DBT for Borderline Personality Disorder

Dialectical Behaviour Therapy or DBT is a cognitive behavioural therapy originally developed for treating Borderline Personality Disorder (BPD). Since its inception, however, its applicability has been broadened to other psychological ailments such as binge eating, depression, substance use and more. This blog outlines how DBT was developed, what is involved in DBT, and how to engage a Gold Coast DBT practitioner.

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder is a severe disorder of instability of mood, chronic feelings of emptiness, severe difficulties with interpersonal relationships, high levels of impulsivity, and often with high rates of suicidal and/or self-injury behaviour. BPD affects roughly 2% of the population at any one point in time and about 6% over the lifespan (Grant et al., 2008).

In more serious cases, it can be extremely debilitating and result in hospitalizations and frequent trips in the ambulance due to self-inflicted cuts, suicide attempts or other self-inflicted injuries. Sufferers of BPD also tend to have stormy, intense and unstable relationships in their personal lives which tend to go from periods of idealization to complete devaluation (known as splitting). As such, these relationships tend to be marked by high levels of conflict as they often go from one extreme to the other, both in their emotional state, and in their relationships. It is for this reason that it is not uncommon for partners or family members to be affected by this pattern and seek therapy themselves. We are also quite happy to support family members of those with BPD.

How was DBT developed?

Dialectical behaviour therapy (DBT) was developed by Dr Marsha Linehan. Her story is as tragic as it is remarkable. Marsha, as she has become to be known, suffered from BPD long before it was recognized as its own condition and long before any such treatments existed. She was in and out of hospital from the age of 17, continually battling with urges to harm herself for years.

Marsha described in her journey with BPD how it was only once she went on to accept herself for who she was (practicing radical acceptance) that her life began to change. She later went on to complete a Ph.D. in Psychology, serve on several high-level academic positions before going on to develop her unique approach for working and treating sufferers of BPD. This was aptly called Dialectical Behaviour Therapy. It strives for dialectics which means a balance between two opposites; acceptance and change. To date, DBT remains the most effective treatment for BPD and has also been adapted for broader use including for use adolescents, substance use and even eating disorders.

What does DBT entail?

DBT can take place in individual therapy, a group program or some combination of both. The advantage of the individualised component is that it helps to better tailor the intervention to the needs of the client presenting to therapy. The group program will typically involve a 6- to 12-month skills group that meets weekly. In more severe cases, clients will usually be involved with both a skills group and an individual therapist. We are happy to consult with you around what you individual needs may be.

DBT in its entirety entails a series of four skills modules which each target specific areas of BPD. In conjunction with this, DBT will also look at specific behaviours that the client may wish to decrease (e.g. self-harm, crises, etc.) and skills they wish to increase (e.g. emotional regulation). As a result, the therapy will be tailored towards your individual needs in the areas that are of most concern to you.

You and your DBT therapist will work together to help you to identify the sequence of events that led up to the behaviour. This is what is known as a ‘chain analysis’. Following this, your therapist will help you to learn the required skills across the 4 modules and help to evaluate the skills you need to cope in these situations, known as ‘missing links’.

What are the four modules?

Firstly, Mindfulness skills comprise the first component of DBT. Throughout this module, you will learn to be able to observe reality, in a non-judgmental manner, and your current mood state in order to be able to sit with and live in the present moment. For example, noticing bodily sensations and controlling one’s attention in the here and now are both ways by which someone can learn to be more mindful.

Secondly, distress tolerance skills are then used to tolerate and survive crises without making the situation worse. These are composed of two parts. Crisis survival skills involve the ability to tolerate painful events and urges when we cannot make things better. Reality acceptance skills aim to reduce suffering by accepting and living my life despite it not being how we may have wanted it.

Thirdly, emotional regulation skills help you to be able to better regulate the highs and of lows of your own emotional state even when you cannot completely control them. We learn to reduce the intensity of painful emotions, change our responses, and learn how to manage difficult situations in the future.

Finally, interpersonal effectiveness skills comprise learning new ways of interacting with others in order to improve and maintain relationships with those close to us and to strangers. As clients with BPD overwhelmingly have struggled with relationships with significant others, family members, and friends throughout their lives, this set of skills helps client to effectively communicate with others. This involves skills around communicating what they want, what they need, but also the skills to set boundaries and be able to say no to unwanted requests. These skills aim to maintain respect for self and others whilst also improving how others respond to us.

Where to next?

Taken together, DBT is quite an effective treatment for those with a BPD diagnosis, those with similar traits to BPD, and those who struggle with intense emotions or intense and unstable relationships. As mentioned earlier, components of DBT can also be applied to other ailments too. If you feel that DBT is something that you may benefit from, then contact our clinic for a consultation with one of our experienced DBT therapists. Download our Referral Information Sheet and take it with you to the doctor so you can discuss an appropriate referral.

Disclaimer: Content on this website is provided for education and information purposes only and is not intended to replace advise from your doctor or registered health professional. Readers are urged to consult their registered practitioner for diagnosis and treatment for their medical concerns.

References

Grant, B.F., Chou, P., Goldstein, R.B., Huang, B., Stinson, F.S., Saha, T.D., … Ruan J. (2008). Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69(4), 533–545.