Borderline Personality Disorder Treated with DBT
Borderline Personality Disorder (BPD) is characterized by emotion dysregulation, strained interpersonal relationships, and low self-worth. People with this diagnosis suffer greatly and have a lot of pain. They are often very sensitive, which can be a real strength, as many report having a lot of empathy for others and having an extremely keen ability to “read” other people. Their emotional intelligence can be incredibly high. But it also can mean that when they are upset, the emotional intensity of their negative emotions can be incredibly painful. That can result in impulsive self-defeating behaviors that may be attempts to try and reduce the pain. Unfortunately, these attempts can cause longer-term damage to relationships and even more emotional pain in the forms of guilt, shame, anxiety, loneliness, etc.
Individuals with BPD commit suicide more frequently than the average population, and at some of the highest rates of any diagnosis and practice non-suicidal self-injurious behaviors (NSSI) 75% of the time (Pompili, Girardi, & Ruberto, 2005; Linehan, 1993).
The good news is there is scientific support for effective treatment. Dialectical Behavior Therapy (DBT) is the preferred therapy for BPD and has proven results in lowering suicidal ideations and non-suicidal self-injury in various studies that administered assessment both during treatment and one-year post treatment. Typically a year in length, DBT programs report the greatest treatment effects in the first four months of treatment, with the subsequent eight months dedicated to refining and consolidating new skills (Linehan, Armstrong, & Suarez, 1991).
Assessing Effectiveness of Brief Form of DBT
Treatment is rigorous and intensive with weekly individual therapy, weekly group skill sessions, telephone consultations, and clinician team meetings. DBT modules include mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. Treatment requires a significant investment on the part of patients. This includes time, effort, and emotional and financial resources. And while it may be worth it, given the benefits, there is no doubt that it requires a significant commitment over an extensive amount of time. This was likely part of the impetus for Stanley, Brodsky, Nelson, and Dulit’s 2007 pilot study to examine the effects of a shorter intervention, Brief Dialectical Behavior Therapy (DBT-B). The researchers’ study consisted of 20 patients with a diagnosis of BPD, all expressing suicidal ideations at the beginning of outpatient treatment. Participants were assessed for urges to self-injury, self-injury episodes, suicidal ideation, and subjective distress at baseline and after six months of DBT.
Practical for Certain Populations
Results of the study indicated that a six-month intervention of DBT did lead to significant reductions in distress, self-injury, suicidal ideation, and hopelessness (Stanley et al., 2007). The program examined by the researchers was also successful in retaining clients throughout the entire course of treatment. These findings are preliminary and as such require more research; however, the implications look quite promising for tailoring programs to populations who struggle to make the financial and time commitments necessary for standard (year-long) DBT programs.
DBT provides a comprehensive set of tools and offers clients the opportunity to develop a multitude of coping skills to help them reduce their suffering, navigate well during tumultuous times, and effectively manage challenging situations. It is important to find therapists with strong clinical skills, who are sensitive to the needs of clients and have the capacities to empathize and validate in the ways that can make DBT and other therapies effective.
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Linehan, M., Heard, H., & Armstrong, H. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50, 971-974.
Pompili, M., Girardi, P., & Ruberto, A. (2005). Suicide in borderline personality disorder: A meta-analysis. Norwegian Journal of Psychiatry, 59, 319-324.
Stanley, B., Brodsky, B., Nelson, J., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11, 337-341.