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Dialectical Behavior Therapy for Borderline Personality Disorder: An Overview


Borderline Personality Disorder (BPD) is a mental health condition defined by the National Institute of Mental Health as a disorder that “severely impacts a person’s ability to manage their emotions.” Intense mood swings and emotional outbursts can cause issues in the way they feel about themselves and their interpersonal relationships, and it can increase impulsivity.

Dialectical Behavior Therapy for Borderline Personality Disorder is an evidence-based treatment that incorporates parts of cognitive behavioral therapy, helping treat individuals through talk therapy that helps them understand the relationship between thoughts, emotions, and behaviors, teaching ways to change their lives while accepting things as they are.

The DBT Treatment Plan for BPD

The DBT treatment plan for borderline personality disorder has several stages. The Center for Addiction and Mental Health (CAMH) lists them as follows:

  • Stage 1: The patient feels out of control, and the goal is to help them achieve behavioral control.
  • Stage 2: Once behaviors are under control, the next goal is to move emotions from desperation and suffering into full emotional experiences.
  • Stage 3: This stage is to help build a fulfilling, healthy life with goal-setting, building self-respect, and finding peace to help the individual learn what normal levels of happiness and unhappiness are.
  • Stage 4: Not everybody falls into this stage. The aim of Stage 4 is to find a deeper meaning through spirituality.

DBT is often offered as group skills-training sessions along with individual psychotherapy sessions and usually takes around one year, although there are shorter “DBT-informed” programs available as well.

The American Psychological Association defines the goals of DBT as establishing a “dialectic” that helps patients accept the reality of their behaviors and their lives while also helping them to learn to change their lives for the better by changing dysfunctional behaviors and learning to regulate their emotions.

Techniques and Core Components of DBT

The key DBT therapy techniques and components include:

  • Mindfulness: The practice of being aware and present in the moment rather than ruminating on memories, thoughts, or emotions.
  • Distress tolerance: Recognizing and understanding your emotions in stressful times, and learning to manage intense emotion, responding in healthy ways.
  • Interpersonal effectiveness: Learning how to ask for what you need, communicate effectively, set healthy boundaries, and respect yourself and others.
  • Emotion regulation: Being more aware of emotions and knowing how to control them.

Real-life Dialectical Behavior Therapy Examples

dbt therapy techniques

The following are some dialectical behavior therapy examples:

  • A patient who is feeling distressed after a phone call did not go the way they were expecting may hop into a cold shower to bring their focus back into the “now” as a mindfulness technique.
  • Somebody with difficulty in romantic relationships may practice assertiveness and ask for what they want in group therapy sessions and learn to say no, bringing these skills into future romantic endeavors and fostering a healthier relationship.
  • A person who starts to feel out of control during stressful situations can gain a deeper understanding of unhelpful thoughts and how they connect to emotion and behavior, learning to accept discomfort or distress while changing how they think about a scenario.
  • Someone who regularly “blows their top” or overreacts to perceived slights can learn how to regulate intense emotions before they take hold, so they can see things from a more rational point of view while feeling more confident in their ability to handle daily stress.
  • A person who often feels upset or angry can use self-soothing techniques to reduce tension and high emotions in their daily life, like stretching, squeezing a stress ball, changing location, trying focused breathing, holding an ice cube, or running cool water over their hands, finding five things in the room you can see or hear, and counting to ten slowly.

Why Choose DBT? Unveiling its Benefits

Through interpersonal effectiveness training, emotion regulation practice, mindfulness techniques, and distress tolerance, patients learn new ways to interact with the world and understand themselves better in the process. The benefits of DBT are well-known, which is why it is a popular modality in treating BPD.

Essential Coping Skills for BPD

Some of the most essential coping skills for BPD that are taught during DBT sessions include:

  • Staying present when emotions and negative thoughts start to take over.
  • Communicating needs clearly, with more assertiveness.
  • Learning to respect and listen to others.
  • Understanding emotions and how they relate to thoughts and behaviors.
  • Learning how to accept what is happening.
  • Increasing the positive thought process.
  • Applying logical actions to emotions and thoughts.

These skills are not difficult to learn, but they require consistent practice, which is why dialectical behavior therapy comes with “homework” or at-home practice. New ways of thinking do not happen overnight, especially after a lifetime of maladaptive behavior. 

Frequently Asked Questions About Dialectical Behavior Therapy for Borderline Personality Disorder

What is the primary goal of DBT when treating BPD?

The main goal of dialectical behavior therapy is to replace unhealthy, unhelpful, or maladaptive behaviors with healthy coping strategies.

How does DBT differ from other forms of therapy for BPD?

In DBT, more emphasis is placed on emotional regulation, mindfulness techniques, and acceptance than in other treatment modalities.

How long does a typical DBT program last for BPD patients?

For most patients, a DBT program can take six months to one year to complete. Still, because everybody is unique, with their own challenges, needs, and preferences, it could take longer, especially when other mental health conditions or substance use disorders are present.

Are there any potential risks or downsides to DBT?

Part of DBT includes working in group sessions, which, although essential and helpful, some people may find intimidating or daunting. Other downsides to DBT include having to do “homework” and committing to spending a lot of time on therapy outside of sessions.

You also have to be comfortable with the idea of making challenging changes to your life and the way you think. Because DBT is rooted in mindfulness practices from Zen Buddhism, conservative people from other religious backgrounds may also object to the practices.

How do group sessions in DBT aid BPD patients?

Part of dialectical behavior therapy is teaching interpersonal effectiveness. This means that patients need to learn how to build healthy relationships, get to know new people, and communicate clearly with one another. A safe, understanding, and encouraging group setting is the best place for this type of learning to occur, and gives patients ample opportunity for practice.

Can DBT be used in combination with medication for BPD?

In many cases, prescription medications for borderline personality disorder can be used in conjunction with dialectical behavior therapy. The National Institutes of Health (NIH) does note that the goal of DBT is to reduce dependency on medications like benzodiazepines in favor of healthy coping skills.

How can one find a licensed DBT therapist?

There is a national DBT-LBC licensing board website where you can search by state, city, or zip code, or you can use the Psychology Today list of licensed professionals who offer DBT treatment.

For more information about DBT treatments, you can call the Alter Behavioral Health™ today at 949-996-9518. Find out how to get the help you need from trusted professionals, or learn more about dialectical behavior therapy techniques and benefits.

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