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
DBT is a multifaceted treatment approach created by Dr. Marsha Linehan in the
DBT, while created for BPD, has also been helpful for those with:
DBT is a skills-based treatment program broken into four main modules:
- Mindfulness. Mindfulness teaches you to focus on the here and now by becoming aware of your thoughts, feelings, and sensations.
- Interpersonal effectiveness. In this module, you learn, for example, how to communicate effectively, build and cultivate healthy relationships, and express your needs.
- Emotion regulation. DBT teaches you techniques to help you understand and manage your emotions.
- Distress tolerance. In this module, you learn techniques to manage overwhelming emotions or difficult situations.
Each module consists of various skills that are specific to that module’s theme. Some skills you may learn include:
- wise mind
- radical acceptance
- building positive experiences
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,
DBT is particularly effective for improving:
- suicidal thoughts and behaviors
- difficulties with anger management
- overall daily functioning, including socially
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:
- Mentalization-based therapy (MBT). MBT helps people with BPD identify and understand their own and others’ actions, feelings, and thoughts.
- Transference-focused therapy (TFP). In TFP, your therapist allows you to “transfer” thoughts or feelings you may have about another person onto them, which may allow them to understand your symptoms better. In collaboration, you can work out ways to change behaviors or negative thinking that your BPD may cause.
- Good psychiatric management (GPM). GPM teaches you problem-solving and stress-management strategies to help with life difficulties and to better understand yourself.
- Schema-focused therapy (SFT). SFT helps people with BPD change negative patterns of thoughts, behavior, and emotions, which are known as “schemas.”
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.
Are you in a crisis or considering suicide?
If you’re having thoughts of suicide or self-harm, you can access free support right away with these resources:
- The National Suicide Prevention Lifeline. Call the Lifeline at 800-273-8255, 24 hours a day, 7 days a week.
- The Crisis Text Line. Text HOME to the Crisis Text Line at 741741.
- The Trevor Project. LGBTQIA+ and under 25 years old? Call 866-488-7386, text START to 678678, or chat online 24-7.
- Veterans Crisis Line. Call 800-273-8255, text 838255, or chat online 24-7.
- Befrienders Worldwide. This international crisis helpline network can help you find a local helpline.
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 firstname.lastname@example.org.
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.
For family members and friends
If someone you care about has been diagnosed with BPD, and you’re interested in learning more about the condition and how to be a supportive ally, the National Education Alliance for Borderline Personality Disorder offers the Family Connections Program, a free 12-class course in which you learn about:
- BPD and its treatment
- DBT-based relationship skills
- how to take care of yourself
- how to communicate effectively
Keep in mind that the current wait time is 5–6 months, and you have to be 18 years or older to participate.