DBT: help for borderline personality disorder (BPD)

“Having BPD is difficult, but not hopeless.  I’ve learned to use what makes me different to grow a beautiful person, a better person.” –Anonymous

DBT: Helping people with
borderline personality disorder

Dialectical behavioral therapy (DBT) is about help for people with borderline personality disorder (BPD).  It was created by Marsha Linehan, PhD, to help people with BPD improve the quality of their lives.

The therapy is an intensive 6-month program that targets difficult-to-treat symptoms like suicidal thoughts & behaviors, poor sense of self, mood regulation difficulties, problems relating to others, and poor stress tolerance.  The program was created specifically for people with BPD.  Lately it’s been found to help people with other disorders, like drug abusers or people with a history of trauma.

Here’s a quick overview of BPD.

Borderline Personality Disorder in a Nutshell

What’s BPD?

BPD is a mental health condition characterized by patterns of dysfunction in mood, sense of self, behavior, and functioning.  They have intense mood swings, are sensitive to social rejection (even imagined), and an unstable self-image.  They have problems being alone. Their identity is dependent entirely on their relationship with others.  They’ll go to great lengths to avoid abandonment.

People with BPD also tend to have black and white thinking.  They often describe life in terms of all good or all bad, with nothing in between.  People are seen as all good/all bad too, and sometimes a friend’s worth will oscillate between the two.

The most alarming aspects of BPD is the person’s tendencies to injure themselves purposefully.  Rage and assaultive behaviors are common too.

“With BPD my emotions are 10x’s amplified than an average person.  When I’m mad, sad, hurt, happy, my emotional regulation is 10x’s more amplified.  Both a blessing and a curse to feel so deeply.” –Chanelle, FB user.

What causes BPD?

The disorder is related to a chaotic, invalidating environment during early childhood.  This is the home where a kid’s mother praises him for something on day one, then slaps him for doing the same thing on day two. The child’s life is filled with inconsistent messages about his worth, and this sense of identity is frequently connected to sexual abuse.

The theory of an invalidating childhood makes sense.  If as a child you didn’t get fed unless you acted out, then you kicked and screamed often and emphatically!  Anything less would have meant starving to death.  In that situation, “kicking and screaming” worked as an effective coping skill.  This “skill” carries over to adulthood.  Kicking and screaming, hurting oneself, hurting others… it means that the person with BPD isn’t forgotten.

What are the treatments?

Medications can help with mood swings, depression, impulsivity, anger, and behavioral problems, but DBT is the treatment of choice.

Okay, so tell me a little about DBT

As mentioned beforehand, DBT is an intensive life skills program aimed at treating BPD.  The main goal of therapy is to diminish self-injurious behaviors, but there’s also an emphasis on teaching people to live in the moment, cope better with stress, come to terms with and regulate emotions, and improve social skills.  DBT involves both individual and group interaction.  The social aspect is key to treatment.

A basic run-through

The major premise of DBT is that patients are trying the best they can and that they can do even better with the right support and direction.  That’s a contradiction between acceptance and change: the mental health provider accepts the patient as they are but challenges them to do better.

The “dialectical” part of DBT kicks in here: it’s about balancing contradiction.  Balancing acceptance and requesting change is a tremendous part of treatment.

DBT uses this contradiction in a therapeutic way.  People in general, including non-BPD people, are more likely to cooperate and change their behaviors if they feel understood and acknowledged.  In DBT, the therapist first joins with the patient and acknowledges that their current behaviors make sense in context of past experiences.  They’re doing the best they can.  Once they have the patient’s permission and trust, they then offer alternative approaches to the problem.

“You are so good.  So good.  You’re always feeling so much.  And sometimes it feels like you’re gonna bust wide open from all the feeling, doesn’t it?  People like you are the best in the world, but you sure do suffer for it.” — Silas House.

What’s DBT like?

DBT involves both group and individual therapy.

Group therapy follows a very specific outline made up of four modules.  The class involves loads of homework, i.e. working on specific coping skills.  These skills are practiced and reported back to the class. The four modules include:

• Mindfulness. Strengthening the “self” by embracing the moment.
• Interpersonal skills. Highlights social skills and assertiveness training
• Emotional regulation. Aims to better understand and deal with negative emotions, while increasing positive emotion
• Stress tolerance. Presents specific coping skills to increase resilience.

Individual therapy focuses on reducing self-injurious behaviors, dealing with crises, and balancing acceptance with change.  The DBT therapist is typically available 24/7 to help patients use their coping skills in a crisis.

How about an example?

Here’s a quick example. The Stress Tolerance Module starts with a page devoted to “Crisis Survival.”  When dealing with a crisis, there are four options the patient can try.

(1) Distraction methods using the mnemonic “Wise Mind ACCEPTS”

(2) Self-soothing exercises

(3) Improving the moment using the mnemonic “IMPROVE”

(4) Weighing the pro’s and con’s of what they’re doing

Let’s hone in on #3, improving the moment: IMPROVE.  IMPROVE stands for:

• Imagery (different examples of imagery are offered)
• Meaning (the patient is encouraged to find purpose in their situation)
• Prayer (or spiritual/philosophical reflection)
• Relaxation (examples include muscle relaxation, a hot bath, or getting a massage)
• One thing in the moment (focusing all energy on the now)
• Vacation (methods of escape are described, including getting in bed and pulling the sheets over one’s head, checking into a hotel and turning off the phone for a day, or going to a park and lying on a blanket)
• Encouragement (being one’s own cheerleader, repeating a soothing phrase over and over, like “It won’t last forever.”)

People with BPD tend to have dramatic, painful lives filled with crises and meltdowns — and limited resources to deal with them — so these seven stress-busting methods can be a godsend. Typically the facilitator reviews the skills in great detail.  They give personal examples. The skills are play-acted in class.  Afterwards, students practice the methods at home and report back when they next meet.  There are homework sheets and coping skill diary cards to help organize efforts.

Where can I learn more about DBT?

If you’re interested in learning more, talk to your provider or check out DBT programs in your area.  Alternatively, look into self-help DBT books or dbt self help websites.

In conclusion:

DBT focuses on helping people with BPD learn how to live and love life.  This includes a medley of skills ranging from Eastern mindfulness and a deeper sense of self to assertiveness, resilience, and regulation of emotions.  In the end, these are skills we all use (or could use) in our day-to-day struggle to enjoy life.

“It was really hard for many, many years.  But I’ve learned to grow with the way I was born with BPD.  I love myself now and because I have been through so much…. I can help [others] so much.” — Anonymous, FB user.