Dialectical Behavior Therapy For Borderline Personality Disorder

Borderline personality disorder (BPD) can be a challenging condition to manage. This mental health condition is characterized by intense emotional instability, impulsivity, a fear of abandonment, and difficulty maintaining relationships. However, those living with BPD can learn to better manage their emotion control skills through therapeutic modalities like dialectical behavior therapy (DBT). 

What is borderline personality disorder?

Borderline personality disorder (BPD) is a mental illness characterized by patterns of instability in emotional reactions, interpersonal relationships, self-image, and emotions. It is considered a cluster B personality disorder in the current version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. Individuals that have the diagnostic criteria for BPD often experience intense and unstable emotions, have difficulty managing their emotions, and may engage in impulsive and risky behaviors such as self harm or suicidal behaviors.

• Fear of abandonment or rejection, leading to intense efforts to avoid both
• Biological risk factors for major depressive disorder
• Unstable relationships, often characterized by alternating between idealizing and devaluing their partner
• Identity disturbance, including an unstable sense of self
• Impulsivity, including reckless driving, substance abuse, or binge eating disorder
• Suicidal or self injurious behaviors
• Emotional instability, including intense and rapidly changing moods
• Chronic feelings of emptiness or boredom
• Difficulty controlling anger or irritability
• Paranoia or dissociation in response to stress

Dialectical behavior therapy (DBT) is a type of psychotherapy originally developed by psychologist Marsha M. Linehan in the late 1980s to begin treating borderline personality disorder. Marsha Linehan also has borderline personality disorder, inspiring her decision to develop a first line treatment like DBT. 

• Individual therapy: Individual psychotherapy calls for one-on-one sessions between the individual and a DBT therapist. The therapist may help individuals identify their specific challenge areas and teach them skills to manage their emotions and behaviors. 
• Group skills training: Group skills training calls for a focus on specific skills to manage emotions and behaviors through group sessions. Group therapy may be led by a trained DBT therapist covering four key areas: mindfulness, distress tolerance, and interpersonal effectiveness. 
• Coaching: Coaching is done between sessions and can help individuals apply skills in real-life situations. Through coaching, a therapist may be able to provide immediate assistance to a client during a difficult situation or emotion. A therapist can support a client through phone coaching when they are not in the immediate vicinity.
• Consultation: Consultation allows for DBT therapists to discuss cases with other therapists and receive support. A DBT consultation team may help therapists effectively manage their caseload and provide better client care.

DBT uses a dialectical approach to balance opposing ideas or perspectives. In dialectical behavior therapy, dialectics can involve balancing acceptance and change with challenging emotions. Therapists work with individuals to accept their current emotions and behaviors while encouraging them to make changes to improve their quality of life and relationships. Since borderline personality disorder can cause interpersonal challenges, this approach is often vital in DBT. 

DBT treatment often calls for four distinct modules: mindfulness, distress tolerance, emotional control, and interpersonal effectiveness. Dialectical behavioral therapists can teach clients techniques in each of these areas to reduce instances of reactivity and help them navigate challenging circumstances.

Mindfulness in dialectical behavior therapy

Mindfulness is a core component of dialectical behavior therapy. It involves being present in the moment and non-judgmentally observing one's thoughts, feelings, and sensations. Mindfulness can help individuals with borderline personality disorder learn to control their emotions and reduce impulsive behaviors. 

Distress tolerance involves relaxing the mind and body when faced with intense emotional responses. Distress tolerance skills can be helpful for those living with borderline personality disorder, particularly those who may find it challenging to manage intense emotions without resorting to self-destructive behaviors or psychiatric hospitalization. 

Examples of distress tolerance techniques for those living with BPD that are learned in dialctical behavior therapy include distraction, the TIPP skill, and radical acceptance, which involves accepting circumstances beyond your control. 

Emotional control

A dialectical behavior therapist may help a client learn various skills to aid in emotional control. These may include problem-solving, identifying and labeling emotions, and checking the facts to challenge emotional thinking. They may also help clients learn to change or widen their perspectives to understand situations more comprehensively.  

• In the Berlin Borderline Study, clients who underwent outpatient DBT showed significant symptom improvement. 
• A study of chronically parasuicidal women showed that the subjects who received DBT had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days.
• One pilot study of 12 adolescents with borderline personality disorder found that self-injurious behavior declined significantly during and after treatment. 
• One randomized clinical trial found DBT effective in treating drug use in those living with BPD. 
• A comparative study found that individuals with BPD showed significant positive changes in depression, anxiety, global functioning, and social adjustment across one year of DBT treatment. 

Should you try dialectical behavioral therapy for BPD?

If you're living with borderline personality disorder, eating disorders, or another mental illness it may be worth considering treatment from a mental health professional. Through DBT and other forms of talk therapy, like cognitive-behavioral therapy (CBT), you can learn valuable skills to improve your emotional health and interpersonal relationships. Also, if you want to learn more about DBT therapy you can find a DBT skills training manual online.