

"It is hard to be happy without a life worth living. This is a fundamental tenet of DBT. Of course, all lives are worth living in reality. No life is not worth living. But what is important is that you experience your life as worth living, one that is satisfying, and one that brings happiness.” ― Marsha Linehan
While there are several therapies used in the treatment of BPD the most popular and effective treatment is called DBT or dialectical behavioral therapy.
This form of therapy was first developed in the 1970s by Dr. Marsha Linehan. Initially DBT was used primarily in the treatment of suicide and self-harming behaviors. But by the 1990s due to the work of Dr. Linehan DBT had become the principal therapy in the treatment of Borderline Personality Disorder.
It has also been used successfully to treat eating disorders, substance abuse disorders, and PTSD. In fact, DBT has been empirically validated for a variety of different populations and conditions including substance use disorders, suicide, PTSD, self-harm, symptoms of depression and anxiety, eating disorders, including binge eating and bulimic tendencies. There is less evidence however supporting the effectiveness of DBT in the treatment of anorexia.
Dialectical behavioral therapy helps people tolerate and regulate their emotions. It is based on cognitive behavioral principles and focuses on problem solving and acceptance.
The American Psychological Association defines DBT as a form of psychotherapy that comprises elements of cognitive behavior therapy (CBT) and mindfulness. The term “dialectical” refers to the combination of two opposing ideas. The first of these ideas is the acceptance of the reality of a person’s life and behaviors. The second opposing idea is the change of situations and dysfunctional behaviors.
The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white or all-or-nothing styles of thinking. DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.
DBT is a stage-based therapy, meaning it involves specific stages of treatment. The following are the four stages of DBT therapy.
Stage 1: This stage involves stabilizing people and helping them gain control of their behaviors. Therapy in stage 1 involves crisis intervention and keeping people safe from suicide, self-harm, or addiction issues.
Stage 2: During stage 2, individuals will work on their emotional pain and traumatic experiences. Therapists help clients to identify unhelpful thoughts, behaviors, and beliefs.
Stage 3: Stage 3 involves solving issues the individual associates with their everyday life. Therapy focuses on maintaining progress and setting achievable goals. The aim is to help people take responsibility for their actions and find joy in life.
Stage 4: In the final stage, individuals work toward advancing their lives and achieving spiritual fulfillment.
Dialectical behavior therapy provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on helping patients to achieve four essential skills. These are:
Distress Tolerance
This skill involves being able to feel intense emotions, such as anger or grief, without reacting impulsively or using maladaptive coping techniques, such as substance abuse or self-harm.
Emotional regulation
Regulating emotions is a key component of DBT. Individuals learn to recognize and accept their emotions without judgment. They learn to stop letting negative emotions take over. Individuals can learn to stop an emotion, such as sadness, from escalating into feelings of anguish, depression, guilt, and shame. They can also learn how to increase emotions that feel good, such as joy and love.
Mindfulness
Mindfulness involves developing an increased awareness of the present moment while having an open, nonreactive attitude and an acceptance of how things are. Living in the moment can have positive outcomes for a person’s awareness of their body, their ability to regulate their emotions, and their perception of themselves. DBT helps people to learn mindfulness techniques so they can more fully live in the present.
Interpersonal effectiveness
Learning to regulate emotions can help people to deal with conflict and to communicate more effectively. In turn, these skills increase interpersonal effectiveness, or the ability to interact with others. Through DBT, people can learn interpersonal skills, such as listening, assertiveness, and other social skills.
The Benefits of Dialectical Behavioral Therapy
The Benefits of DBT include:
A reduction in suicidal and self-harming behaviors
Improved tolerance and regulation of emotions
A reduction in symptoms of anxiety, depression, trauma, and stress
Learning to set reasonable goals to improve quality of life
Decreasing maladaptive behaviors and thoughts affecting quality of life and relationships
Improving self-belief and self-respect
DBT appears to be an effective therapy for BPD and other issues that can be challenging to treat, including substance abuse, and eating disorders.
It is a structured treatment that involves individual therapy, group work, and phone consultations. Individuals will learn to regulate and accept their emotions and to set goals to improve their quality of life.
DBT may not be for everyone, however. If an individual does not feel that DBT is working for them, they should consider trying one of the many other types of therapy. A doctor or mental health professional can advise on their options.
Patient frequency rates and length of hospitalization have been shown to decrease in several studies that have been conducted on DBT. And it has also been supported not just with adults but with adolescents as well. Women are the primary gender in which DBT has been used but there has also been some evidence that it is helpful with both genders.
The Effectiveness of DBT in Treating BPD
While DBT is not a cure for borderline personality disorder, it can be very effective in reducing and managing the symptoms of the condition. A 2014 German study attempted to examine the effectiveness of DBT for BPD under the routine health care situations.
The study was conducted over the course of four years with six assessment points. Overall, 78 patients started the study, 47 patients completed one year of treatment. Patients significantly improved regarding self-injurious behaviors, number of inpatient hospital stays, and severity of borderline symptoms. At the end of one year or treatment, 77% of the patients no longer met criteria for BPD diagnosis.
