might identify the thought “If I say no, they will hate me,” examine where that belief comes from, and practice a more realistic alternative. In DBT, you might use a distress tolerance skill, like paced breathing or splashing cold water on your face, to calm your body enough to actually try the new behavior. You might also use an interpersonal effectiveness skill to phrase your “no” clearly and kindly.
In that way, CBT can help you change the thought, while DBT can help you survive the feeling that comes with testing it. They can operate as two parts of one plan.
What might it feel like to do both at the same time?
It can feel busy. You may have two sets of worksheets, two sets of vocabulary, and two sets of homework. One week you might be tracking cognitive distortions, and the next you might be practicing a mindfulness exercise from DBT. For some people this variety is energizing. For others it feels like too much to remember in the moment.
It can also feel confusing at first. A CBT therapist might encourage you to question a thought, while a DBT group might encourage you to observe the thought without judging it. These are not opposites, but they can sound that way. What helps is understanding the purpose behind each. Questioning a thought is for loosening its grip. Observing a thought is for stepping back from it. Both reduce the thought’s power, just through different routes.
What are the potential challenges of doing both?
The biggest challenge is coordination. If you are seeing two different providers, they may not know what the other is assigning. You can end up with overlapping homework, conflicting advice, or two treatment plans that do not quite line up.
Another challenge is cost and time. DBT in particular often involves individual therapy plus a weekly skills group. Adding CBT on top can mean multiple sessions per week, which is not realistic for everyone.
There is also the risk of doing too much at once. Therapy works best when you can practice skills between sessions. If you are drowning in handouts and acronyms, you may not practice anything deeply. A combined approach should make your life more manageable, not more complicated.
When is a combined approach recommended?
A combined approach may be worth considering when you have more than one goal, and one therapy does not address all of them. For example, you might be in DBT for intense emotions and self harm, but also want focused CBT for panic attacks or a specific phobia. Or you might be doing CBT for depression and find that you need DBT skills to cope with urges that come up when your mood drops.
It can also help when you have made progress in one therapy but feel stuck in a particular area. Some people complete a full DBT program and later add CBT to work on lingering beliefs. Others do CBT and add a DBT skills group because they need more support tolerating distress between sessions.
There is no rule that says you must choose one forever. Many people move between approaches over time. Doing both at once is just one option, not the only one.
What questions should you ask your therapist?
If you are thinking about doing both, start with a conversation. Useful questions include:
- Do you think combining CBT and DBT makes sense for what I am working on right now?
- Would it be better to do them at the same time, or one after the other?
- If I see another therapist for one approach, how will you coordinate with them?
- What would a typical week of homework look like if I did both?
- Are there specific skills from one approach that you think would support the other?
- What signs would tell us that doing both is too much?
A good therapist will be honest about what they can offer and what they cannot. Some are trained in both CBT and DBT and can blend them within a single treatment. Others specialize in one and may refer you to a colleague for the other.
What are the alternatives to doing both at the same time?
If doing both at once feels like too much, you have other options.
One is to choose a primary therapy and borrow skills from the other as needed. For example, you might do CBT as your main treatment and learn a few DBT distress tolerance skills for crisis moments. Many therapists do this informally even when they are not running a full DBT program.
Another option is sequencing. You might complete a DBT skills group first, then move into CBT once you feel more stable. Or do CBT first, then add DBT if you notice that emotional intensity keeps getting in the way.
You can also look for a therapist trained in both approaches. Some clinicians integrate CBT and DBT techniques in a single session, so you do not have to manage two separate treatments. This can feel smoother and less expensive than seeing two providers.
Whatever you choose, the goal is the same: a set of skills you can actually use when things get hard. If combining two therapies helps you do that, it is worth exploring. If it gets in the way, it is fine to slow down and focus on one thing at a time.
For more on what each therapy involves, see the National Institute of Mental Health’s overview of psychotherapies or the American Psychological Association’s definition of DBT. If you are unsure what kind of support you need, the NAMI HelpLine can point you toward local resources.