Dialectical Behavior Therapy for BPD

Dialectical behavior therapy (DBT) is a type of psychotherapy used to treat borderline personality disorder (BPD). Learn more about this therapy and how it can help someone with BPD, along with what to expect during a dialectical behavior therapy session.

What Is Dialectical Behavior Therapy?

DBT was developed by Marsha Linehan, Ph.D., in the early 1990s. It is a form of cognitive behavioral therapy (CBT), meaning that it focuses on the role of cognition—which includes one's thoughts and beliefs, and behavior or actions—in the development and treatment of BPD.

In DBT, the goal is to reduce borderline personality disorder symptoms by developing healthy coping skills to replace unhealthy behaviors. Skills that can be developed during dialectical behavior therapy include those related to mindfulness, emotional regulation, and increasing one's tolerance to distress.

How DBT Works

DBT is based on Dr. Linehan's theory that the core problem in BPD is emotion dysregulation. This dysregulation results from mixing biology, including genetic and other biological risk factors, and an emotionally unstable childhood environment.

An example of an unstable environment during childhood might include a caregiver who trivializes or responds erratically to a child's expression of emotion. It could also include a caregiver who punished the child if they showed emotion.

The focus of DBT is on helping the client learn and apply skills that will decrease emotion dysregulation and unhealthy attempts to cope with strong emotions. This helps reduce BPD symptoms.

Dialectical Behavior Therapy Effectiveness for BPT

DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials, the most rigorous type of clinical research. It is considered the "gold standard" first-line treatment for borderline personality disorder.

Research suggests that DBT is effective in reducing psychiatric hospitalization, substance use, and suicidal behavior in people with BPD. It also reduces treatment dropout rates, feelings of anger, and interpersonal difficulties.

While DBT is no longer the only therapy to have shown effectiveness in controlled trials, it has grown a large evidence base and is considered one of the best treatments for BPD in terms of documented success rates.

To be clear, DBT is not a cure for borderline personality disorder, but it can be very effective in reducing or managing symptoms of the condition. One study found that 77% of people no longer met the criteria for BPD after a year of treatment with dialectical behavior therapy.

What to Expect With DBT

Usually, DBT includes a combination of group skills training, individual psychotherapy, and coaching. Individuals are asked to monitor their symptoms and use of learned skills daily while their progress is tracked. There are four key sets of coping skills developed in dialectical behavior therapy.

Mindfulness Meditation Skills

Mindfulness meditation skills are focused on being fully in the present. They center on learning to observe, describe, and participate in all experiences, including thoughts, sensations, emotions, and things happening externally in the environment without judging these experiences as "good" or "bad."

For example, people with BPD may find themselves overwhelmed with emotions during an argument and may then act out on those feelings without considering the consequences. Mindfulness skills help them learn how to interpret and regulate these emotions, allowing them to step back and respond more appropriately.

Interpersonal Effectiveness Skills

The focus of this skill module is on learning to successfully assert your needs and to manage conflict in relationships. When interpersonal effectiveness skills are developed, it can help instigate change in the person's feelings of anxiety and depression.

Distress Tolerance Skills

The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run. An example would be engaging in self-harm.

When faced with strong emotions, a person with BPD may engage in impulsive or risky behaviors to escape what feels like an intolerable feeling. Substance use, violence, excessive alcohol use, and other risky actions are just a few examples of behaviors someone might engage in to temporarily feel better.

The problem is that these behaviors make things worse in the long term. Distress tolerance skills allow people to learn how to better cope with such emotions and respond in more adaptive ways.

Emotion Regulation Skills

In this module, patients learn to identify and manage emotional reactions. Regulating emotions involves enhancing or reducing emotions in order to respond effectively and achieve individual goals.

Gaining these emotional skills allows people with BPD to better interpret their emotions and find ways to manage and express them that are healthy and non-destructive. Examples of skills a person might work on include learning how to accept emotions, changing behaviors to change the situation, or finding ways to deal with an emotion without lashing out.

Finding a Therapist Specializing in DBT

If you are interested in DBT, you can ask your therapist, physician, or another mental health professional for a referral to someone who specializes in this approach. The Behavioral Tech Institute also provides an online directory that can help you find DBT providers in your area.

Dialectical behavior therapy can help reduce BPD symptoms. Connecting with a therapist who offers this form of psychotherapy is a good step in managing this condition.