Dialectical Behavior Therapy is a structured, evidence-based treatment, based on cognitive-behavioral principles, is currently the only outpatient treatment program available for BPD. Several empirical pieces of research have proved that the efficacy of DBT is not only in Borderline Personality Disordersbut also in other psychological issues like eating disorders, post-traumatic stress, drug dependency, etc. The behavioral toolbox of DBT targets the comorbid psychiatric symptoms of BPD like an unstable sense of self-recognition, emotional distress, self-harm behaviors, and ensures rightful adjunctive care throughout the program.
The word "dialectic" means integrating two opposite things - change and acceptance, as pillars for development. DBT aims to demonstrate BPD's problematic symptoms by replacing maladaptive behaviors with essential coping mechanisms like core mindfulness, emotion regulation, and distress tolerance skills. This way, it allows patients to work up their approaches to stress relief and satisfactory life.
What is Borderline Personality Disorder?
Borderline Personality Disorder (BPD) is a mental illness marked by patterns of self-image difficulties, emotional instability, dysfunctional behaviors, and unstable relationships. According to the National Institute of Mental Health, around 1.6 percent of adults living in the United States suffer from BPD.
People with Borderline Personality Disorder suffer from the constant fear of being abandoned and face difficulties in tolerating loneliness or isolation. Frequently, they display inappropriate anger, impulsiveness, and disruptive mood swings that can ruin their existing relationships, thereby pushing themselves into the vicious cycle of intense emotional pain and destructive behaviors. BPD generally develops during early childhood or adolescence, and with age, it may gradually get better. Fortunately, there are various treatments and therapies available to help you combat BPD and live a life of comfort and satisfaction.
What causes BPD?
Researchers are still trying to discover the exact cause of BPD. Multiple factors may contribute to this illness, such as genetics, environmental factors like childhood trauma, and brain abnormalities.
1. Genetics
BPD may be a genetic condition. A study conducted on twins and their families, published in the Journal of Personality Disorders, demonstrates that the disorder may be inherited or associated with a substantial genetic aspect.
2. Environmental Factors
Growing up in a neglectful, abusive, or unstable environment can cause BPD - for example, a history of child abuse can raise your risk of BPD in adulthood.
3. Serotonin Abnormalities
Serotonin is a hormone that helps in mood regulation. Inconsistency in serotonin production may make you susceptible to BPD. Research has shown that specific changes in areas of the brain responsible for emotion regulation, aggression, and distress tolerance, can also cause BPD.
How to apply DBT in treating BPD?
DBT is not an absolute cure for Borderline Personality Disorder, but its skill-sets can help manage and reduce the symptoms of this condition. The Berlin Borderline study suggests that nearly 77% of people no longer displayed BPD symptoms after a year of treatment with DBT.
DBT consists of a combination of group skills training, individual psychotherapy, and phone coaching. Patients in DBT are advised to record their symptoms and apply the acquired skills accordingly, while their progress is monitored throughout therapy.
Four main types of skills are covered in DBT skills training. These are:
1. Mindfulness Meditation Skills
Mindfulness meditation skills imply being fully aware of the present. These skills require you to learn to observe, describe, and experience the events of thoughts, sensations, emotions, and things happening externally in the environment, with a nonjudgmental stance. These core skills of mindfulness are necessary to operate other skills of DBT effectively.
For example, people with BPD may find themselves overwhelmed with emotions during an argument and may be susceptible to dysfunctional behaviors without contemplating the consequences. Mindfulness skills help people interpret and regulate these emotional vulnerabilities, thereby allowing them to introspect and reciprocate more responsibly.
2. Interpersonal Effectiveness Skills
The focus of this skill is on asserting your requirements, establishing effective communication, and managing conflict in relationships.
3. Distress Tolerance Skills
The distress tolerance skill-set promotes ways to acknowledge and tolerate distress without indulging in destructive behaviors like self-injury, overeating, or violence. When faced with an uncomfortable situation, a person with BPD may engage in impulsive or risky behaviors as an escape route to ride out intense emotions. This can be substance use, excessive alcohol consumption, or any other dangerous practice that can promote temporary relief in the beginning but cause severe damage in the long-run. Distress tolerance skills allow people to cope better with such emotions and replace maladaptive behaviors with more responsible ones.
4. Emotion Regulation Skills
In this module, you can learn how to manage your emotions and regulate your reactions to achieve your desired goals. Gaining emotion regulation skills will enable you to introspect your feelings and find effective ways to direct and express them to avoid distorted actions.
Conclusion
Although medications can provide intensive care to patients dealing with BPD, DBT is a proven therapy they can effectively benefit from.
While DBT is not the only therapy to have shown results in controlled trials, it has grown a good empirical base for considering one of the best treatments for BPD, as per documented success rates.
