DBT and BPD: The Good News

G. Pacana

3/15/20244 min read

Marsha Linehan
Marsha Linehan

“I honestly didn’t realize at the time that I was dealing with myself. But I suppose it’s true that I developed a therapy that provides the things I needed for so many years and never got.” ― Marsha Linehan

DBT, or dialectical behavior therapy, is a form of cognitive therapy that focuses on helping individuals identify and change faulty thinking patterns. DBT differs from traditional cognitive behavior therapy in that its goal is to help patients learn to live in the moment, develop healthy ways to cope with stress, regulate emotions, and improve their relationships with others.

The term dialectical can be understood as the process of accepting two seemingly opposite ideas as coexisting. In the case of dialectical behavior therapy, this means accepting oneself completely while at the same time recognizing the need to change one’s behavior. While these ideas may seem contradictory, DBT teaches individuals that it is possible and necessary to accomplish both.

“The word dialectic (in dialectical behavior therapy) means to balance and compare two things that appear very different or even contradictory. In dialectical behavior therapy, the balance is between change and acceptance (Linehan, 1993). You need to change the behaviors in your life that are creating more suffering for yourself and others while simultaneously also accepting yourself the way you are. This might sound contradictory, but it’s a key part of this treatment. Dialectical behavior therapy depends on acceptance and change, not acceptance or change.”

― Matthew McKay

Dialectical behavior therapy was developed in the 1970s by psychologist Marsha Linehan. Dr. Linehan created DBT specifically to address the unique needs of individuals with borderline personality disorder. This includes chronic suicidal and self-harming behavior. Marsha Linehan was inspired to develop DBT as a result of her own mental health struggles and experiences. Her personal journey included being diagnosed with schizophrenia and undergoing extreme treatments like electroconvulsive therapy.

A German study set out to determine the effectiveness of DBT for individuals diagnosed with BPD.

The study began with 238 individuals who were screened by telephone. Of these, 152 patients were invited for further assessment.

Of the original 152 Seventy patients started DBT treatment, 17 dropped out, and an additional six did not provide data at the 12-month assessment. Ultimately, 47 patients completed the one-year treatment and provided data for the study.

Overall, 78 patients started the study, and 47 patients completed one year of DBT treatment. These patients significantly improved regarding self-injurious behaviors, the number of inpatient hospital stays, and the severity of borderline symptoms. At the end of one year of treatment, 77% of the patients no longer met the diagnostic criteria for BPD, demonstrating the potential of DBT to facilitate remission in a substantial proportion of patients.

Highlights of the Study:

DBT was associated with a significant reduction in suicidal behaviors and the need for hospitalization. Subjects receiving DBT were half as likely to make a suicide attempt compared with those receiving community treatment by experts. Additionally, DBT was effective in reducing hospitalization for suicide ideation and lowering the medical risk across all suicide attempts and self-injurious acts combined.

Patients undergoing DBT showed better treatment adherence, with fewer dropouts from therapy. This suggests that DBT facilitates a more engaging and supportive treatment environment, which is crucial for the recovery process in BPD.

Several factors were found to contribute to remission in the treatment of borderline personality disorder:

  1. Social and Vocational Adjustment: Social and vocational adjustment at follow-up also predict better psychosocial outcomes, indicating that functional improvement is a key component of recovery.

  2. Employment: Full-time employment has been identified as a predictor of good psychosocial outcomes, which is an important aspect of recovery beyond the remission of BPD symptoms.

  3. Treatment Utilization: High rates of treatment utilization, including psychotherapy and medication, are common among BPD patients, although treatment itself was not identified as a predictor of diagnostic remission or good psychosocial outcomes in some studies.

  4. Comorbid Psychiatric Disorders: The presence of co-morbid psychiatric disorders such as major depressive disorder (MDD), substance use disorder (SUD), and anxiety disorders can decrease the likelihood of achieving good psycho-social outcomes.

  5. Symptomatic Improvement: Improvement in BPD psychopathology is associated with functional improvement, although this relationship is less clear in the long term.

  6. Rehabilitation Model of Treatment: Incorporating life skills training, such as the use of public transportation, budgeting, personal care, and vocational training, is key to fully addressing the recovery needs of patients who achieve remission of BPD symptoms.

  7. Stability of Remission: Remission of symptoms tends to be stable over time, with low rates of symptomatic recurrence after sustained remission, which compares favorably with remission and recurrence rates for other mental disorders.

  8. Active Engagement in Recovery: The desire and willingness to engage in the recovery process is crucial for progress, with individuals who have recovered often emphasizing intrinsic motivational factors.

  9. Hope: Hope is an important factor that can be generated through vocational and relational engagement, contributing to a sense of agency and progress in recovery.

These factors highlight the multifaceted nature of recovery in BPD, encompassing both symptomatic remission and the broader context of psychosocial functioning.

DBT is a highly effective treatment modality for BPD, demonstrating significant benefits in reducing suicidal behaviors, improving treatment adherence, reducing symptom severity, and facilitating high rates of remission. These outcomes underscore the importance of DBT as a first-line treatment for BPD, capable of significantly enhancing the quality of life for individuals affected by this disorder.

Sources: ncbi.nlm.nih.gov, Nami.org, sciencedirect.com