CBT, DBT and REBT: Differences, Uses and Limits

Cognitive Behaviour Therapy (CBT), Dialectical Behaviour Therapy (DBT), and Rational Emotive Behaviour Therapy (REBT) are three of the most popular and effective therapeutic approaches used by psychologists and therapists today. While all of these cognitive therapies focus on our thoughts, feelings, and behaviours, their application has key differences. Understanding these differences, along with their respective uses and limits, can help individuals make informed choices about their mental health treatment.

Cognitive Behaviour Therapy (CBT)

CBT is an effective form of talk therapy developed by American psychiatrist Aaron Beck in the 1960s. It is based on the assumption that our thoughts, feelings and behaviours influence each other. Thus, CBT believes that changing one's thoughts and actions or behaviours can also lead to change in one's feelings. So, a CBT therapist often helps clients challenge unhelpful thought patterns and replace them with more helpful or realistic ones.

CBT aims to empower clients with practical tools to change their thinking and behaviours through cognitive restructuring, behavioural activation, gradual exposure and skills training. CBT's focus on practical skills and thought restructuring makes it an evidence-based, effective approach for treating various conditions such as anxiety, OCD, phobias and depression.

Key Techniques in CBT

• Cognitive Restructuring: This is the process of identifying and challenging irrational or unhelpful thinking patterns and replacing them with more realistic and helpful thoughts.
• Exposure: Sometimes, people might be gradually exposed to the situation or object they fear. This is particularly helpful in cases of anxiety, phobias and OCD.
• Behavioural Activation: This technique is particularly used in the treatment of depression and it involves deliberately encouraging people to engage in activities they enjoy or find meaningful so that their mood improves.
• Mood Tracking: This is a technique that helps people become more aware of how their thoughts impact their feelings.

Thus, CBT helps people not only to identify and change unhelpful thinking patterns, but it also encourages them to engage in positive activities that improve mood.

Rational Emotive Behaviour Therapy (REBT)

American psychologist Albert Ellis developed REBT in the 1950s. Much like CBT, REBT is also based on the principle that unwanted behaviours or feelings are often a result of unhelpful or flawed patterns of thinking. However, unlike CBT, which focuses on modifying thoughts, REBT goes deeper and explores irrational beliefs.

Irrational beliefs are unrealistic, rigid thinking patterns not based on facts or logic. Thus, REBT aims to help people identify these irrational beliefs and re-evaluate them to form more rational thinking patterns. Rational beliefs are generally based on reality and are likely to change over time as well.

REBT uses a technique called disputation to help clients challenge and modify their irrational beliefs. What makes REBT different from CBT is that it encourages unconditional Self-Acceptance, which helps clients to accept themselves as human beings with flaws and mistakes without harsh self-judgment. This self-acceptance is seen as crucial for developing healthy emotional responses and behaviours.

The ABC Model of REBT

Based on the assumption that we are generally unaware of the negative thoughts and irrational beliefs that affect us in daily life, Albert Ellis came up with three guiding principles of REBT that help explain how our thoughts, feelings and behaviours are connected. It is called the ABC model. The model consists of three components:

• Activating or Adverse Event (A): This refers to the external situation or event that triggers a negative emotional or behavioural response. It could be anything from having a minor disagreement to losing one's job.
• Beliefs (B): This refers to the thought or belief/interpretation we have about the activating event. It can be something along the lines of 'Other people never understand me' or 'I am the worst employee so I lost my job.' According to Ellis, irrational beliefs are generally rigid, and unrealistic.
• Consequence (C): The beliefs that people hold about the activating event will then lead to an emotional response. Irrational beliefs typically lead to unhealthy emotions such as anxiety, depression, or anger, and maladaptive behaviours such as avoidance or aggression.

By exploring the connection between our actions, thoughts and behaviours, REBT not only facilitates self-awareness but also empowers people to challenge their irrational beliefs and move towards change.

The Three Core Irrational Beliefs Of REBT

Albert Ellis identified three common irrational beliefs that lead to negative emotions, which he referred to as the "Three Basic Musts." These three 'musts' usually revolve around a demand or an expectation, either from ourselves, others, the environment or life in general. These are:

1. "I must do well and win the approval of others" or else I am not good enough.
2. "Others must treat me kindly, and meet my expectations" or else they may not be good or deserve punishment.
3. "Life must be easy, without discomfort or inconvenience, and I must always get what I want, or else I will be unhappy."

Strongly sticking to these 'musts' or irrational beliefs can cause feelings of inadequacy, resentment, and frustration when reality differs from these expectations. REBT encourages people to challenge these irrational beliefs and adopt more flexible, accepting attitudes towards themselves, others, and life as well.

REBT And Unconditional Acceptance

To help people overcome irrational beliefs, REBT encourages people to develop acceptance at three levels. They are:

1. Unconditional Self-Acceptance (USA): Involves accepting ourselves with all our flaws and strengths without any judgements.
2. Unconditional Other-Acceptance (UOA): This involves accepting others with their imperfections and not demanding perfection.
3. Unconditional Life-Acceptance (ULA): This involves accepting life with all its ups and downs without insisting on comfort or fairness.

Dialectical Behaviour Therapy (DBT)

DBT was developed by Marsha Linnehan, an American psychiatrist. Initially, it was designed to treat Borderline Personality Disorder (BPD) but now it is used to treat various other conditions such as anxiety and depression as well. In simple terms, dialectic means bringing together opposite ideas. Thus, DBT focuses on helping people integrate opposite ideas by encouraging self-acceptance and empowerment by teaching them emotional regulation skills.

Unlike CBT which focuses on changing one's thoughts, DBT is much more focused on dealing with one's emotions. Thus, DBT empowers clients by focusing on self-awareness and also teaches them emotional regulation skills to deal with difficult emotions.

Key Concepts of DBT

• Mindfulness: Encourages clients to be in the moment and observe their thoughts without judgement.
• Distress Tolerance: Involves building resilience to handle crises and cope with intense emotions in positive ways, such as through distraction, self-soothing, etc.
• Interpersonal Effectiveness: Encourages clients to build healthy communication skills to enhance interpersonal relationships.
• Emotional Regulation: Teaches clients skills to manage intense emotions through grounding and other activities.

Due to these skills, DBT is beneficial for people with borderline personality disorders, self-harm behaviours and people who experience emotional dysregulation.

How Do CBT, REBT, and DBT Differ?

Let's look at the differences between the three therapies through the table below:

Aspect	CBT	DBT	REBT
Focus	Focuses on changing negative thought patterns	Focuses on dealing with intense emotions	Focuses on dealing with irrational beliefs
Techniques	Cognitive Restructuring, exposure	Mindfulness, emotion regulation, distress tolerance	Disputation, Unconditional Self-Acceptance
Whom does it help?	People with anxiety, phobias, depression	People struggling with intense emotions	People struggling with unhelpful beliefs

Uses and Applications: Comparing CBT and DBT

While the table above provides a general overview, it's helpful to look more closely at how CBT and DBT compare when applied to specific conditions like anxiety and ADHD.

CBT vs DBT For Anxiety

Anxiety is a common mental health condition involving constant worry and other physical symptoms such as shortness of breath, raised heart rate, etc. Mental health professionals use various modalities or therapies in the treatment of anxiety. Although both CBT and DBT focus on reducing anxiety symptoms, they have key differences.

CBT Techniques for Anxiety

CBT is one of the most popular and evidence-based approaches to dealing with anxiety. What sets CBT apart from other approaches is its comprehensive focus on changing both thoughts and behaviours that might be causing anxiety. Some CBT techniques to deal with anxiety are:

• Identifying Patterns: The initial part of CBT treatment focuses on helping people identify thoughts or behaviours that might be contributing to their anxiety. This is done through worksheets.
• Thought Stopping: This technique involves teaching people the skills required to interrupt negative thought patterns.
• Cognitive Restructuring: This involves replacing or reframing negative or unhelpful anxiety-provoking thoughts and replacing them with more helpful ones.
• Exposure Therapy: Exposure therapy involves confronting anxiety-provoking situations while practising relaxation techniques and coping skills so that anxiety reduces over time.

DBT Techniques for Anxiety

Although there has been limited research on the effectiveness of DBT in anxiety treatment, it is effective in reducing anxiety symptoms. A few techniques used in DBT for anxiety are:

• Mindfulness: Mindfulness involves being in the present moment, accepting and observing one's thoughts, emotions, and bodily sensations without judgment. Mindfulness can help stop ruminating and worrying about the future, which are common in anxiety.
• Distress Tolerance: DBT focuses on teaching people to manage difficult emotions and situations effectively without engaging in unproductive or unhelpful behaviours. These skills can help manage anxiety-provoking situations effectively.
• Emotional Regulation: This skill involves teaching people to cope with intense emotions through healthier responses. This can help stop excessive suffering that comes from intense emotional experiences.
• Interpersonal Effectiveness: This involves learning effective communication skills, such as boundary setting, and conflict resolution strategies, which can help improve relationships and reduce social anxiety.

Which Is Better for Anxiety?

Various studies report that CBT is one of the most effective treatments for anxiety. A literature review from 2019 revealed that people who underwent CBT reported reduced anxiety symptoms even 12 months post-treatment. Another study in 2021 found that CBT can significantly reduce moderate and even severe anxiety symptoms.

There is also evidence to support the effectiveness of Dialectical Behavior Therapy (DBT) in reducing anxiety symptoms. A study involving 173 participants in 2016 found that DBT skills training led to a decrease in anxiety symptoms, among patients in a psychiatric hospital.

Thus, research suggests that both CBT and DBT can help with anxiety reduction. However, there is more evidence to suggest that CBT is effective for anxiety treatment as compared to DBT.

CBT vs DBT For ADHD

ADHD is one of the most common neurodevelopmental disorders, characterized by symptoms such as inattention, hyperactivity, and impulsivity. While medications are often used to treat ADHD, psychotherapeutic interventions like CBT and DBT have also been found to be effective in reducing ADHD symptoms.

How CBT Helps Treat ADHD

• Cognitive Restructuring: Experiencing a condition like ADHD can cause a lot of distress in one's daily life, leading to a lot of negative thoughts and a loss of confidence. CBT can help people with ADHD challenge these negative thoughts about themselves and replace them with more positive ones through cognitive restructuring.
• Skill Building: CBT not only works with thoughts but can also help people develop healthier habits with the help of skill-building. CBT teaches specific skills such as organization, time management, and problem-solving, which are crucial for people with ADHD as they are often likely to struggle with executive function.
• Successive Approximation: Successive approximation involves dividing a big task into smaller tasks and doing them in a step-by-step process. This skill can be very useful for someone with ADHD, as they are likely to feel overwhelmed by a big task.
• Behaviour Modification: This involves identifying unhelpful behaviours and replacing them with appropriate behaviours. It can be very useful in the treatment of ADHD to change impulsive behaviour.

How DBT Helps Treat ADHD

• Emotional Regulation: Experiencing ADHD can bring up a lot of distressing emotions, such as sadness, frustration, etc. Dysregulated emotions can make ADHD symptoms worse. Emotional regulation can help people with ADHD cope with intense emotions effectively. This can have other positive effects, such as increased self-care.
• Distress Tolerance: As mentioned earlier, ADHD can cause a lot of distressing emotions. Distressing emotions can lead to impulsive behaviours. DBT encourages people to learn healthier coping mechanisms by empowering them with distress tolerance skills.
• Mindfulness: DBT uses mindfulness exercises that promote awareness of thoughts, emotions, and sensations without judgment, helping people with ADHD improve focus and reduce impulsivity.
• Interpersonal Effectiveness: DBT teaches communication and interpersonal skills, which are valuable for navigating relationships and social interactions, areas that can be challenging for someone with ADHD.

Effectiveness of CBT and DBT for ADHD

There is a lot of evidence to suggest that CBT can be effective in treating ADHD. A 2016 study involving 46 teenagers on ADHD medication showed that CBT can significantly improve ADHD symptoms that may not respond well to medication alone.

Another 2018 review of 14 studies concluded that CBT, especially when combined with medication, was effective in reducing hyperactivity, inattention, impulsivity, anxiety, and depression, while also enhancing overall functioning compared to medication alone.

Research suggests that DBT can be an effective treatment for ADHD as well. A study conducted in 2011 on adults with ADHD found that DBT skills training can help reduce ADHD symptoms in a group of patients. Another study conducted in 2014 on college students found that DBT skills training given in group therapy form can help reduce symptoms of ADHD among college students.

Thus, research suggests that both DBT and CBT can be effective in treating ADHD. While CBT can help by challenging negative thoughts and skill-building, DBT can help people with ADHD cope with distressing emotions. Both these approaches come with their strengths, ultimately, the right approach depends on individual needs and preferences. Using a combination of the two approaches might be helpful as well.

Applying CBT: A Practical Example for Rumination

To illustrate how CBT works in practice, let's look at how it can be applied to address rumination. It's quite common to think about and reflect on situations that don't go well. It can help us learn and identify areas for improvement. But sometimes, our minds can become stuck on distressing and uncomfortable thoughts about our past or future. That's when it becomes rumination. If left unchecked, rumination can become a vicious cycle, leading to a lot of uncomfortable emotions or unhealthy coping mechanisms.

Rumination involves a persistent focus and repetition of negative thoughts, often revolving around past mistakes, anxieties about the future, or perceived shortcomings. This pattern of thinking can contribute to heightened stress, anxiety, and even depression. Rumination is typically triggered by a difficult situation, such as losing a job or arguing with a loved one. Additionally, rumination can also be caused by unresolved trauma from the past, low self-esteem or mental health conditions such as anxiety or OCD.

CBT-Based Techniques To Overcome Rumination

• Identifying Negative Thought Patterns: The first step in cognitive therapy is to identify the negative thoughts or unhealthy behaviours that might be contributing to the rumination. This requires individuals to observe themselves for some time and become aware of the thought patterns and triggers behind rumination. Individuals can become more aware of their thoughts and triggers by recording their thoughts in a journal, which makes it a commonly recommended tool in CBT.

• Challenging Negative Thoughts: The second and one of the most important steps involves challenging negative thoughts that are the focus of rumination. This can be done by asking yourself reflective questions and considering alternative, healthier ways of thinking. Some examples of reflective questions are:

  • Is it a fact or just a thought?
  • Is there any other way to think about the situation?
  • How is this thought helping me?
  • What changes will I see if I can let go of this thought?

• Cognitive Restructuring: Cognitive restructuring involves replacing negative thoughts with more positive and realistic ones. By consciously shifting focus to alternative perspectives, individuals can gradually rewire their thinking patterns. Thus, even though one cannot stop thinking, one can reduce rumination by replacing negative thoughts with realistic ones.

• Schedule Your Worry Time: CBT often encourages people to keep a slot in their day designated for their worries or ruminating thoughts. This can be done by setting 10-15 minutes aside to write ruminating thoughts before going to bed. Individuals are also encouraged to postpone their worries if they occur outside the scheduled 'worry time'.

• Consider Costs and Benefits: Sometimes people might feel that rumination helps with reflection and problem-solving, but in reality, it only leads to frustration and stuckness. By recognizing the negative impact and limited benefits, individuals can encourage themselves to reduce rumination, leading to increased mental and physical well-being.

• Distraction: Sometimes, distracting yourself from ruminating thoughts can help break the cycle, allowing you to refocus on more important tasks. Distraction can be anything healthy that helps you cope, like talking to a friend, listening to music, or engaging in a hobby.

The Limits of CBT: When CBT May Not Be Effective

While CBT has demonstrated efficacy in treating various mental health conditions, it also has its limitations. Two notable areas where CBT may fall short are in the treatment of trauma and ADHD.

Why CBT May Not Work With Trauma

Trauma is a complex emotional response to a distressing event such as an accident, a natural disaster, or abuse. However, a person may experience trauma as a response to any event that is physically or emotionally threatening. Trauma can lead to immediate responses such as shock or denial and even long-term responses such as flashbacks, nightmares, and unpredictable emotions. Most people tend to experience an event in their lives that could be considered traumatic, but the impact of trauma differs for every individual.

Trauma not only impacts people psychologically, but it can also impact the brain and the body. Research suggests that experiencing trauma can impair or reduce the brain's ability to differentiate between threatening and non-threatening situations, leading a person to feel unsafe or anxious most of the time.

When someone feels anxious, the brain's prefrontal cortex, which is responsible for logical thinking or regulating thoughts and emotions, functions in a limited capacity, leading the individual to feel emotionally and physically overwhelmed or dysregulated.

Trauma is frequently stored in the body as emotions and physical sensations; therefore, addressing physical symptoms is just as important as dealing with psychological symptoms to facilitate recovery. While CBT can help address the negative thoughts related to the traumatic event, it may completely ignore the trauma's bodily symptoms.

Many trauma therapists believe that bodily symptoms of trauma need to be addressed first before moving on to the thoughts related to it, as primary trauma exists within the body and not only in thoughts. Thus, CBT might not work with trauma because it relies heavily on an individual's thinking, whereas trauma causes physical and emotional dysregulation, which limits an individual's capacity for logical thinking. Also, many times, trauma can cause negative thinking and unhealthy behaviours. In such cases, addressing negative thinking solves only a surface-level issue, but the root cause of trauma may remain unaddressed.

While CBT may not be the most effective approach for addressing trauma, other approaches such as Eye Movement Desensitization and Reprocessing (EMDR), somatic therapy and Narrative Therapy can help address the root causes of trauma and thus facilitate holistic healing. Specialized trauma-focused therapies, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), and various somatic approaches, have been specifically developed to address the unique challenges of trauma.

Why CBT May Not Work For ADHD

ADHD is a challenging, neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that significantly impact daily functioning. It is usually diagnosed in childhood, but its symptoms can continue in adulthood as well. People with ADHD have differences in their brain activity and development, which leads to challenges such as difficulty paying attention, difficulties sitting still and struggles with self-control and impulsivity.

Managing ADHD can be overwhelming, as it affects almost all areas of a person's life, from academics to relationships. Due to its overwhelming nature, people with ADHD can struggle with other conditions, such as anxiety and depression.

While CBT has been very effective in the treatment of depression and anxiety, it may not be effective with ADHD due to the following reasons:

• CBT Can Be Overwhelming: As mentioned earlier, CBT focuses on changing one's thinking. Thus, people are required to keep track of their thoughts and emotions during and outside of therapy sessions. Talking and keeping track of one's feelings might be overwhelming for someone who is already struggling with attention and organization issues, making CBT ineffective.

• CBT and Invalidation: Coping with ADHD can be overwhelming and thus, it creates a lot of feelings of shame, guilt, etc. Thus, addressing these feelings is an integral part of the treatment. However, due to its intense focus on changing thoughts, some people may find CBT very invalidating.

• Homework Assignments: CBT puts a lot of emphasis on homework between sessions. However, people with ADHD may struggle with homework assignments due to their difficulties. In such cases, homework may become an additional source of stress and may even trigger feelings of shame if they aren't able to start or finish it.

• CBT and Childhood ADHD: CBT is ineffective in addressing ADHD symptoms in childhood, as children may lack the necessary level of insight and thinking required for CBT.

Thus, CBT may not be effective in the treatment of ADHD due to its heavy focus on changing thoughts. However, this does not mean that CBT is completely ineffective in the treatment of ADHD. Research suggests that CBT can help treat ADHD in various ways, such as:

• It can help improve procrastination and increase productivity, which are major challenges in ADHD.
• It can help improve self-esteem by encouraging people to build a positive and realistic view of themselves.
• It can help address other mental health conditions, such as anxiety and depression if they coexist with ADHD.

Apart from CBT, alternative treatments such as social skills training, family therapy and Dialectical Behaviour Therapy have been effective in the treatment of ADHD.

Beyond Traditional CBT: Inference-Based Cognitive Behaviour Therapy (I-CBT)

Traditional CBT has undergone significant changes, leading to the development of various other CBT-based psychotherapy approaches. One such new and unique approach is Inference Based Cognitive Behaviour Therapy (I-CBT).

I-CBT is a comparatively newer form of CBT specifically designed to treat OCD. Unlike traditional CBT, which focuses on identifying and challenging intrusive thoughts, I-CBT goes deeper and looks at the origin or the reasons for obsessions or intrusive thoughts. So, ICBT focuses on helping people identify and correct faulty thought processes that are contributing to their obsessions.

According to ICBT, obsessions emerge when people are confused between possibility and actual real-life evidence. This confusion between imagined possibility and reality is known as inferential confusion. Thus, ICBT focuses on helping people resolve dysfunctional thought processes that are the basis of their obsessions.

Key Techniques of ICBT

• Identifying OCD-related obsessions
• Understanding the process by which doubts are formed
• Interrupting doubt sequences before they are formed
• Challenging negative inferences by comparing them against reality
• Using the five senses to be in touch with reality

Thus, ICBT helps people with OCD by targeting the root cause of their obsessions and compulsions—inferential confusion. By correcting the faulty reasoning process, people can reduce the frequency and intensity of their obsessions and compulsions.

How CBT and ICBT Differ

Aspect	CBT	ICBT
View Of Obsessions	CBT believes that obsessions are caused by misinterpretation of common intrusive thoughts	ICBT believes that intrusive thoughts are caused by faulty reasoning patterns
Aim	CBT aims to change the content of intrusive thoughts	ICBT aims to change the faulty thought process that leads to obsessions
Exposure	May involve exposure to anxiety-provoking stimuli, depending on the situation	It is cognitive in nature without requiring any exposure to anxiety-provoking stimuli
Application	CBT can be used to treat various conditions, such as anxiety, depression and OCD	ICBT is specifically used only in the treatment of OCD. Its application to other conditions is yet to be tested

Both traditional CBT and ICBT are effective treatments, especially when it comes to treating OCD. However, the best approach depends on a person's unique needs and comfort. While traditional CBT is applicable across various conditions, ICBT is only beneficial in the treatment of OCD, making traditional CBT a much more comprehensive approach among the two.

Conclusion

CBT, REBT, and DBT are all effective therapeutic approaches with unique strengths. While CBT focuses on changing negative thought patterns through practical tools and skills, REBT goes deeper to challenge irrational beliefs and encourages unconditional acceptance, and DBT helps individuals manage intense emotions through mindfulness and emotional regulation skills. Each approach has its uses—CBT is broadly applicable to anxiety, depression, OCD, and phobias; REBT is particularly helpful for those struggling with rigid, unhelpful beliefs; and DBT is especially beneficial for those dealing with emotional dysregulation, borderline personality disorder, and self-harm behaviours.

However, these therapies also have their limits. CBT may not be the most effective approach for trauma or ADHD due to its heavy reliance on thinking and homework. In such cases, alternative or complementary approaches like EMDR, somatic therapy, DBT, or even newer variants like I-CBT for OCD may be more appropriate. The best approach ultimately depends on a person's needs and therapeutic goals. In some cases, therapists might adapt elements from all three therapies to make a comprehensive and holistic treatment plan. Ultimately, all three therapies provide effective relief and help to individuals.

References

Aardema, F. (n.d.). What is I-CBT? Inference-Based Cognitive-Behavorial Therapy. Retrieved June 20, 2024, from https://icbt.online/what-is-icbt/

Alternatives to CBT for Neurodivergent Clients. (n.d.). Autism Understanding | Clinical Psychologists | Assessments Newcastle. Retrieved February 19, 2024, from https://www.autismunderstanding.com.au/blog/alternatives-to-cbt-for-neurodivergent

Camilleri, J. (2021, November 20). Why CBT Doesn't Work for Trauma & PTSD? Tips By A Therapist. Therapy Hunter. https://therapyhunter.com/why-cbt-doesnt-work-for-trauma

CBT for ADHD: How It Works, Examples & Effectiveness. (n.d.). Choosing Therapy. Retrieved March 15, 2024, from https://www.choosingtherapy.com/cbt-for-adhd/

CBT for Anxiety: How It Works & Examples. (n.d.). Choosing Therapy. Retrieved March 14, 2024, from https://www.choosingtherapy.com/cbt-for-anxiety/

CBT for OCD: How It Works, Examples & Effectiveness. (n.d.). ChoosingTherapy.Com. Retrieved June 20, 2024, from https://www.choosingtherapy.com/cbt-for-ocd/

CBT vs. DBT: What's The Difference? (2016, May 17). Psych Central. https://psychcentral.com/lib/whats-the-difference-between-cbt-and-dbt

Cognitive Behavioral Therapy for ADHD: How can it help? (2022, February 21). Psych Central. https://psychcentral.com/adhd/cbt-for-adhd

DBT for Anxiety: 4 DBT Techniques to Cope With Anxiety. (n.d.). Choosing Therapy. Retrieved March 14, 2024, from https://www.choosingtherapy.com/dbt-for-anxiety/

DBT for Attention Deficit Hyperactivity Disorder (ADHD). (n.d.). Guidepost DBT. Retrieved March 15, 2024, from https://guidepostdbt.com/dbt-for-attention-deficit-hyperactivity-disorder

DBT Vs. CBT: Understanding the Differences. (n.d.). ChoosingTherapy.Com. Retrieved January 15, 2025, from https://www.choosingtherapy.com/dbt-vs-cbt/

Does cognitive behavioral therapy (CBT) work for ADHD adults? (n.d.). Retrieved February 19, 2024, from https://www.getinflow.io/post/cbt-adhd-cognitive-behavioral-therapy-for-adhd

Fleming, A. P., McMahon, R. J., Moran, L. R., Peterson, A. P., & Dreessen, A. (2015). Pilot Randomized Controlled Trial of Dialectical Behavior Therapy Group Skills Training for ADHD Among College Students. Journal of Attention Disorders, 19(3), 260–271. https://doi.org/10.1177/1087054714535951

Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., Johnson, A., Rück, J., Wiwe, C., Bothén, P., & Nordström, A.-L. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training group: Results from a randomized controlled trial. Behaviour Research and Therapy, 49(3), 175–185. https://doi.org/10.1016/j.brat.2011.01.001

How Cognitive Behavioral Therapy Can Help Manage ADHD. (2021, October 7). Healthline. https://www.healthline.com/health/adhd/cbt-for-adhd

How Dialectical Behavior Therapy (DBT) Works. (n.d.). Verywell Mind. Retrieved January 15, 2025, from https://www.verywellmind.com/dialectical-behavior-therapy-1067402

How Does PTSD Affect the Brain? The Physical Effects of Trauma. (2015, September 16). Psych Central. https://psychcentral.com/ptsd/the-science-behind-ptsd-symptoms-how-trauma-changes-the-brain

How To Stop Ruminating. (2023, March 14). Therapy Central. https://therapy-central.com/2023/03/14/how-to-stop-ruminating/

How to Stop Ruminating: 12 Tips to Stop Repetitive Thoughts. (n.d.). Retrieved December 29, 2023, from https://www.healthline.com/health/how-to-stop-ruminating

I-CBT for Overcoming OCD: What You Need to Know—Weston Family Psychology. (n.d.). Retrieved June 20, 2024, from https://westonfamilypsychology.com/blog/i-cbt-for-overcoming-ocd-what-you-need-to-know/

Inference-Based CBT (I-CBT): How it Works, Examples, & Effectiveness. (n.d.). ChoosingTherapy.Com. Retrieved June 20, 2024, from https://www.choosingtherapy.com/icbt/

Kaushal, S. (2023, November 26). Why CBT Isn't Always an Effective Approach For Trauma And PTSD. Calm Sage – Your Guide to Mental and Emotional Well-Being. https://www.calmsage.com/why-cbt-doesnt-work-for-trauma/

Rational Emotive Behavior Therapy: Principles, Techniques, Efficacy. (2018, September 13). Healthline. https://www.healthline.com/health/rational-emotive-behavior-therapy

Rational Emotive Behavioral Therapy (REBT). (n.d.). Retrieved March 15, 2024, from https://www.goodtherapy.org/learn-about-therapy/types/rational-emotive-behavioral-therapy

REBT Vs. CBT: Understanding the Differences. (n.d.). ChoosingTherapy.Com. Retrieved January 15, 2025, from https://www.choosingtherapy.com/rebt-vs-cbt/

Stop Ruminating – Simple Steps You Can Take to Short-Circuit the Cycle of Depression. (2014, July 25). Cognitive Behavioral Therapy Los Angeles. https://cogbtherapy.com/cbt-blog/stop-ruminating-and-end-depression

Ways to Stop Ruminating | Stop Rumination | Repetitive Thoughts. (n.d.). Cognitive Behavioral Therapy Los Angeles. Retrieved December 29, 2023, from https://cogbtherapy.com/stop-ruminating

What is trauma? (n.d.). Retrieved January 2, 2024, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/trauma/about-trauma/

What Is Rational Emotive Behavior Therapy (REBT)? (n.d.). Verywell Mind. Retrieved March 15, 2024, from https://www.verywellmind.com/rational-emotive-behavior-therapy-2796000

Why is CBT inappropriate for trauma survivors? (n.d.). Trauma Aware America. Retrieved January 2, 2024, from https://traumaawareamerica.org/is-cbt-appropriate-for-trauma-survivors/