Dialectical Behavior Therapy for Borderline Personality Disorder

Abstract

This chapter elaborates on the multiple integrative aspects of dialectical behavior therapy (DBT), an evidenced-based treatment for individuals who meet criteria for borderline personality disorder (BPD). It discusses how behavioral theory, Zen, and dialectics provide the primary principles and describes how the dialectical principles perform various integrating roles throughout the therapy. It also clarifies the construct of traumatic invalidation, a component of the treatment’s biosocial theory. The section on methods describes key therapeutic strategies, including problem-solving and validation. A case example illustrates the dialectical and integrative nature of the treatment. The chapter also reviews the results of randomized controlled trials examining the efficacy of DBT for BPD and identifies the settings, ages, and other clinical disorders for which the treatment also has empirical support.

Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm

“…Two previous studies have shown higher outpatient psychotherapy costs for DBT compared to the control group [ 12 , 13 ]. In these studies, the original DBT program for adults was used, so that the intervention had longer duration.…”

“…A study with female adult patients (N = 44) showed that DBT treatment incurred significantly higher psychotherapy costs, but lower inpatient care and emergency room costs than TAU over a period of 12 months. However, the results indicated no statistically significant differences in total treatment costs [ 12 ]. Another economic evaluation of DBT (age > 16 years, N = 40), yielded a similar result as it showed no significant differences in total treatment costs [ 13 ].…”

Responsiveness in integrative therapies.

“…Dialectical behavior therapy (DBT; Linehan, 2015) for borderline personality disorder is the most studied and empirically supported integrative therapy for a particular disorder, often connected to the theoretical integration pathway. In addition to its dialectic frame (Heard & Linehan, 2019), DBT integrates interventions such as mindfulness, acceptance, and focusing on dialectical processes into more traditional CBT interventions, such as problem-solving (Linehan, 2015). This integration can facilitate responsiveness, as described in Chapter 12 of this volume.…”

How are expert therapists similar, different, and integrative in the treatment of borderline personality disorder?

“…DBT’s primary goal is to teach patients coping strategies to eliminate behavioral dyscontrol (Linehan, 1993; Linehan, 2014). A DBT approach integrates and adapts behaviorism, social behaviorism, and practices of CBT to include problem-solving strategies, life skills training, exposure, and contingency management (Heard & Linehan, 2019; Matusiewicz et al, 2010). DBT also focuses on dialectics, emphasizing that the change process of therapy is changing an entity into its opposite (e.g., thesis into antithesis) and combining the two to form a higher truth (e.g., synthesis; Heard & Linehan, 2019).…”

“…A DBT approach integrates and adapts behaviorism, social behaviorism, and practices of CBT to include problem-solving strategies, life skills training, exposure, and contingency management (Heard & Linehan, 2019; Matusiewicz et al, 2010). DBT also focuses on dialectics, emphasizing that the change process of therapy is changing an entity into its opposite (e.g., thesis into antithesis) and combining the two to form a higher truth (e.g., synthesis; Heard & Linehan, 2019). DBT has shown to be efficacious in stabilizing self-destructive behavior and enhancing patient compliance (Panos et al, 2014) as well as for BPD severity, psychosocial functioning, and depression (Storebø et al, 2020).…”