Treating BPD With Cognitive Behavioral Therapy

Cognitive-behavioral treatments are the cornerstone of therapy for people with borderline personality disorder. Different types of cognitive-behavioral therapy, including two unique types that are used to help those specifically with BPD, can help people adopt healthy coping skills and achieve a good quality of life.

What Is Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy (CBT) is a type of psychotherapy that targets the “cognitive” (thinking-related) and “behavioral” (action-related) aspects of a mental health condition.

What to Expect From Cognitive-Behavioral Therapy

CBT is very focused on the present, meaning that you do very little talking about your past. While you may talk to your therapist about how you came to think or behave the way you do, most of the therapy is focused on how your current ways of thinking/acting are related to your symptoms, and how to change these patterns.

CBT is also fairly directive, meaning that your therapist will often take an active role in your therapy session, giving you direct advice and guidance.

Because cognitive behavioral therapists operate under the assumption that your symptoms are in part related to patterns of thinking and behaving that you have learned over the course of many years, they believe that one or two hours of therapy each week will not produce any major change.

For this reason, most CBT therapists assign homework—they want you to work to change the patterns outside of the therapy session. So don’t be surprised if you leave your CBT therapy session with handouts to read and homework sheets to complete.

CBT for BPD

While the basic principles of CBT can be helpful for people with borderline personality disorder (BPD), some experts have noted that the disorder requires specialized CBT techniques. Two unique cognitive-behavioral therapies that have been designed specifically for BPD are:

• Dialectical Behavior Therapy
• Schema-Focused Therapy

Both dialectical behavior therapy (DBT) and schema-focused therapy have been shown to be effective in reducing BPD symptoms. DBT consists of both individual and group therapy sessions, as well as phone coaching sessions, where a person with BPD focuses on behavioral skills like:

• Achieving mindfulness—paying attention to the present or living in the moment
• Regulating emotions
• Tolerating distress or conflict
• Navigating relationships with other people
• Achieving motivation to avoid unhealthy coping skills, like self-harm

Schema-focused therapy is based on the idea that personality disorders like BPD develop as a result of maladaptive thoughts or behaviors early on in life. People then develop unhealthy coping skills, like avoidance, to avoid triggering those thoughts or behaviors.

Schema-focused therapy is not like traditional cognitive-behavioral therapy in that it's more flexible and attuned to a person's emotions. It also requires a longer treatment period, ranging from one to four years.

Finding a Cognitive Behavioral Therapist

While CBT has been around for decades, it can be difficult to find a therapist who has been trained in this approach. If you are interested in finding a CBT therapist in your area, try the Association for Behavioral and Cognitive Therapy’s Find-a-Therapist Directory.

If you are interested in finding a Dialectical Behavior therapist, try the Behavioral Tech Clinical Resources Directory. It's also a good idea to speak with your primary doctor or psychiatrist for a referral to ensure this is the right treatment plan for you.