Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment for borderline personality disorder (BPD) that is based on the theory that emotion dysregulation is the core feature of BPD. This article focuses on aspects of DBT theory and techniques that specifically address emotion. The dialectical and biosocial theories that underlie DBT are reviewed with an emphasis on how each relates to emotional experiencing in BPD. Selected treatment strategies that address emotion dysregulation and their hypothesized mechanisms of change are also described. Relevant research findings are incorporated throughout to provide an empirical foundation for the DBT theories and strategies that are discussed.     

Children At-Risk for Borderline Personality Disorder

Adult patients who have been diagnosed with borderline personality disorder (BPD) have provided valuable information about events and family dynamics that are frequently associated with BPD. Clinicians who work with children are frequently aware of family or individual characteristics that may put a child at risk for developing BPD. Such situations frequently involve attachment issues with the child's caregivers and can include sexual abuse, divorce, alcoholism/substance use, illness/ death, and neglect. Child characteristics such as learning difficulties and temperament may also predict BPD. Yet, many children are resilient and seemingly unaffected by these events or situations, especially when early intervention may prevent development of BPD.     

The MMPI,Prototypal Typology,and Borderline Personality Disorder

This study demonstrates inherent features in the DSM-III diagnostic criteria for personality disorders (i.e., overlapping diagnoses and heterogeneous symptomatology) that limit efforts to identify a sensitive and specific MMPI profile for the borderline personality disorder. A sample of 71 inpatients was administered an MMPI and a semistructured interview that systematically evaluated each of 81 symptoms for the 11 DSM-III personality disorders. Interrater reliability was substantially higher than has been obtained with unstructured interviews. The effect on the borderline MMPI profile of (a) variation in the number of borderline symptoms and (b) overlap with the schizotypal, histrionic, and antisocial diagnoses was demonstrated. We discuss implications with respect to a prototypal model of classification.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review

Carers of patients with borderline personality disorder (BPD) experience high levels of distress. Several studies have been carried out on interventions designed to decrease their burden. However, the evidence from these studies has not been summarized. The objective of this work is to explore the clinical utility of interventions developed for family members of patients with BPD. A systematic review was conducted following the PRISMA guidelines (registration number CRD42018107318), including psychological interventions focused on relatives of patients with BPD. The following databases were used: PsycINFO, PubMed, EBSCOhost, and Web of Science. Two independent researchers reviewed the studies to determine whether the eligibility criteria were met. A total of 2,303 abstracts were identified. After duplicates had been removed, 1,746 studies were screened. Finally, 433 full‐text articles were reviewed, yielding 11 studies that satisfied the inclusion criteria. Results show that these interventions with different clinical formats and settings are effective. The quality of the included studies varies, and the empirical support for these programs is still preliminary. The results help to establish a general framework for interventions specifically developed for family members of patients with BPD, but additional efforts should be made to improve the methodological quality of this field of research and more solidly determine the utility of these interventions. Given the paucity of data so far, this information may open up new lines of research to improve the effectiveness of future programs for carers of patients with BPD and help to reduce their burden.     

Strategies for Securing Commitment to Treatment from Individuals Diagnosed with Borderline Personality Disorder

Individuals diagnosed with borderline personality disorder (BPD) are notoriously difficult to engage in treatment. The purpose of this paper is to highlight therapeutic strategies that are likely to facilitate early alliance in therapy with individuals diagnosed with BPD. The seven strategies include, collaborative assessment, the use of contracts, motivational interviewing, linking treatment targets to client goals, commitment strategies, validation, and the use of metaphors. Clinical vignettes are presented to elucidate the concepts described and demonstrate their use in clinical practice.     

对边缘性人格障碍亚型的研究

边缘性人格障碍是一种最常见的人格障碍。描述性精神病学、心理测验和精神分析的研究发现,边缘性人格障碍可能是由若干个异质性的亚群体组成,不同的亚群在症状表现、病因、心理病理机制、对治疗干预的反应和预后等方面可能都存在着很大的差异,可以根据不同的维度将其进行亚型分类,而使同一个亚群中的个体差异小于不同亚群之间的个体差异。     

对边缘性人格障碍亚型的研究

边缘性人格障碍是一种最常见的人格障碍.描述性精神病学、心理测验和精神分析的研究发现,边缘性人格障碍可能是由若干个异质性的亚群体组成,不同的亚群在症状表现、病因、心理病理机制、对治疗干预的反应和预后等方面可能都存在着很大的差异,可以根据不同的维度将其进行亚型分类,而使同一个亚群中的个体差异小于不同亚群之间的个体差异.     

Borderline Personality Disorder: towards a systemic formulation

The diagnostic label, Borderline Personality Disorder (BPD), is rapidly gaining currency in the UK. Although many systemic practitioners are skilled and experienced at working with the clinical difficulties associated with the diagnosis, there is little systemic literature on the topic. This paper discusses some of the difficulties for systemic practitioners in engaging with the concept of BPD and offers some pointers for the development of systemic practice in this area.     

Recommending Interventions for a Borderline Personality Disorder Patient

Borderline personality disorder (BPD) is a severe personality disorder leading to unstable emotional state, impulsivity, disturbed relationships and personal distress. This paper suggests a 12-step intervention plan including Dialectical Behavior Therapy (DBT) to Mr. X, a 21 year old male psychiatric inpatient having BPD, to promote his mental health. Therapy could not be conducted as the patient dropped out of treatment and got himself discharged from the hospital. This paper outlines implications for treatment on the basis of the clinical presentation of Mr. X. Mr. X presents himself with the BPD features showing suicidal tendencies, substance abuse and disturbed emotions. In depth interview of the patient showed extreme emotional disturbance and difficulty in controlling emotions and suicidal ideations. He was admitted at the Nur Manzil Psychiatric Centre, Lucknow, India and was kept under close observation because of being obsessed with suicidal thoughts; he also tried to kill himself. The DBT skills training and problem solving approach along with contingency management and behavioral chain analysis are suggested according to the clinical profile of Mr. X in order to reduce his self mutilating acts and substance abuse. Thus a general feeling of personal well being can be achieved thereby reducing personal distress.     

Attachment in Adolescence and Borderline Personality Disorder

Borderline personality disorder (BPD) has been conceptualized as a constellation of symptoms related to problems in self-functioning, emotion regulation, and interpersonal relationships. Its etiology has been connected to individuals’ early childhood environment, caregiving relationships, and traumatic life events. Recent literature has noted the potential presence of BPD beginning in adolescence, or even earlier in childhood. Attachment theory offers a lens for understanding the symptoms of borderline personality disorder and identifying potential aspects of treatment that may be specifically valuable for adolescent patients. Adolescence marks a time when the attachment system has increased relevance due to the importance of identity formation, peer relationships, body representations and the development of autonomy at this time, in the face of physical changes and academic challenges. This article will summarize research on attachment, body representations, personality disorders, and features of development in adolescence, in order to enhance clinical understanding of patients who presenting with these types of difficulties.     

Borderline Personality Disorder and Development: Counseling University Students

Students with borderline personality disorders are difficult to counsel and present problems in consultation. Providing these students with structure through consistent limit setting can produce positive changes in their behavior.     

Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients’ practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according to the skills deficit model of BPD that underlies DBT. This study was designed to examine the type and frequency of skills practiced by DBT patients. Participants were 49 women, who met criteria for BPD and current and chronic suicidal behavior, receiving 1 year of standard DBT as part of a clinical trial. Skills were recorded on the daily diary cards completed by participants each week and reviewed by their individual therapists. Results indicated that the majority of participants reported practicing skills most days throughout treatment. Crisis survival and mindfulness skills were practiced most frequently in our sample. Hierarchical linear modeling demonstrated that skills practice increased as a function of time in therapy. Directions for future research are discussed.     

The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder

The authors describe a new cognitive-behavioral systems-based group treatment for outpatients diagnosed with borderline personality disorder (BPD). The program is identified by the acronym STEPPS, which stands for Systems Training for Emotional Predictability and Problem Solving. The STEPPS program was developed to address the cognitive distortions and behavioral dyscontrol typical of clients with BPD, and combines this with skills training and a systems component. The latter involves clients with BPD and those in their system including family members, significant others, and health care professionals. The program is fully manualized, and involves 20 two-hour weekly group meetings; specific goals (or lessons) are identified for each session. Preliminary data from the US and the Netherlands have shown that the group achieves high levels of acceptance from clients and therapists and that the model may be effective in helping to relieve the symptoms associated with BPD. Work is now underway to confirm the effectiveness of the model through a randomized controlled trial.     

Strategies Used in the Treatment of Borderline Personality Disorder: A Survey of Practicing Psychologists

One hundred and twenty three practicing psychologists completed surveys regarding the therapeutic techniques they employ for patients with Borderline Personality Disorder (BPD). Participants identified their predominant orientation and rated the frequency with which they used a range of 27 specific strategies. Logistic regression analyses identified an expected relationship between specific techniques and the theoretical orientations to which they are most closely linked. These findings suggest a high level of concordance between self-described theoretical orientation and the specific treatment techniques utilized, but also that some theoretical orientations are comprised of smaller independent clusters of strategies. The implications of these findings are discussed.     

Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.