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Dialectical Behavior Therapy for Borderline Personality Disorder

Updated: Dec 16, 2023

Dialectical Behavior Therapy (DBT) is considered the most effective treatment for Borderline Personality Disorder (BPD). DBT is a comprehensive and evidence-based psychotherapy approach specifically designed to help individuals struggling with BPD. The therapy includes mindfulness practices to assist BPD individuals in regulating their emotions, improving interpersonal relationships, and developing coping strategies for managing distressing situations.

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In this article, we'll discuss how Dialectical Behavior Therapy (DBT) proves to be beneficial in treating BPD. We will also explore the specific techniques used by DBT for addressing BPD, and consider whether it can ultimately lead to a complete cure for BPD.

What Kind of Therapy is DBT?

DBT is a type of psychotherapy that falls under the umbrella of cognitive-behavioral therapies. It focuses on building four essential skill sets: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills empower individuals to navigate emotional challenges, cope with distress, and foster healthier relationships.

Why is DBT Used for treating BPD?

Dr. Marsha M. Linehan developed Dialectical Behavior Therapy in the 1980s, leveraging her personal experience with Borderline Personality Disorder (BPD) to create an approach that uniquely addresses the challenges associated with this condition. The therapy combines cognitive-behavioral techniques with mindfulness and acceptance strategies, providing patients with essential skills to manage their emotions and behaviors effectively.

DBT has proven to be beneficial for a wide range of BPD presentations, from mild to severe. The structured nature of DBT, along with its emphasis on skill-building and emotional regulation, aligns well with the needs of individuals struggling with BPD, making it a favored therapeutic approach in their treatment. The nature of DBT allows it to be tailored to the specific needs of each BPD individual regardless of the age group.

Effective DBT Techniques

DBT offers a range of techniques to help individuals with BPD develop coping skills, regulate emotions, and improve interpersonal relationships. Here are some of the DBT techniques commonly used for BPD:

1. Mindfulness Skills DBT places a strong emphasis on mindfulness, helping individuals stay present in the moment and develop a greater awareness of their thoughts and emotions.

Observing: Paying attention to the present moment without judgment. This involves noticing sensations, emotions, and thoughts without trying to change them.

Describing: Putting words to experiences. This helps in clarifying and articulating what one is observing.

Participating: Fully engaging in the present moment and being involved in what is happening.

2. Distress Tolerance DBT teaches distress tolerance skills, allowing individuals to cope with high-stress situations without resorting to harmful behaviors. These include engaging in activities or behaviors that provide temporary relief from distress, which includes activities like contributing, comparing, opposing emotions, pushing away, self-soothing, and activities such as taking a warm bath, listening to calming music, or practicing deep breathing exercises.

3. Emotion Regulation Identifying and Labeling Emotions: Recognizing and naming specific emotions. This helps in gaining clarity about what one is feeling.

Opposite Action: Acting in a way that is opposite to the emotional urge, particularly when the emotion is intense and not in line with the situation.

Checking the Facts: Evaluating whether the intensity of the emotion matches the facts of the situation.

4. Interpersonal Effectiveness A set of strategies for asserting oneself and communicating effectively. It includes “DEARMAN” which stands for Describe, Express, Assert, Reinforce, Stay Mindful, Appear Confident, and Negotiate. This technique encourages BPD individuals to maintain healthy relationships by being gentle, interested, validating, setting boundaries, and resolving conflicts.

5. Balancing Rational and Emotional Mind This involves finding a middle ground between logic and emotions and making decisions that are both reasonable and emotionally satisfying.

6. Non-Judgmental Stance

Practicing acceptance and refraining from labeling experiences or emotions as good or bad. This helps reduce self-criticism and judgment.

7. Radical Acceptance Fully accepting reality as it is, even when it's painful or difficult. This helps in reducing resistance to what cannot be changed. For individuals with BPD, who may experience moments of confusion between dreams and reality, Radical Acceptance serves as a grounding tool, providing stability during emotional chaos.

8. Building Mastery Through this structured process, individuals are guided to identify realistic, attainable goals aligning with their interests, values, and aspirations. These objectives serve as stepping stones, allowing individuals to experience a steady progression of successes, ultimately enhancing their overall sense of competence, confidence, and self-assurance.

9. ABC PLEASE A set of self-soothing behaviors to maintain emotional stability. It stands for Accumulating positive emotions, building mastery, coping ahead, treating Physical illness, balanced Eating, Avoiding mood-altering substances, getting regular exercise, and getting regular sleep.

These techniques are typically taught and practiced in individual DBT therapy sessions and skills training groups. Consistent application of these skills can lead to significant improvements in emotional regulation, interpersonal effectiveness, and overall quality of life for individuals with BPD.

What is the DBT program?

A DBT program is a structured and comprehensive therapeutic approach designed to help individuals develop skills for emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness.

It typically involves:

Individual Therapy: In DBT, individuals meet one-on-one with a therapist for individual therapy sessions. During these sessions, the therapist and client work together to set goals, address specific challenges, and develop personalized strategies for applying DBT skills in their daily life.

Group Skills Training: This component involves attending regular group sessions led by a trained DBT therapist. These sessions focus on teaching and practicing the specific skills outlined in the four main modules of DBT: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.

Phone Coaching: Many DBT programs offer phone coaching as a way for individuals to receive support and guidance between therapy sessions. This allows clients to reach out to their therapist for assistance in applying DBT skills during moments of crisis or distress.

Consultation Team: DBT therapists typically participate in consultation teams, where they meet with other DBT therapists to discuss cases and receive ongoing training and support. This helps ensure that therapists are providing high-quality, consistent DBT treatment.

Homework Assignments: Individuals participating in a DBT program are often given homework assignments to practice and reinforce the skills they learn in therapy and group sessions. This helps to integrate the skills into their daily life.

Duration and Structure: The duration of a DBT program can vary widely depending on the individual's needs and progress. It typically involves a commitment to regular therapy and group sessions over an extended period, often ranging from several months to a year or more.

Tailored Approach: A key feature of DBT is its adaptability. Therapists work closely with clients to tailor the treatment to their specific needs and circumstances, ensuring that the skills and techniques are relevant and effective for each individual.

Targeted Goals: The overarching goal of a DBT program is to help individuals build a life worth living. This may involve reducing self-destructive behaviors, improving emotional regulation, enhancing relationships, and increasing overall life satisfaction.

Is DBT available online?

Yes, DBT is available online. With the advancement of technology and the increasing demand for remote mental health services, many therapists and mental health providers now offer DBT therapy through secure video conferencing platforms, phone calls, or even messaging and chat-based platforms. This allows individuals to access DBT treatment from the comfort of their own homes or any location with internet access. It's important to ensure that any online DBT therapy is provided by a qualified and licensed mental health professional who is experienced in delivering DBT treatment.

How effective is DBT for BPD?

Numerous research studies and clinical trials have shown that DBT can lead to significant improvements in various aspects of BPD, including emotional regulation, interpersonal relationships, and overall quality of life.

Here are some key points highlighting the effectiveness of DBT for BPD:

Reduction in Suicidal Behaviors: One of the most notable achievements of DBT is its success in reducing suicidal behaviors among individuals with BPD. Research has shown that DBT significantly lowers the rates of suicide attempts and self-harm incidents.

Improved Emotional Regulation: DBT equips individuals with practical skills to identify, understand, and regulate their emotions. This leads to a decrease in intense mood swings, impulsivity, and emotional instability commonly associated with BPD, leading to the maintenance of healthy relationships with family, friends, and love interests.

Improved Overall Quality of Life: Studies have shown that individuals who engage in DBT experience a significant increase in their overall quality of life. This includes various aspects such as psychological well-being, social functioning, reducing posttraumatic stress responses related to previous traumatic events, increasing self-respect, and meeting other goals.

Applicability across Age Groups: DBT has been found effective for a wide range of age groups, including adolescents, adults, and older individuals. The skills taught in DBT are adaptable and applicable throughout the lifespan.

It's important to note that individual responses to therapy can vary, and the effectiveness of DBT may be influenced by factors such as the severity of BPD symptoms, the presence of co-occurring disorders, and the level of commitment to treatment.

Can DBT Fully Cure BPD? While DBT is an incredibly effective treatment for BPD, it's important to understand that BPD, like many mental health conditions, may not have a definitive "cure" in the traditional sense. Instead, DBT equips individuals with valuable skills to manage their symptoms, regulate emotions, and build healthier relationships. With consistent practice and ongoing support, individuals can experience significant improvements in their quality of life. Through commitment and perseverance, BPD individuals can unlock a brighter, more balanced future.

How long does DBT take to treat BPD?

Research indicates that significant improvements can be observed within a few months of consistent DBT practice. However, it's important to note that progress is a gradual process and long-term commitment to therapy is often necessary to sustain positive outcomes.

In conclusion, DBT is widely recognized as one of the most effective treatments for BPD, providing individuals with practical skills to lead more balanced, fulfilling lives. However, individuals must consult with mental health professionals to determine the most appropriate treatment plan for their specific needs.


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