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If you've been diagnosed with BPD or have thoughts of self-harm, learn about borderline personality disorder treatment with dialectical behavior therapy (DBT).
Table of contents:
Key Facts:
It may be difficult to accept borderline personality disorder (BPD) as a possible diagnosis. However, if you struggle with any BPD symptoms or you've already been diagnosed, there is hope for management of the symptoms. BPD is characterized by:
Dialectical behavior therapy (DBT) is often considered the gold standard for the treatment of borderline personality disorder.
DBT is a type of talk therapy under cognitive behavioral therapy (CBT), which explores the relationship between beliefs, thoughts, and behaviors. "Dialectical" involves the integration of opposing ideas. DBT involves both acceptance and change, whereas CBT primarily focuses on change.
DBT was first developed in the 1970s by the American psychologist, Marsha Linehan, PhD. In her initial years of practice, Dr. Linehan attempted to apply standard CBT to patients with BPD and ran into issues with patients feeling invalidated by the need to change. Many patients with BPD have suffered harmful invalidation early in their lives, and traditional CBT caused them more pain.
Once realizing this, she created a specialized approach that alternates from acceptance to change, so patients feel that their emotions and experiences are valid, while at the same time exploring ways in which their thinking may be irrational.
For example, the feeling of being upset is valid, but any black-and-white thinking you have behind your feelings needs to be challenged. This process of alternating from the validation of feelings to the challenging of the thoughts behind them leads to improved emotional regulation.
There are four essential skills, or modules, taught in DBT, which are:
In addition to these four essential skills, DBT also incorporates:
Randomized controlled trials found that DBT is not only effective for BPD but also for other conditions like substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders. [1]
While DBT has proven benefits, finding a therapist trained in DBT can still be a challenge. To find a therapist locally, it's recommended that you ask family, friends, and other professionals for recommendations and referrals.
If you have limited or no behavioral health coverage, the barrier to receiving treatment can come down to cost. Fortunately, many therapists have successfully adapted DBT to make it available online through teletherapy, which is more convenient and often more affordable.
After an initial pre-assessment evaluation, the DBT treatment process is standardized by four components (modes):
Individual psychotherapy: You have weekly sessions with the therapist to discuss such topics as diary cards, application of learned skills, issues blocking progress, and effective coping skills.
Group skills training: Rather than operating like traditional group therapy where participants share, this setting functions more like a class with the therapist teaching you the four essential skills.
Telephone coaching: The therapist is available for you to call, usually during designated times, for short phone calls to answer questions or to help navigate a crisis.
Therapist consultation team: The therapist receives training and support from a consultation team.
If you have PTSD or another type of trauma, the therapist will integrate trauma work methods, such as exposure therapy, into your one-on-one sessions.
Because patients with BPD often engage in self-harm or struggle with suicidal ideation, therapists address these issues in weekly sessions and are available for telephone crisis calls. However, if you would benefit from it, pharmacotherapy is considered an important adjunctive role to help keep you out of crisis or to help with symptoms of psychosis, such as hearing voices or experiencing hallucinations.
In addition to psychotherapy, group skills learning, and telephone coaching, you'll find even more success if you include family and friends in your efforts in recovery. Explaining the concept of validation can help them understand your need for acceptance and support while also seeking to change destructive behaviors.
Seeking out others who are diagnosed with BPD or suffer from BPD symptoms in group therapy or online forums can help you connect and find support and encouragement on your journey to recovery.
Therapists need to be trained in DBT to effectively treat patients with BPD because invalidating communication can create strong emotional reactions and failed therapy. For example, if you're asked what you did before someone did something harmful to you, it can make you feel as though the therapist is implying that the harmful action was your fault.
Because of this, DBT needs to incorporate cultural sensitivity, depending on where it's being applied. Culturally-adapted DBT has been shown to be more effective than non-adapted DBT in certain situations. [2]
You don't have to live with unstable emotions that lead to destructive behavior and self-harm. If you feel lost and want a life worth living, you can find help for borderline personality disorder (BPD) through dialectical behavior therapy (DBT). Take control by seeking therapy for improvement of symptoms and recovery of BPD. Get help today.
