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Dialectical Behavioral Therapy (DBT) for Borderline Personality Disorder

Borderline personality disorder is a mental illness that is characterized by the inability to control strong negative feelings or impulses that often result in destruction of, or interference with, interpersonal relationships. People with borderline personality disorder lack the ability to let things roll off their backs and often experience unwarranted paranoia and jealousy. People on the receiving end of these intense emotions either end the relationship or withdraw from all but the most fleeting of contact with the patient. Understandably, this further erodes the patient’s emotional stability. In severe cases, the patient may self-harm or become suicidal. Borderline personality disorder is extremely debilitating and very difficult to treat.

Researchers have yet to determine what puts someone at risk for borderline personality disorder, although patterns among patients have been observed. For instance, some people are simply predisposed to experiencing feelings more intensely than others. Still others report having been subjected to emotional or physical trauma as a child.

The most common pattern, however, occurs in patients who report having grown up in households that discouraged the show of emotion altogether or criticized the show of certain emotions. The patient eventually discovered that only an intense and dramatic display of emotion would garner any sort of familial response, given that normal emotions were discounted. Unfortunately, this learned behavior did not end when the child reached adulthood and, instead, inappropriately carried over into other types of relationships.

There is no known medication that can completely control the effects of borderline personality disorder. Fortunately, mental health professionals have recently made great strides in treating borderline patients with a specific type of talk therapy called dialectical behavioral therapy (DBT). Marsha M. Linehan, a professor in the Department of Psychology at the University of Washington, the originator of dialectical behavior therapy, which has been shown to reduce the incidence of self-harm and suicide attempts, eating disorders and depression.

The point of DBT is to teach patients how to control the emotions that are causing problems in their relationships with others. DBT consists of individual sessions and group skills training. In most cases, therapists will also make themselves available by phone to handle any crises that may arise when not in session.

DBT is a type of cognitive behavioral therapy, a very useful tool in teaching patients how to think and behave in healthier and more productive ways. However, whereas regular cognitive behavioral therapy focuses on change rather than on why a patient turned out the way they did, those who practice DBT help borderline patients accept who they are and how they got there.

One of the first tasks during dialectical behavioral therapy is actually experiencing the problematic emotions, recognizing what is happening, and accepting what has occurred. After that, the patient can be taught techniques to minimize the intensity of the feelings and move on. This change in behavior is designed to make interpersonal relationships, or harmful responses, less intense and problematic.

During the acceptance phase, DBT patients learn how their current emotional responses developed as a means to deal with difficult experiences or events. Instead of pointing out how harmful the response has become, the patient is asked to accept that the response did serve a purpose at one time. Once patients have accepted the emotions for what they are, they learn better ways to deal with stress and difficult situations. DBT is vital when patients have engaged in sel- harm or expressed thoughts of self-harm or suicide.

Like with many types of talk therapy, the rapport between the borderline patient and DBT therapist is extremely important as relationships play an integral part in the borderline patient’s life. Dialectical behavioral therapy focuses heavily on this relationship to encourage the patient to change.

Individual DBT sessions typically occur once a week; the goal of these sessions is to help patients learn to control their behavior and emotions. This is most important when a patient is actively thinking of hurting herself or in cases where the patient’s behavior will get in the way of the therapeutic process. Progress during these sessions is measured by a series of goals set at the beginning of treatment. The therapist tailors sessions to help the patient achieve these goals.

Patients are asked to keep record of the emotions and behavior that occurred when not in session so that specific situations or incidents can be examined in therapy. Unlike traditional psychotherapy, DBT works best with specific examples of certain behaviors and emotions, rather than general descriptions. The more specific the description, the greater the chance that the therapist will be able to help the patient devise a better way to handle the issue in the future. For each incident, DBT will help the patient identify what caused the problem, why the problem became more serious than it should have been, and the eventual negative fallout.

During group DBT sessions, patients learn better ways to deal with problems or situations they have encountered. Specifically, patients focus on crisis control, interpersonal interactions, emotion regulation, and staying in the present. Patients are often asked to complete homework assignments that require them to use the skills they’ve learned in everyday situations.

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