Which therapy has been most effective for treating borderline personality disorder?
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Show Imagine having difficulty controlling your thoughts and actions. Imagine that your sense-of-self is almost entirely dependent on your relationships with others. Imagine struggling to manage stress, rejection or conflict. This is what it’s like to live with Borderline Personality Disorder (BPD): a mental health condition characterized by a pattern of ongoing instability in moods, behavior, self-image and functioning. BPD is a highly-misunderstood condition—even within the mental health field. So, to better understand this complex condition, I talked with a NAMI HelpLine volunteer who bravely told me his story. Randy* was diagnosed with BPD at 17 after a suicide attempt landed him in the hospital. “The concept of being able to like yourself and want to live just went over my head,” he explained. “I also couldn’t handle being rejected. If I sent a text message and they didn’t get back to me for five minutes, I’d already be thinking about killing myself.” After several years of talk therapy and one month of cognitive behavioral therapy, Randy's therapist suggested dialectical behavior therapy last January. Dialectical behavior therapy (DBT) is a cognitive behavioral treatment developed to help people manage symptoms that are considered “difficult to treat,” such as: impulsivity, interpersonal problems, emotional dysregulation, self-harm and suicidal behaviors. DBT works for a range of conditions (substance abuse, depression, PTSD, among others), but it was originally developed to treat chronically suicidal individuals with BPD. Skill-Building Through DBTDBT is a combination of group therapy and individual treatment designed to help therapists offer the best treatment possible. What makes DBT unique and effective is its focus on teaching participants a set of behavioral skills that help them cope with their difficult symptoms. “The skills are what people talk about when they talk about DBT; they are the active ingredient in DBT,” explains the creator of DBT, Dr. Marsha Linehan. These skills include:
Each skill is a separate module of DBT and it takes a full year to go through all four modules in group therapy. Some may choose to repeat a module to help make those specific skills stick—like Randy, who repeated all the modules twice and the distress tolerance module three times because that’s the skill he struggles with the most. It takes a lot of time and energy to learn these coping mechanisms and implement them when symptoms flare. Everything in DBT is connected and works together to help people manage their symptoms. Skills are introduced in group therapy lessons and are learned through practice and homework. “We have a handbook,” Randy says. “It ranges from things like how to talk to someone you don’t agree with without getting emotional to ‘I’m freaking out, what do I do?’” This is followed with individual therapy that includes lessons tailored to each person so they can apply what they’ve learned to everyday life. The Gold StandardWhile it takes time and effort, the components of DBT work together effectively. Even though DBT has only been around for a couple decades, it has already improved and saved the lives of many. Research shows it’s incredibly effective—one study from 2014 showed that 77% of participants no longer met criteria for BPD diagnosis after undergoing treatment. DBT is recognized as the “gold standard” for people with BPD. “It’s weird how much better I’ve gotten from it. Looking back, I was so different; I didn’t know how to handle life. Sometimes I still don’t, but I’m getting there. I’m getting better.” *Name has been changed to protect our volunteer's privacy Laura Greenstein is communications coordinator at NAMI. If you or someone you know is interested in entering a DBT program, you can search for a certified clinician here. Dialectical behavioral therapy (DBT) may improve symptoms of borderline personality disorder (BPD) by teaching skills that include mindfulness and emotion regulation. Marked by difficulties with emotional regulation, interpersonal relationships, self-image, thoughts of suicide, and other symptoms, living with borderline personality disorder (BPD) isn’t always easy. However, it’s possible to live a happy, fulfilling life with the right kind of treatment and support. Research shows that the prognosis for BPD is good, especially for those who seek treatment through specialized therapy. The most popular and most effective form of therapy for BPD is dialectical behavioral therapy (DBT). This form of therapy was created for people with borderline personality disorder in mind. If you’ve been diagnosed with BPD, know that you’re not alone. In fact, it’s estimated that about 1.6% of U.S. adults are affected by this condition. DBT is a multifaceted treatment approach created by Dr. Marsha Linehan in the early 1990s. Linehan created DBT in hopes of providing relief to those living with BPD, a condition she’s experienced, as she later revealed in her book “Building a Life Worth Living: A Memoir.“ DBT, while created for BPD, has also been helpful for those with:
DBT is a skills-based treatment program broken into four main modules:
Each module consists of various skills that are specific to that module’s theme. Some skills you may learn include:
Each module consists of group and individual therapy, as well as homework assignments. Your therapist may also be available for phone coaching in moments where skills may need to be practically applied. DBT is skills-based, meaning it’s both practical and achievable. Typically, a DBT program lasts 1 year. Since those with BPD often experience black-and-white thinking, one of the foundations of DBT is literally within its name: dialectics. Dialectics is defined as holding two seemingly opposite ideas at one time, considering both to be truths. In DBT, “dialectical” refers to the idea of needing both acceptance and change to help improve symptoms. This can bring greater balance and reduce black-and-white patterns of thought. The other foundation of DBT is mindfulness. Through mindfulness, those living with BPD can learn to make more intentional, conscious decisions and decrease impulsivity and other unhelpful or potentially harmful behaviors over time. One mindset taught during mindfulness is “wise mind,” which encourages dialectical thinking in crisis and normalcy. It also helps you to attend to your emotions and reason to make wise and balanced decisions. Ultimately, DBT helps those with BPD both function and flourish in their everyday lives. What does research say about DBT?Research has shown DBT to be the most effective form of treatment for those with BPD. In fact, one study found that after the first year of treatment, 77% of participants no longer met the diagnostic criteria of BPD. DBT is particularly effective for improving:
BPD symptoms such as chronic feelings of emptiness, difficulties with personal relationships, and an intense fear of abandonment tend to be more difficult to treat with DBT — but not impossible. It’s important to remember that BPD doesn’t look the same for everyone. Different people may have different symptoms, and though DBT may help many people with the condition, it may not work for everyone. If you feel as if DBT isn’t helping you, there are many other options you can discuss with your treatment team, including:
At times, short-term hospitalizations may be necessary. This is particularly true in times of extreme stress and when you experience suicidal or impulsive behaviors. Currently, there is no medication specifically for BPD. Some people with co-occurring conditions such as anxiety or depression may benefit from taking antidepressants. Your doctor can help you figure out whether medication may be beneficial in your case. Overall, dialectical behavior therapy (DBT) has been shown to be the most effective form of treatment for people with borderline personality disorder (BPD), especially if you experience thoughts of suicide or self-harm or want to reduce anger. It also helps with social skills and overall quality of life. If you think DBT may be right for you, finding a qualified and experienced therapist in your area is crucial. The National Education Alliance for Borderline Personality Disorder offers helpful tips when searching for a suitable therapist. Plus, the Borderline Personality Disorder Resource Center maintains a database of healthcare professionals in the United States who have experience treating BPD. You can call them at 1-888-694-2273 or send them an email at . Though living with BPD can be challenging at times, try to keep in mind that you’re not alone and that you can get better with the right treatment and support. What is the most effective treatment for personality disorders?Psychotherapy, also called talk therapy, is the main way to treat personality disorders.
Why is CBT not effective for BPD?Traditional forms of therapy, such as CBT, may not be effective in healing the deep emotional trauma that causes your current reactive responses because most of these pre-language trauma memories are shielded from your cognitive process. Your intellectual, 'logical' brain is bypassed when you are triggered.
Is CBT effective for BPD?CBT has been shown to be effective in managing BPD in relationships. In a study, it revealed that those in CBT treatment for a year had better outcomes. CBT helped these couples reduce feelings of hopelessness and impulsivity, a big factor of BPD behavior.
Why is DBT effective for borderline personality disorder?6 Dialectical behavior therapy aims to address the symptoms of BPD by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
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