Dialectical Behavior Therapy For Personality Disorders (DBT)

If you’ve been diagnosed with BPD or have thoughts of self-harm, learn about borderline personality disorder treatment with dialectical behavior therapy (DBT).

Table of contents:

• Symptoms of BPD
• DBT as Treatment for BPD
• Core Components of DBT
• Efficacy of DBT
• DBT Treatment Process
• Finding a DBT-Trained Therapist
• Adjunctive Pharmacotherapy
• Find Help for DBT through CBT

Key Facts:

• BPD often involves emotional instability and self-harm.
• DBT is clinically proven to effectively treat BPD.
• DBT treatment includes one-on-one therapy and skills learned in a group setting. 

It may be difficult to accept borderline personality disorder (BPD) as a possible diagnosis. However, if you struggle with any BPD symptoms or you’ve already been diagnosed, there is hope for management of the symptoms. BPD is characterized by:

• Emotional instability
• Impulsivity
• An unstable sense of self
• Chaotic relationships
• Fear of abandonment
• Black-and-white thinking
• Self-harm
• Suicidal ideation
• Suicide attempts

Dialectical behavior therapy (DBT) is often considered the gold standard for the treatment of borderline personality disorder.

Understanding DBT in BPD Treatment

DBT is a type of talk therapy under cognitive behavioral therapy (CBT), which explores the relationship between beliefs, thoughts, and behaviors. “Dialectical” involves the integration of opposing ideas. DBT involves both acceptance and change, whereas CBT primarily focuses on change.

DBT was first developed in the 1970s by the American psychologist, Marsha Linehan, PhD. In her initial years of practice, Dr. Linehan attempted to apply standard CBT to patients with BPD and ran into issues with patients feeling invalidated by the need to change. Many patients with BPD have suffered harmful invalidation early in their lives, and traditional CBT caused them more pain. 

Once realizing this, she created a specialized approach that alternates from acceptance to change, so patients feel that their emotions and experiences are valid, while at the same time exploring ways in which their thinking may be irrational.

For example, the feeling of being upset is valid, but any black-and-white thinking you have behind your feelings needs to be challenged. This process of alternating from the validation of feelings to the challenging of the thoughts behind them leads to improved emotional regulation.

Core Components of DBT

There are four essential skills, or modules, taught in DBT, which are: 

• Mindfulness: Adopted from Eastern meditation philosophy, this is the practice of being fully in the present rather than dwelling in the past or worrying about the future by focusing on what is tangible to your senses in the current reality.
• Distress Tolerance: With this skill, you can learn that difficulty is a part of life and learn to use coping skills to transform intolerable suffering into distress you can manage without resorting to harmful behaviors.
• Interpersonal Effectiveness: You learn to put into practice effective social skills needed to maintain healthy relationships.
• Emotion Regulation: This skill will help you understand your emotions and have more control over them.

In addition to these four essential skills, DBT also incorporates:

• Diary cards: You will use these between sessions to track emotions, actions, and times when you’ve effectively applied a new skill.
• Chain analysis: This exercise helps you see the cause-and-effect process, the chain of events, that leads from thoughts to your problem behaviors.

Efficacy and Application of DBT

Randomized controlled trials found that DBT is not only effective for BPD but also for other conditions like substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders. [1]

Navigating DBT Treatment

While DBT has proven benefits, finding a therapist trained in DBT can still be a challenge. To find a therapist locally, it’s recommended that you ask family, friends, and other professionals for recommendations and referrals. 

If you have limited or no behavioral health coverage, the barrier to receiving treatment can come down to cost. Fortunately, many therapists have successfully adapted DBT to make it available online through teletherapy, which is more convenient and often more affordable.

The DBT Treatment Process

After an initial pre-assessment evaluation, the DBT treatment process is standardized by four components (modes):

Individual psychotherapy: You have weekly sessions with the therapist to discuss such topics as diary cards, application of learned skills, issues blocking progress, and effective coping skills.

Group skills training: Rather than operating like traditional group therapy where participants share, this setting functions more like a class with the therapist teaching you the four essential skills.

Telephone coaching: The therapist is available for you to call, usually during designated times, for short phone calls to answer questions or to help navigate a crisis.

Therapist consultation team: The therapist receives training and support from a consultation team. 

If you have PTSD or another type of trauma, the therapist will integrate trauma work methods, such as exposure therapy, into your one-on-one sessions.

DBT’s Comprehensive Approach

Because patients with BPD often engage in self-harm or struggle with suicidal ideation, therapists address these issues in weekly sessions and are available for telephone crisis calls. However, if you would benefit from it, pharmacotherapy is considered an important adjunctive role to help keep you out of crisis or to help with symptoms of psychosis, such as hearing voices or experiencing hallucinations.

Supporting DBT Therapy

In addition to psychotherapy, group skills learning, and telephone coaching, you’ll find even more success if you include family and friends in your efforts in recovery. Explaining the concept of validation can help them understand your need for acceptance and support while also seeking to change destructive behaviors.

Seeking out others who are diagnosed with BPD or suffer from BPD symptoms in group therapy or online forums can help you connect and find support and encouragement on your journey to recovery.

DBT in Diverse Contexts

Therapists need to be trained in DBT to effectively treat patients with BPD because invalidating communication can create strong emotional reactions and failed therapy. For example, if you’re asked what you did before someone did something harmful to you, it can make you feel as though the therapist is implying that the harmful action was your fault.

Because of this, DBT needs to incorporate cultural sensitivity, depending on where it’s being applied. Culturally-adapted DBT has been shown to be more effective than non-adapted DBT in certain situations. [2]

Find Help for BPD Symptoms Through DBT

You don’t have to live with unstable emotions that lead to destructive behavior and self-harm. If you feel lost and want a life worth living, you can find help for borderline personality disorder (BPD) through dialectical behavior therapy (DBT). Take control by seeking therapy for improvement of symptoms and recovery of BPD. Get help today.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007584/
2. https://pubmed.ncbi.nlm.nih.gov/35420839/