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Dialectical Behavior Therapy for Borderline Personality Disorder

written by: Nicole Etolen • edited by: Daniel P. McGoldrick • updated: 3/4/2011

Treating borderline personality disorder, a condition characterized by its long-term patterns of erratic emotions, can be a challenge to mental health workers. Dialectical behavior therapy combines several techniques to get to the heart of the disorder rather than treat each crisis individually.

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    What Is Borderline Personality Disorder

    Borderline personality disorder is a severe mental illness characterized by long-term mood instability, difficulty with interpersonal relationships, and erratic behavior, according to the National Institute of Mental Health. Patients with borderline personality disorder experience rapid mood swings, with bouts of anger or anxiety lasting only a few minutes or for hours at a time, but with such frequency that it interferes with their ability to function fully in society. Borderline personality disorder patients often engage in some form of self-harm, including cutting, suicidal thoughts, and attempts to commit suicide.

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    Dialectical Behavior Therapy for Borderline Personality Disorder

    Marsha M. Linehan and her team of researchers developed dialectical behavior therapy during the late 1970’s, making it a relatively new treatment compared to other behavior therapies. After numerous failed attempts to use cognitive behavior therapy for the treatment of suicidal patients with borderline personality disorder, Linehan and her team began adapting the therapy’s protocols to better suit the needs of the disorder. Dialectical behavior therapy combines individual therapy, group therapy and telephone contact between the patient and therapist to keep track of progress. Patients receive weekly individual therapy sessions, but they also must attend a two-hour weekly group session for at least the first year of treatment. Group sessions focus on developing skills to develop appropriate interpersonal relationships, regulate emotions and increase distress tolerance. Additionally, the patient makes a commit to call his or her therapist before attempting acts of self-harm.

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    Stages of Dialectical Behavior Therapy

    Dialectical behavior therapy for borderline personality disorder is broken down into several stages, each targeting a specific behavior or situation. Stage 1 focuses on four different targets: keep the patient alive and prevent self-harming behaviors; reduce or eliminate behaviors that interfere with therapy (such as non-attendance, frequent outbursts or abusive behavior towards the therapist); decrease behaviors that interfere with quality of life (such as eating disorders, phobias, depression, and patterns of skipping school or work); and learn the necessary life skills in the group sessions.

    Stage 2 teaches the patient to experience emotions fully, without shutting down those that cause discomfort. After successful completion of stage 1, patients have control of their behavior, but they are still suffering from many of the emotions that caused them to lose control in the first place. The goal of this stage is to prevent patients from engaging in behaviors that dissociate them from certain emotions, such as avoiding life events or completely removing themselves from social situations.

    Stage 3 helps borderline personality patients cope with ordinary problems, such as marital discord or career goals. At this point, many patients choose to take a break from therapy and work on the goals of this stage on their own. Stage 4 focuses on providing a sense of “completeness." Having conquered thoughts of self-harm, developed skills needed to address behavior problems and learned to cope with daily stressors, patients are encouraged to discover a sense of completeness. For some patients, this means finding a path of spirituality that brings meaning to their lives. For others, it may mean a change in careers. Linehan recognized that providing patients with the tools to have a full, meaningful life was just as essential as keeping them alive and out of harms way for the moment. She felt that having a life worth living was just as important as having a desire to stay alive.

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    Evidence of Benefits

    The benefits of using dialectical behavior therapy for borderline personality disorder have been extensively researched in numerous studies. A 2003 study performed by the DeViersprong Center of Psychotherapy at the University of Amsterdam concluded that “dialectical behavior therapy is superior to the usual treatment in reducing high-risk behaviors in patients with BPD." The results of this study were published in the February, 2003 issue of the British Journal of Psychiatry. A 2006 study performed by Lineham herself, along with several other researchers, tracked patient progress over a two-year period and compared the results of dialectical behavior therapy to other forms of therapy. The study found that dialectical behavior therapy is “uniquely effective in reducing suicide attempts." Results were published in the July 2006 issue of the Archives of General Psychiatry.

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    Sources

    National Institute of Mental Health: Borderline Personality Fact Sheet

    http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml

    Behavioral Tech: Dialectical Behavior Therapy FAQs http://www.behavioraltech.com/downloads/dbtFaq_Cons.pdf

    DBT Self Help: DBT In A Nutshell http://www.dbtselfhelp.com/DBTinaNutshell.pdf

    Verheul R, et al. “Dialectical Behavior Therapy for Women With Borderline Personality Disorder" British Journal of Psychiatry. February, 2003

    Lineham, MM, et al. “Two-year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder" Archives of General Psychiatry July, 2006.

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