DBT for Borderline Personality Disorder (BPD)

Dialectical Behaviour Therapy (DBT) for Borderline Personality Disorder (BPD)
Dialectical behaviour therapy (DBT) focuses on the concept of mindfulness, or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behaviour, manage distress, and improve relationships. It seeks a balance between accepting and changing behaviours. This proactive, problem-solving approach was designed specifically to treat BPD. Treatment includes individual therapy sessions, skills training in a group setting, and phone coaching as needed. DBT is the most studied treatment for BPD and the one shown to be most effective.

DBT’s Theory of Borderline Personality Disorder

Dialectical Behaviour Therapy is based on a bio-social theory of borderline personality disorder. Linehan hypothesises that the disorder is a consequence of an emotionally vulnerable individual growing up within a particular set of environmental circumstances which she refers to as the Invalidating Environment. An emotionally vulnerable person is someone whose autonomic nervous system reacts excessively to relatively low levels of stress and takes longer than normal to return to baseline once the stress is removed. It is proposed that this is the consequence of a biological diathesis.



DBT for Borderline Personality Disorder (BPD)

The term Invalidating Environment refers essentially to a situation in which the personal experiences and responses of the growing child are disqualified or “invalidated” by the significant others in her life. The child’s personal communications are not accepted as an accurate indication of her true feelings and it is implied that, if they were accurate, then such feelings would not be a valid response to circumstances. Furthermore, an Invalidating Environment is characterised by a tendency to place a high value on self-control and self-reliance. Possible difficulties in these areas are not acknowledged and it is implied that problem solving should be easy given proper motivation. Any failure on the part of the child to perform to the expected standard is therefore ascribed to lack of motivation or some other negative characteristic of her character.
Linehan suggests that an emotionally vulnerable child can be expected to experience particular problems in such an environment. She will neither have the opportunity accurately to label and understand her feelings nor will she learn to trust her own responses to events. Neither is she helped to cope with situations that she may find difficult or stressful, since such problems are not acknowledged. It may be expected then that she will look to other people for indications of how she should be feeling and to solve her problems for her. However, it is in the nature of such an environment that the demands that she is allowed to make on others will tend to be severely restricted. The child’s behaviour may then oscillate between opposite poles of emotional inhibition in an attempt to gain acceptance and extreme displays of emotion in order to have her feelings acknowledged. Erratic response to this pattern of behaviour by those in the environment may then create a situation of intermittent reinforcement resulting in the behaviour pattern becoming persistent.

DBT places strong emphasis on acceptance and validation.
The two core elements are, Acceptance skills (Mindfulness skills & Distress Tolerance skills) and Change skills (Emotional Regulation skills & Interpersonal Effectiveness)

What skills are taught in DBT?

Mindfulness: the practice of being fully aware and present in this one moment
Distress Tolerance: how to tolerate pain in difficult situations, not change it
Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
Emotion Regulation: how to change emotions that you want to change