Dialectical Behavior Therapy (DBT)

Developed by Marsha Linehan, Ph.D, DBT is based on cognitive-behavioral therapy and helps individuals with BPD manage their emotions, develop healthy relationships and lead a meaningful life. “DBT helps people to come to regulate their emotions and be able to truly enjoy life,” according to Baugh.

DBT consists of individual therapy, group skills training and phone coaching. Each week, individuals spend one hour with a therapist and two hours in a group session and complete assignments between sessions. Because symptoms affect every part of a person’s life, “one hour of therapy a week is just not going to cut it,” Salters-Pedneault said.

DBT requires at least a six-month to a year-long commitment, because it’s highly structured, and it takes six months to go through all the modules in a skills group once, Baugh said. It’s often more effective for clients to practice these stages a second time to cement skills and start chipping away at any trauma.

The first stage addresses suicide and self-harming behavior. Stage two involves treating emotional trauma from the past. Stages three and four help clients work on “problems of living and develop their capacity for joy and a sense of being comfortably at home in the universe,” Baugh said.

For more information on DBT and its stages, see here and here.

Challenges & Strengthening Recovery

To get the most benefit out of therapy, and common to DBT practice, Dr. Wheelis asks her clients to tape-record their sessions. “By listening to the session during the week a client can learn more about their struggles.” This can be especially useful for emotionally challenging sessions. Her clients are required to spend a minimum of 20 hours each week participating in meaningful activities outside of therapy (e.g., church, charity, work). The goal is to help individuals develop a life worth living.

Keep in mind that therapy is a process, so “it’s important to be patient, work hard and give therapy a chance to work,” Chapman said. Approach each new skill or lesson with an open mind. For instance, people may doubt the usefulness of mindfulness skills, but with practice and time, many say it’s “the most helpful skill they’ve learned.”

“Sometimes therapy can be like being on a long hike and staying the course despite thunderstorms, blizzards and so on,” Chapman said. If you find yourself losing motivation or wanting to skip sessions or homework, Chapman recommended asking your therapist for help. He helps his clients “come up with at least three critically, life-and-death-important reasons for sticking with therapy, and remind themselves of these reasons when things get rough.”

Ultimately, “Try your best to be kind, compassionate, nonjudgmental and understanding toward yourself… accept yourself for who you are right in this moment, and at the same time, find ways to help improve your life. Remember that you are not to blame for your problems, but you can do something about them,” he said.

Finding Treatment

“Treatment for BPD is available and it is effective, but it may take time and effort to find the right provider,” Salters-Pedneault said. Look for a provider who specializes in BPD. Behavioral Tech has a list of DBT specialists, and the non-profit organization TARA has more information. If there isn’t a specialist in your area, Chapman suggested checking your local college for psychologists or a psychological association, which may have referral directories.

You also can contact mental health professionals at a local hospital or medical center for a referral to programs or clinicians who specialize in BPD. Some areas have mental health directories. For instance, Vancouver has the “Red Book,” which lists mental health services in your community.


Typically, selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment. SSRIs reduce depression, anxiety, anger, impulsivity and self-injurious and suicidal behavior (Bockian, Porr & Villagran, 2002).

Paul Soloff, M.D., a psychiatrist at the Western Psychiatric Institute and Clinic at the University of Pittsburgh and an expert on BPD, has written extensively about matching medication with symptoms, and has developed these categories.

  • Cognitive-perceptual: problems with thought and perception, such as paranoid thinking, suspiciousness and hallucinations.
  • Impulsive-behavioral dyscontrol: impulsivity, aggressive behavior, suicidal threats, substance abuse.
  • Affective-dysregulation: mood instability, intense and inappropriate anger, feelings of sadness.

According to a recent meta-analysis, which looked at medication efficacy for various personality disorders, antipsychotics were effective in treating cognitive-perceptual symptoms, while mood stabilizers were effective in treating anger and the impulsive-behavioral dyscontrol (Ingenhoven, Lafay, Rinne, Passchier & Duivenvoorden, 2010). Some research also has shown that olanzapine, an atypical antipsychotic, can reduce BPD symptoms, but not all studies have found this, Dr. Schulz said.

In general, a major drawback is that few studies have compared “medications in head-to-head trials,” Dr. Schulz said. Still, there’s been considerable research and many studies do show encouraging results, he concluded.

Maximizing Medication

According to Dr. Schulz, these are some of the ways to maximize the effectiveness of your medication.

  • Discuss possible side effects with the prescribing physician. “The physician and patient need to always candidly review the benefits of the prescribed medication in comparison to side effects and move on to other medications or see if the patient still needs medication if side effects outweigh benefits,” he said.
  • Take medication as prescribed, and be open with your doctor. “If a patient doesn’t discuss taking medication irregularly, the psychiatrist may think the medication isn’t working and either increase the dose or change medications when such a plan isn’t necessary.”
  • Be patient. “Medications generally show best effects over time,” so you won’t experience “immediate or miraculous results.”
  • Avoid alcohol and drugs.