Dialectical Behavior Therapy for BPD

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Dialectical behavior therapy (DBT), developed by Marsha Linehan, Ph.D., at the University of Washington, is a type of psychotherapy, sometimes called "talk therapy," used to treat borderline personality disorder (BPD). DBT is a form of cognitive behavioral therapy (CBT), meaning it's a therapy that focuses on the role of cognition, which refers to thoughts and beliefs, and behavior, or actions, in the development and treatment of BPD.

DBT includes some changes to the traditional cognitive-behavioral elements of therapy. These changes are intended to specifically help reduce the symptoms of BPD.

Research Support

DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials, the most rigorous type of clinical research. DBT is considered the "gold standard" first-line treatment for borderline personality disorder.

While DBT is no longer the only therapy to have shown effectiveness in controlled trials, it has grown a large evidence base and is considered one of the best treatments for BPD in terms of documented success rates.

Research suggests that DBT is effective in reducing psychiatric hospitalization, substance use, and suicidal behavior. Participants in the study also had significant reductions in hospital stays, self-injurious behaviors, and the severity of borderline symptoms.

Theoretical Basis

DBT is based on Dr. Linehan's theory that the core problem in BPD is emotion dysregulation, which results from mixing biology, including genetic and other biological risk factors, and an emotionally unstable childhood environment, for instance where caregivers punish, trivialize, or respond erratically to the child's expression of emotion, together.

The focus of DBT is on helping the client learn and apply skills that will decrease emotion dysregulation and unhealthy attempts to cope with strong emotions.

What to Expect

Usually, DBT includes a combination of group skills training, individual psychotherapy, and phone coaching, although there are exceptions. Patients in DBT are asked to monitor their symptoms and use of learned skills daily while their progress is tracked throughout therapy.

There are four main types of skills that are covered in DBT skills training. These are:

Mindfulness Meditation Skills

Mindfulness meditation skills are focused on being fully in the present. These skills center on learning to observe, describe, and participate in all experiences, including thoughts, sensations, emotions, and things happening externally in the environment, without judging these experiences as "good" or "bad." These are considered core skills that are necessary in order to implement other DBT skills successfully.

For example, people with BPD may find themselves overwhelmed with emotions during an argument and may then act out on those feelings without considering the consequences. Mindfulness skills help people learn how to interpret and regulate these emotions, allowing them to step back and respond more appropriately.

Interpersonal Effectiveness Skills

The focus of this skill module is on learning to successfully assert your needs and to manage conflict in relationships.

Distress Tolerance Skills

The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run, for instance, engaging in self-harm.

When faced with strong emotion, a person with BPD may engage in impulsive or risky behaviors in order to escape what feels like an intolerable feeling. Substance use, violence, excessive alcohol use, and other risky actions are just a few examples of behaviors someone might engage in to temporarily feel better. The problem is that these behaviors make things worse in the long-term. Distress tolerance skills allow people to learn how to better cope with such emotions and respond in ways that are more adaptive.

Emotion Regulation Skills

In this module, patients learn to identify and manage emotional reactions. Regulating emotions involves enhancing or reducing emotions in order to respond effectively and achieve individual goals. Gaining these emotional skills allows people with BPD to better interpret their emotions and find ways to manage and express them in ways that are healthy and non-destructive. Examples of skills a person might work on include learning how to accept emotions, changing behaviors in order to change the situation, or finding ways to deal with the emotion without lashing out.

Effectiveness

DBT is not a cure for borderline personality disorder, but it can be very effective for reducing or managing symptoms of the condition. One study found that 77% of people no longer met the criteria for BPD after a year of treatment with dialectical behavior therapy.

Getting Help

If you are interested in learning more about DBT, there are a number of resources available on the Behavioral Tech website. Visit the resources page to learn more about the basics of DBT and Dr. Linehan. The clinical resources directory can help you find DBT providers in your area.

Alternatively, you can ask your therapist, physician, or other mental health professionals for a referral to someone who specializes in DBT.

The Difference Between DBT and Didactic Therapy

Didactic therapy is a group therapy most often used for those with substance use disorders to teach them the facts and help educate them, while DBT is typically for use in the treatment of borderline personality disorder.

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Article Sources

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  1. Stoffers-Winterling JM, Vollum BA, Rucker G, Timmer A, Huband N, Lieb K. Psychological therapies for borderline personality disorder. Cochrane. Published August 15, 2012.

  2. National Alliance on Mental Illness (NAMI). Borderline personality disorder. Updated December 2017.

  3. May JM, Richardi TM, Barth KS. Dialectical behavior therapy as treatment for borderline personality disorderMent Health Clin. 2016;6(2):62–67. doi:10.9740/mhc.2016.03.62

  4. Gross JJ. Emotion regulation: current status and future prospectsPsychological Inquiry. 2015;26(1):1–26. doi:10.1080/1047840X.2014.940781.

  5. Stiglmayr C, Stecher-mohr J, Wagner T, et al. Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study. Borderline Personal Disord Emot Dysregul. 2014;1:20. doi:10.1186/2051-6673-1-20

Additional Reading

  • "What is DBT?" The Linehan Institute: Behavioral Tech (2016).
  • Feigenbaum, J. "Dialectical Behaviour Therapy: An Increasing Evidence Base." Journal of Mental Health, 16:51-68, February 2007.
  • Linehan, MM. "Skills Training Manual for Treating Borderline Personality Disorder." New York: Guilford Press, 1993.