Dialectical Behavior Therapy for Borderline Personality Disorder
In spite of what some people intimate, I do endorse non-drug solutions and one of the best adjunct treatments to medications is psychotherapy. Many types of therapy can work for different people, but one current and research-backed therapy is dialectical behavior therapy (DBT).
Now, don’t let the big words scare you – this is not a scary therapy. This is simply a therapy that uses reason to integrate and synthesize opposite points of view. Meaning, the techniques taught are designed to find a balance in emotion, behavior and acceptance.
Dialectical behavior therapy was designed specifically to treat borderline personality disorder; however, it has shown usefulness in mood disorders and research is currently underway to see if DBT techniques are also useful in other disorders. This therapy represents a huge breakthrough as the first indicated treatment of borderline personality disorder.
What Does Dialectical Behavior Therapy (DBT) Teach?
Dialectical behavior therapy is more about teaching and doing than it is about talking. It is simply not talk-therapy.
Dialectical behavior therapy teaches:
- Mindfullness – involves non-judgementally observing and describing the self and the environment. Involves being fully “present,” in the moment and participating in the activities and world around you.
- Distress tolerance – involves accepting and minding meaning in distress rather than focussing on changing the stressful environment. Involves self-soothing techniques.
- Emotion regulation – involves learning to maintain and regulate emotions; becoming less reactive to the situations around you.
- Interpersonal effectiveness – involves learning how to effectively interact with others to obtain needs, say no and handle interpersonal conflict.
Other techniques such as self-management may also be added to the DBT teachings. It is often done in a group therapy setting.
What is Dialectical Behavior Therapy (DBT) Like?
Now, I admit, I have not had DBT, so I am not speaking from personal experience, but I have talked to local DBT experts who run a four-stage DBT program specifically for borderline personality disorder, and it looks like this:
Stage 1 of DBT
- Decreasing or eliminating self-injurious behaviors
- Decreasing or eliminating behaviors that interfere with therapy
- Reducing or eliminating hospitalization as a way of dealing with distress
- Decreasing behaviors that interfere with quality of life
- Increasing behaviors that enable a person to have a life worth living
- Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with life problems
Stage 2 of DBT
- Decreasing post-traumatic stress
Stage 3 of DBT
- Increasing self-respect
- Setting individual goals
- Solving life problems
Stage 4 of DBT
- Developing the capacity for freedom and joy
Does Dialectical Behavior Therapy (DBT) Work?
That depends on who you ask, but the research says yes, it works.
In randomized clinical trials, DBT was more effective than usual treatment in reducing suicidal and self-injurious behaviors, treatment dropout, hospitalizations, and self-reports of anger and anxious ruminations.Increased rates of global adjustment were observed after one year of treatment, and these gains were maintained over the subsequent year.
Dialectical Behavior Therapy (DBT) and Self-Harming Behaviors
Because many people with borderline personality disorder have self-injurious behaviors, dialectical behavior therapy has developed specific techniques for handling this behavior. I have been asked about these techniques repeatedly and will go into them next time.
Dialectical Behavior Therapy (DBT) Resources
You may not be able to find a therapist who specializes in DBT in your area. This is too bad considering how effective it is. Do not give up; however, as books, workbooks and online resources can walk you through DBT. Here are some DBT book resources:
- Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan
- Sometimes I Act Crazy: Living with Borderline Personality Disorder by Jerold J. Kreisman, MD and Hal Straus
- Stop Walking on Eggshells; Coping When Someone You Care about Has Borderline Personality Disorder by Paul T. Mason and Randi Kregor
- Cutting: Understanding and Overcoming Self-Mutilation by Steven Levenkron
- The High-Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Validation and Intimacy by Alan Fruzzetti
- Surviving a Borderline Parent – How to Heal You Childhood Woulds and Build Turst, Boundaries and Self-Esteem by Kimberlee Roth and Freda B. Friedman
DBT article resources:
- Dialectical Behavioral Therapy: Current Indications and Unique Elements (free article)
- Dialectical Behavior Therapy: Current Status, Recent Developments and Future Directions
- Dialectical Behavior Therapy for Borderline Personality Disorder
DBT and borderline personality disorder website resources:
- Behavioral Tech
- DBT Self-Help
- Treatment and Research Advancements National Association of Personality Disorders (TARA)
- Borderline Personality Disorder Resource Center
- Priory Medical Journals
Note: resources provided by local DBT group and not personally endorsed.