Borderline personality disorder (BPD) was once notoriously difficult to treat. There were few standard treatment modules specifically created for BPD. That is until dialectical behavior disorder (DBT) came along. But what is DBT and why does it work in treating borderline personality disorder?
What is dialectical behavior therapy (DBT)?
Created by psychotherapist Marsha Linehan, dialectical behavior therapy is a treatment that draws on strategies from cognitive-behavioral therapy (CBT) but has Eastern mindfulness at its core. While CBT is one of Western psychology’s most effective treatments when it comes to anxiety in particular, it is only partly effective in treating BPD, depression, and other mood and personality disorders.
CBT challenges irrational thoughts, but using CBT skills is extremely difficult for people with BPD when caught up in the moment. The mindfulness techniques in DBT create the space for the person to pause and regulate their emotions.
How does DBT work for borderline personality disorder?
Eastern mindfulness is at the core of DBT. With mindfulness principles, the person training in DBT is taught to find the “Wise Mind.” The Wise Mind is neither the emotions nor the thoughts. Rather, it is the space to observe both and see them more objectively.
Unlike CBT, which focuses on engaging and challenging thoughts, DBT teaches you to weather thoughts and feelings. Instead of trying to avoid them or letting them spiral out of control, you pause and take a step back, using mindfulness techniques to view them without judgment.
Using DBT, you aspire to non-reactivity. For people with BPD, reacting to challenges, whether real or perceived, causes a lot of damage. Reactions are often disproportionate or based on a misunderstanding, leading to self-destruction and the loss of relationships.
Learning not to react is therefore far more effective than trying to learn to react differently. When a person with DBT is caught up in thoughts and emotions, replacing them with other thoughts and emotions is almost impossible.
This non-reactivity might sound radical and as difficult to implement as any other techniques. But there is a reason mindfulness techniques are easier for people with BPD to learn.
The mindful lifestyle
Mindfulness is not a typical treatment. Rather, it is a different way of approaching life. It encourages us to live in the moment, no matter how difficult that moment may be. Because mindfulness is a lifestyle, it can be learned and implemented when there is very little to react to.
In other words, DBT is taught when emotions and thoughts are at a normal or low level. The mindfulness skills are practiced as a way of relating to life in the moment. Then, when the thoughts and feelings that are usually overwhelming arrive, the individual is prepared to experience them non-reactively.
Of course, it takes time for a person with BPD to become skilled in mindfulness techniques. However, DBT takes this into account and provides practical skills (drawn from CBT strategies) to get through day-to-day challenges.
DBT is the most effective treatment available for borderline personality disorder. It has also been proven useful in treating mood disorders such as depression and bipolar disorder. Today, it is used in inpatient and outpatient treatment centers around the world.