Dialectical Behavior Therapy for Borderline Personality Disorder

Introduction

Dialectical behavior therapy (DBT) is an evidence-based and broad psychiatric therapy treatment package that works through a cognitive-behavioral method. The therapy was discovered in the early 1990s by Marsha Linehan, a psychology scholar at the University of Washington. Linehan was conducting research work on different interventions and cures for mental health disorders. The participants included patients with recurrent suicidal tendencies who were suffering from a borderline personality disorder (Axelrod, 2019). Linehan ended up discovering evidence-based cognitive-behavioral schemes that worked to eliminate patients’ suicidal conduct.

DBT helps people to enhance their capacity to control and hold their emotions and successfully manage interactions with others and also put up with stressful moments. Therefore, DBT treatment is based on a person’s emotions (Axelrod, 2019). It operates by uniting two therapy opposites together, that is, acceptance and change.

The Theoretical Basis for the DBT

Linehan succeeded in developing dialectical behavior therapy by focusing on aiding her patients to change their thinking, emotional state, and behaviors. Other researchers have come to support Linehan’s findings that DBT is probably the best successful intervention that can help patients to reduce dangerous impulse-control conditions, such as a borderline personality disorder (BDP) which is mainly characterized by suicidal tendencies. Therefore, the initial goal of dialectical behavior therapy was to help to cure individuals with acute mental sickness, especially those who have been found to suffer from a BPD with recurring suicidal thoughts (Sahranavard & Miri, 2018). DBT is still applied in curing people with BDP, but today it can also be used to treat substance use disorders (SUDs), including alcohol or drug abuse.

A theoretical application of DBT would apply to a patient who does not exhibit BDP and may well use the therapy. For instance, a case of an opiate-dependent young lady in her mid-20s called Lucy can be considered. She has time and again been cleared from a community-based methadone care program due to drug-positive urinalyses and trouble attending to her treatment. Moreover, the lady has experienced several incidents of significant depression, given that she is staying with her obnoxious husband. He has no interest in quitting his drug abuse behavior. A detailed behavioral analysis shows the principal role of emotional decontrol, occasioning her recurrent drug abuse behavior. The usage tendency escalates many times before engaging in sex with her partner, after arguing with him, or as an outlet to cover damaging feelings, such as gloom (Smee, 2004). Lucy certainly does not meet the required benchmarks for treatment with BPD. However, DBT may still be needed given the many emotional-wrenching encounters she undergoes in the house.

DBT applies problem-oriented methods that are instructive together with helpful practices, such as thinking, reception, compassion, and stressing the patron’s integral aptitude to access their inner ‘wise mind.’ On top of that, DBT employs various dialectical strategies, including corresponding approval with change, using puzzles and imagery, as well as interchanging substantiation with problem-solving. Singular DBT embattled dysfunctional conducts in a tiered order (therapy-interfering, suicidal, substance use, and quality-of-life meddling manners) are replaced with those deeds with competent deeds well-read in a psycho-educational talents group. The personal psychotherapist has to vigorously fortify adaptive conduct. They must also suppress reinforcement or should provide aversive penalties for conduct directed for change (Axelrod, 2019). The approach is aimed at teaching patrons how to control responsive suffering, in place of decreasing undesirable feelings or taking patrons out of their predicaments.

Intended Goals and Outcomes of DBT

Dialectical behavior therapy enables substance abuse addicts to recover through learning various skills that effectively help the addicts to stop engaging in alcoholism and drug abuse. DBT seeks to change the conduct of the recovering addict and the surroundings to make it easier for them to recover. Common strategies used include assisting patients to move to locations and finding peer groups that discourage the abuse of alcohol and drugs. The second strategy is to encourage addicts to get rid of triggers such as alcohol and drug trappings or harmful dealings in their day-to-day life (Axelrod, 2019). Lastly, DBT seeks to strengthen confidence and self-assurance to enable addicts to remain sober through tense times.

DBT seeks to help a person to learn how to balance change and acceptance in such a way that the individual can progress in the direction of a drug-free life. For the duration of the therapy, a person is taught by the therapist ways of controlling cravings, developing healthy emotional status, developing degeneration prevention abilities, and setting progressive and encouraging goals. Generally, these changes cultivate soberness and fashion better mind-body-spirit steadiness. The program underlines crafting a justifiable quality of life while also working on cutting behaviors that cause harm (Sahranavard & Miri, 2018). DBT is effective for treating anyone with difficulty regulating emotions.

Fundamental Intervention Techniques of DBT

There are four main techniques applied in dialectical behavior therapy, including:

Skills Training

While conducting her research work, Linehan taught her patients diverse techniques of responding to different scenarios even as she underpinned recognition of their feelings and experiences. By incorporating acceptance into treatment, she discovered a dialectical philosophy where psychiatrists must balance and bond acceptance with mediations that supported the change. That is how she stumbled upon an all-inclusive interactive treatment program for her patients with BDP. In the same way, to defeat alcohol and drug abuse, group leaders teach addicts valuable skills such as distress tolerance, mindfulness, emotional control, and interactive efficiency (Sahranavard & Miri, 2018). Addicts can apply the skills in their daily activities through some structure and coping mechanisms to progress and put off challenging deeds.

  • Distress Tolerance: DBT teaches a unique mechanism to help to cope with crises without making the situation worse. People are taught ways to effectively admit a challenge and find sense despite stomaching and functioning through upsetting moments (Sahranavard & Miri, 2018). Individuals learn various healthy techniques, including self-soothing, distraction, and balancing the pros and cons.
  • Mindfulness: DBT teaches people ways to be keen and pay close attention to the present moment while regulating their responsiveness (Sahranavard & Miri, 2018). It encourages people to observe, define and play a part in the moment effectively and in a broadminded way.
  • Emotion Control: This teaches people techniques to detect and work through damaging feelings. According to Sahranavard and Miri (2018), DBT and emotional control come in handy in reducing a person’s dynamic susceptibility by augmenting constructive emotional incidents, increasing mindfulness of current reactions, and using distress tolerance methods.
  • Interactive Efficiency: DBT interactive efficiency teaches people to cultivate healthy relational contacts. Patrons learn how to deal with conflict and employ emphatic communication styles (Sahranavard & Miri, 2018). Interactive efficiency focuses primarily on social sites where a person must make requests to others or repel others’ changes.

Individual Therapy

Individual therapy supports the recuperating addicts learn to work the skills acquired during training in everyday encounters. It should be conducted every week for the whole duration of the DBT program. Individual therapy meetings are custom-made to a recuperating addict’s character (Lynch et al., 2018). Afterward, psychiatrists can support the addict to choose the most fitting way to apply his or her newly acquired skills.

Phone Drilling

Phone drilling is a technique that encourages recovering addicts to call their therapists as soon as they get entangled in challenging situations. Lynch et al. (2018) state that the therapist prepares the recovering addict to use distress tolerance and emotional control techniques to control feelings and contain stressful moments.

Team Meetings

Therapists, together with other healthcare providers, hold consultations to motivate the therapists to provide the best care possible for addicts that can be problematic to treat.

Furthermore, recuperating addicts are given homework assignments that they must complete (Leahy, 2017). The duties include preparing a journal of their daily activity, feelings, and cravings they experience during the day.

Advantages and Limitations of DBT in Community-Based Practice

Even though DBT was principally developed to address borderline personality disorder (BPD) with recurring suicidal thoughts, today, the technique is widely used to help individuals with mental health problems. Some of these mental health illnesses include addiction and depression. DBT supports people to learn how to manage strong emotions while controlling impulsivity and disparaging actions (Lynch et al., 2018). Moreover, individuals are taught skills and treatment modalities to offer therapists an occasion to use DBT for many other mental health disorders, extending the bracket of those who benefit from DBT.

Furthermore, by undergoing DBT, a person can break, check on their feelings, and react calmly to the situation they are confronted with. The moment they recognize the real challenge and are clear of solid responses, they are less likely to participate in harmful deeds. DBT enables people to become less hypercritical (What Are the Benefits of Dialectical Behavior Therapy, 2019). The minute they take a relaxed position in their surroundings, they reduce the likelihood of being controlled by deleterious reactions. DBT reduces suicidal thoughts and other self-destructive actions. Patients who go through the entire program (usually 24 months) can relate well with others in society and, in turn, have a consistent engagement that boosts their mental health. People with a healthier self-image are less disposed to engage in alcohol and drug abuse as a way of enduring the daily struggles in life (Leahy, 2017). Therefore, people will be less likely to experience hospitalization due to mental well-being and enjoy a more stable life.

A significant handicap of dialectical behavior therapy is that it was specifically designed for people with general emotional weaknesses, even though it can help people who abuse alcohol and drugs. DBT works best for people who engage in substance abuse disorders and, at the same time, have a borderline personality disorder (Juergens, 2021). Therefore, the therapy reduces effectiveness if applied to people whose emotions do not come to play or have a small impact on their tendency to engage in alcohol and drug abuse.

A major inadequacy of dialectical behavior therapy is the rigidity in the use of DBT. Therapists are required to work with the template provided to help patients strictly. Otherwise, if they try to work by ‘their heads,’ they are disposed to fail miserably. Moreover, DBT is not clear on what suicidality refers to for the participants, nor does it indicate how it is experienced or treated (Comtois et al., 2007). Another limitation is the disjoint two-front approach between understanding and doing. This disjointedness results in irreconcilable conceptual possibilities of learning.

Population(s) who have Benefited from DBT

Two critical randomized controlled trials (RCTs) have been performed to evaluate the effectiveness of DBT for people with SUD and BPD. Both RCTs were conducted at the University of Washington by Dr. Linehan and a few associates (Linehan et al., 1999, 2002). The first research was born on 12 participants, and the second RCT was performed on 23 individuals. The study was conducted over 24 months in both trials, from pre-treatment through a year after the treatment was completed.

Substances populations identified in the literature were using and the efficacy of DBT

The first RCT involved polysubstance-dependent people with a comprehensive history of substance abuse but have never been successful in their attempts to stop the behavior (Linehan et al., 1999). The second trial involved 23 opiate-dependent persons who also suffer from BPD.

In the first RCT, the results show that those who received DBT were very much expected to carry on with treatment. Moreover, the participants reported more significant reductions in drug abuse based on findings from structured interviews and urinalyses conducted all through the trial year. Also, the addicts went to more individual therapy sittings than those who depended on the regular treatment (Linehan et al., 1999). Those who used DBT maintained the improvements realized after the trial, even for up to a sixteen-month follow-up period apart from showing progress in their social and overall change for the duration of the treatment year.

In the second RCT, not only did the DBT subjects report reduced opiate abuse based on the results of urinalysis, but they also sustained the cutbacks during the last four months of treatment (Linehan et al., 2002). Subjects also remained in medicine, and a follow-up after sixteen months exhibited general drops in levels of psychopathology compared to a reference point.

Conclusion

Dialectical Behavioral Therapy (DBT) is a therapy designed to cure patrons suffering from Borderline Personality Disorder (BPD). However, the therapy is now widely used to attend to other mental illnesses, especially for people disposed to harm themselves or commit suicide. It usually covers 24 months within which a patient is taught necessary coping skills. It also involves individual therapy and phone sessions in times of crisis. DBT focuses on helping individuals appreciate and admit the existing challenges even as they work towards being better prepared to cope with tougher happenings. Successful DBT reduces instances of reacting negatively or engaging in destructive conduct. However, it is also worth knowing that DBT is dependent upon a deep therapeutic connection between the patient and their clinician. Considering that literature connecting DBT and SUDs is limited, there is a need for more research that supports the effectiveness of DBT for people with SUD and BPD (Axelrod, 2019). Nonetheless, the current information seems to support its efficacy as extra clinical trials are conducted.

References

Axelrod, S. R. (2019). Dialectical behavior therapy for substance use disorders. In M. A. Swales (Ed.), The Oxford handbook of dialectical behavior therapy (p. 595–614). Oxford University Press.

Comtois, K.A, Elwood, L., Holdcraft. L.C, Smith, W.R, Simpson, T.L. (2007). Effectiveness of dialectical behavior therapy in a community mental health center. Cognitive and Behavioral Practice, 14:406–414.

Juergens, J. (2021). Understanding Dialectical Behavior Therapy (DBT). Addiction Centre. Web.

Leahy, R. L. (2017). Cognitive therapy techniques: A practitioner’s guide. New York: Guilford Press.

Linehan, M.N., Dimeff, L.A., Reynolds, S.K., Comtois, K.A., Welch, S.S., Heagerty, P., and Kivlahan, D.R. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8(4):279–292.

Linehan, M.N., Dimeff, L.A., Reynolds, S.K., Comtois, K.A., Welch, S.S., Heagerty, P., and Kivlahan, D.R. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67(1), 13-26, Web.

Lynch, T., Roelie, H., Ben, W., Sarah, B., Rampaul, C., Paul, C., Susan, C., David, K., Heather, O., Bob, R., Sophie, S., James, S., Maggie S., , Michaela, S., Alan, W., and Ian, R. (2018). Radically open dialectical behavior therapy for refractory depression. Efficacy and Mechanism Evaluation. 5:1-112.

Sahranavard, S., and Miri, M.R. (2018). A comparative study of the effectiveness of group-based cognitive behavioral therapy and dialectical behavioral therapy in reducing depressive symptoms in Iranian women substance abusers. Psychology of Critical Reflection, 31;15. Web.

Smee, B.P (2004). Treatment of individuals with borderline personality disorder using dialectical behavior therapy in a community mental health setting: Clinical application and a preliminary investigation. Cognitive and Behavioral Practice, 11:424–434.

What Are The Benefits Of Dialectical Behaviour Therapy, (2019). My life psychologists. Web.

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