Promising Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy is a type of psychotherapy developed by Dr. Marsha Linehan, Professor of Psychology at the University of Washington, for patients struggling with chronic, intentional self-harm and Borderline Personality Disorder (BPD). This therapy, employing both cognitive and behavioral principles, is rapidly becoming a standard and a promising treatment for Borderline Personality Disorder patients.

Dialectical Behavior Therapy consists of two primary components: individual psychotherapy once a week, and a weekly skills training group (specialized type of group therapy). In addition, patients are offered consultations via telephone with their individual therapist as needed.

This type of therapy is based on a biosocial theory of personality functioning, whereby Borderline Personality Disorder is seen as a biological disorder of emotional regulation. The disorder is characterized by a heightened sensitivity to emotion and an increased emotional intensity, with a slow return to the emotional baseline. Emotional experiences and characteristic behaviors associated with Borderline Personality Disorder theoretically result from the expression of this biological dysfunction in a social environment that is experienced as what Linehan terms as “invalidating” by the borderline patient.

Although there are many examples of invalidating environments, all of them share three common characteristics: (1) individual communications and behaviors are rejected as invalid; (2) painful behaviors and emotional displays are met with punishment that is erratically administered and intermittently reinforcing; and (3) the environment oversimplifies the ease with which problems can be solved and needs can be met.

Most of us have encountered these invalidating environments at some point in our lives, and we usually deal with them by changing our behavior to meet the expectations of others; by changing the environment so that it is no longer invalidating; or, ultimately, by simply leaving the invalidating environment. The dilemma for the patient with Borderline Personality Disorder, however, occurs when the person is unable to meet these expectations, or cannot leave or change the environment, thus experiencing what Linehan calls a "double bind."

The primary “dialectic” that defines the core treatment strategies in Dialectical Behavior Therapy is the tension between the patient’s acceptance and the expectation that they need to change. Acceptance strategies – which are drawn from Zen practices – involve emotional, behavioral and cognitive (thought) validation, as well as teach the patient personal strategies for validation.

The opposite of acceptance is the expectation of change. This expectation comes from behavioral therapy, with its emphasis on rationality, problem solving, logic, and the gaining of knowledge by testing hypotheses (theories). Strategies for promoting change include: problem solving, skills training, exposure, and cognitive modification.

An example of problem-solving skills training is the use of a "chain analysis" to diminish self-injury behavior. An important goal of this training is to identify points during the chain of events when the patient has a chance to do something different (make a different choice). This sets the stage for the patient to avoid the negative behavior in the future.

Linehan has organized Dialectical Behavior Therapy along a fourfold hierarchy. The first priorities are suicidal (or parasuicidal) ideation or behaviors. The second priorities are behaviors that interfere with therapy. The third priorities are behavior that interferes with the patient’s quality of life, and the fourth priorities address skills deficits commonly found in people with Borderline Personality Disorder.

The goals of Skills Training in Dialectical Behavior Therapy are to change behavioral, emotional and thinking patterns that cause the patient personal misery and interpersonal distress. Specific goals include reducing negative behaviors, while increasing more positive behaviors. Patients with Borderline Personality Disorder are taught to attend to the moment without judgment or impulsivity, a quality Dr. Linehan describes as "Core Mindfulness." Newly-learned skills enable patients to improve emotional, cognitive and interpersonal functioning.

Dialectical Behavior Therapy is typically considered a one-year (or less) treatment. During this time, therapy targets behaviors involving life and death, behaviors that impede therapy and activities that affect the patient’s quality of life. At the same time, the patient with Borderline Personality Disorder is taught techniques in the skills group that help him/her cope with the consequences of early childhood trauma, reduce post-traumatic stress, increase self-respect and self-esteem, reduce self-hatred and self-injury, achieve individual goals, and improve interpersonal relationships.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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