What Therapy is Best For Borderline Personality Disorder?

When it comes to Borderline Personality Disorder, there is currently only one empirically-supported treatment protocol for this condition: Dialectical Behavior Therapy, or DBT. 

A form of psychotherapy developed in the late 1980s by Dr Marsha Linehan, this treatment protocol is based on cognitive behavioral principles applied in specific ways in order to target common symptoms of BPD such as chaotic relationships, emotional lability, instability, and impulsivity. Over the last few decades, randomized studies have shown DBT to be effective not only for BPD, but also a wide variety of other psychiatric disorders. 

Traditional DBT usually includes group skills training, individual psychotherapy, and even one-on-one telehealth consultations. Skill development addressed during DBT include mindfulness, interpersonal effectiveness, emotional regulation and distress tolerance. 

What is BPD? 

The Diagnostic and Statistical Manual, 5th Edition (DSM-5), describes Borderline Personality Disorder as “a chronic disorder that includes symptoms such as frantic efforts to avoid real or imagined abandonment, unstable relationships, identity disturbance, impulsive and dangerous behaviors, recurrent suicidal threats or self-mutilating behaviors, affective instability, feelings of emptiness, difficulties controlling anger, and/or stress-related paranoid thoughts or dissociation.” 

While the psychological spotlight most often shines on clinical disorders such as major depressive disorder, PTSD and more, BPD actually accounts for much higher ongoing healthcare costs, a higher number of hospitalizations, frequent ER visits, and consistent use of outpatient services. 

What Does “Dialectical” Really Mean? 

The term “dialectical” refers to the “interaction of conflicting ideas.” Where BPD creates significant inner conflict, DBT seeks to integrate acceptance and change. 

How Effective is DBT for BPD? 

A number of randomized trials covering the success of DBT in treatment of BPD have been completed over time. Over and over these studies have proven the efficacy of DBT, as it far surpasses community-based treatment in its ability to reduce parasuicidal behavior, diminish rate of hospitalizations, and improve likelihood of adherence to treatment protocols. 

DBT is also effective in treating a wide variety of other psychiatric disorders, many of which tend to come along with BPD diagnosis due to crossovers in symptoms and diagnostic criteria (such as suicidal behavior, impulsivity, engaging in risky behavior, mood swings, and more).  

 

DBT Skills Training 

Mitigating the symptoms of BPD is a significant priority in DBT training, and is addressed through a specific set of psychosocial skill development that targets BPD deficits (unstable sense of self, chaotic relationships, emotional instability, impulsivity, and fear of abandonment). These skills include: 

  • Core mindfulness
  • Interpersonal effectiveness
  • Emotional regulation 
  • Distress tolerance. 

DBT therapy usually involves meeting at least once weekly for up to 2 hours, and patients can expect to spend approximately 6 months working through the different stages (or modules) of DBT treatment protocol. For patients who experience heightened symptoms of BPD, it’s usually suggested that they stay in DBT skills training groups for about a year. It can take time to work through significant trauma history (often the root cause of BPD) and some of the less concerning symptoms may take time to address because the priority will be placed on addressing any suicidal behaviors. 

Improving Your Quality of Life with DBT for BPD

One of the easiest and best ways to begin the DBT treatment process is to join an online therapy group, which offers easy, affordable weekly access from the comfort of your own home to all of the benefits DBT has to offer. 

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