This type of therapy has the potential to help anyone and everyone. Marsha Linehan came up with the concept of teaching clients suffering from Borderline Personality Disorder how to utilize their intellect and play Devil's Advocate with themselves.

The primary problem sufferers of BPD (Borderline Personality Disorder) face is that of not knowing how to get their needs met. Although no one knows for sure what causes BPD, many sufferers were abused in some manner as young children. Many had parents who were alcoholics and addicts. They had a rather skewed example of how you should get your needs met. Acting out was one way; pretending to be perfect, another. When growing up in such an invalidating background the child learns that they can't trust themselves, because children see themselves through their caregiver's eyes.

DBT (Dialectic Behavior Therapy) is, in a nutshell, where the client learns to become mindful of the opposing sides of themselves, and to use this internal reasoning to get their needs met in healthy ways. Acceptance of yourself, and your shortcomings is encouraged, (this is the origin of the self-injury behaviors seen in persons diagnosed with BPD - non-acceptance of what they see as their bad side. They are too aware that they are lacking in life skills that most people learned when very young; they feel bad about themselves, and have poor self-esteem, and punish themselves, or self-injure to feel alive.) They don't trust their own judgement. At the same time as practicing self acceptance, change is gently encouraged.

DBT requires commitment from the client. There must be a commitment to one-on-one therapy with a therapist trained in DBT, and attendance of group classes, where homework must be completed. They learn to balance the rational mind and the emotional mind with the wise mind. Everyone goes back and forth between these, but in clients with BPD, they tend to swing more wildly in one direction or the other, and frequently get trapped going in circles. DBT helps the client become aware of the dynamics of what goes on inside their own head. They learn to take control of the situation, and to balance their emotions and reasoning. They are taught to validate that their emotions aren't something they can help; they just are. Emotions are feelings, which are never wrong. It is the behavior that emotions bring about that can be changed. They are taught that although they can't help how they feel, they have complete control over how they react to these emotions.

People with BPD have difficulty in controlling their emotions. They tend to be ruled by them, and in individual, and group therapy, they are taught to use the rational mind to balance the emotional whirlwind. This therapy has helped lots of people take control of their out-of-control lives. It has eased the suffering of many. (Including the author's.)

DBT uses core mindfulness skills, interpersonal acceptance skills, emotion modulation skills, and distress tolerance skills to teach clients how to regulate their emotions and improve interpersonal relationship skills.

There are four stages of therapy:
1. The assessment of the client, and their commitment to the therapy.
2. Focusing on self-injury behaviors, or parasuicidal gestures, and therapy interfering behaviors, and obtaining a commitment to contact the therapist by phone before carrying out any type of self-harm.
3. Focusing on post-traumatic stress disorder related problems.
4. Focusing on self-esteem issues and individual treatment goals.

The core strategies in DBT are validation and problem solving. The effectiveness of DBT has been assessed in two major clinical trials. In the first trial, Linehan compared the effectiveness of DBT with business as usual treatments, which include medications to treat symptoms of depression, and/or anxiety. In the second trial, Linehan examined the effectiveness of DBT skills training when added to standard community therapy. Assessments were based on the number of parasuicidal behaviors, and a range of questionnaire measures of mood. In the first trial, the control group reported an increase in parasuicial behaviors, and the risk was higher in the nonDBT group that these behaviors would be carried out. During the follow-up year, clients receiving DBT had less inpatient hospital stays, and less parasuicidal behaviors. They scored higher on Global Assessment Scores, and exibited better work performance.

One major critisism of the first trial was the control group's lack of consistent therapuetic experience, which could lead to mistakenly determining that DBT is superior to traditional treatment modalities.

The second trial compared standard community psychotherapy without added skills training, to DBT. Secondly, it compared the standard community treatment from the first trial, with the group receiving DBT. Comparisons seem to show DBT modalities reduced inpatient hospital stays, parasuicide, and therapy interfering behaviors.

In order to fully assess the superiority of DBT over conventional treatments, more studies need to be done.

Reference:
Linehan, Marsha M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press.
Linehan, Marsha M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: The Guilford Press.

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