How Dialectical Behavior Therapy Can Help People with BPD

DBT is a multifaceted treatment approach created by Dr. Marsha Linehan in the early 1990s. Linehan created DBT in hopes of providing relief to those living with BPD, a condition she’s experienced, as she later revealed in her book “Building a Life Worth Living: A Memoir.“

DBT, while created for BPD, has also been helpful for those with:

• substance use
• eating disorders
• attention deficit hyperactivity disorder (ADHD)

DBT is a skills-based treatment program broken into four main modules:

• Mindfulness. Mindfulness teaches you to focus on the here and now by becoming aware of your thoughts, feelings, and sensations.
• Interpersonal effectiveness. In this module, you learn, for example, how to communicate effectively, build and cultivate healthy relationships, and express your needs.
• Emotion regulation. DBT teaches you techniques to help you understand and manage your emotions.
• Distress tolerance. In this module, you learn techniques to manage overwhelming emotions or difficult situations.

Each module consists of various skills that are specific to that module’s theme. Some skills you may learn include:

• self-soothing
• wise mind
• radical acceptance
• building positive experiences

Each module consists of group and individual therapy, as well as homework assignments. Your therapist may also be available for phone coaching in moments where skills may need to be practically applied.

DBT is skills-based, meaning it’s both practical and achievable. Typically, a DBT program lasts 1 year.

Since those with BPD often experience black-and-white thinking, one of the foundations of DBT is literally within its name: dialectics.

Dialectics is defined as holding two seemingly opposite ideas at one time, considering both to be truths. In DBT, “dialectical” refers to the idea of needing both acceptance and change to help improve symptoms. This can bring greater balance and reduce black-and-white patterns of thought.

The other foundation of DBT is mindfulness. Through mindfulness, those living with BPD can learn to make more intentional, conscious decisions and decrease impulsivity and other unhelpful or potentially harmful behaviors over time.

One mindset taught during mindfulness is “wise mind,” which encourages dialectical thinking in crisis and normalcy. It also helps you to attend to your emotions and reason to make wise and balanced decisions.

Ultimately, DBT helps those with BPD both function and flourish in their everyday lives.

What does research say about DBT?

Research has shown DBT to be the most effective form of treatment for those with BPD. In fact, one study found that after the first year of treatment, 77% of participants no longer met the diagnostic criteria of BPD.

DBT is particularly effective for improving:

• suicidal thoughts and behaviors
• difficulties with anger management
• overall daily functioning, including socially

BPD symptoms such as chronic feelings of emptiness, difficulties with personal relationships, and an intense fear of abandonment tend to be more difficult to treat with DBT — but not impossible.

It’s important to remember that BPD doesn’t look the same for everyone. Different people may have different symptoms, and though DBT may help many people with the condition, it may not work for everyone.

If you feel as if DBT isn’t helping you, there are many other options you can discuss with your treatment team, including:

• Mentalization-based therapy (MBT). MBT helps people with BPD identify and understand their own and others’ actions, feelings, and thoughts.
• Transference-focused therapy (TFP). In TFP, your therapist allows you to “transfer” thoughts or feelings you may have about another person onto them, which may allow them to understand your symptoms better. In collaboration, you can work out ways to change behaviors or negative thinking that your BPD may cause.
• Good psychiatric management (GPM). GPM teaches you problem-solving and stress-management strategies to help with life difficulties and to better understand yourself.
• Schema-focused therapy (SFT). SFT helps people with BPD change negative patterns of thoughts, behavior, and emotions, which are known as “schemas.”

At times, short-term hospitalizations may be necessary. This is particularly true in times of extreme stress and when you experience suicidal or impulsive behaviors.

Currently, there is no medication specifically for BPD. Some people with co-occurring conditions such as anxiety or depression may benefit from taking antidepressants. Your doctor can help you figure out whether medication may be beneficial in your case.

Overall, dialectical behavior therapy (DBT) has been shown to be the most effective form of treatment for people with borderline personality disorder (BPD), especially if you experience thoughts of suicide or self-harm or want to reduce anger. It also helps with social skills and overall quality of life.

If you think DBT may be right for you, finding a qualified and experienced therapist in your area is crucial.

The National Education Alliance for Borderline Personality Disorder offers helpful tips when searching for a suitable therapist.

Plus, the Borderline Personality Disorder Resource Center maintains a database of healthcare professionals in the United States who have experience treating BPD. You can call them at 1-888-694-2273 or send them an email at bpdresourcecenter@nyp.org.

Though living with BPD can be challenging at times, try to keep in mind that you’re not alone and that you can get better with the right treatment and support.