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Dialectical behavior therapy, DBT, is a type of therapeutic treatment that falls under the larger umbrella of CBT (cognitive behavioral therapy). DBT was developed in the late 1980s by Marsha Linehan, Ph.D., as a means to specifically treat individuals with borderline personality disorder (BPD). As time has progressed, it has proven to be an effective method in the treatment of individuals that suffer from other types of mental health disorders. While DBT utilizes a cognitive behavioral approach, it predominantly emphasizes the psychosocial aspects of treatment. The theory behind the DBT approach takes into consideration the notion that some individuals are prone to react in a more intense manner when it comes to certain emotional situations. The biological response manifests as an exponential increase in one’s arousal level (different from an average person’s), elevating one’s emotional stimulation, which in turn takes an individual a longer duration of time for the individual to return to his or her baseline arousal level. In order to adequately regulate one’s emotions an individual with borderline personality disorder must integrate specialized coping techniques. 

Borderline Personality Disorder

Borderline personality disorder is a mental health disorder that impacts the way an individual thinks about him or herself and others. As is described by the National Institute of Mental Health, it is characterized by an ongoing pattern of varying moods, behaviors, and self-image. The precise cause for developing borderline personality disorder remains unknown. There are, however, certain risk factors that research has suggested that may increase one’s susceptibility. Contributing risk factors include: genetics, one’s brain structure, family history, as well as environmental, social, and cultural factors. The symptoms of borderline personality disorder typically result in impulsive actions and relationship problems. The Mayo Clinic provides examples of signs and symptoms that are commonly exhibited in individuals with borderline personality disorder. They include the following:

  • Engaging in risky and/ or impulsive behaviors (i.e. reckless driving, excessive gambling, binge eating, substance abuse, unsafe sex…etc.)
  • Intense fear of abandonment
  • Suicidal ideations
  • Self-injury
  • Severe mood swings (i.e. elation, irritability, shame, anxiety…etc.)
  • Pattern of unstable relationships
  • Irrational displays of anger
  • Distorted self image
  • Feelings of emptiness
  • Stress related paranoia

Every person is different and an individual with borderline personality disorder has the propensity to experience any combination of the above symptoms. Borderline personality disorder is notorious for being an incredibly challenging mental health disorder to both diagnose and treat. The article, Why Psychiatrists are Reluctant to Diagnose Borderline Personality Disorder, pinpoint several challenges psychiatrist’s face when diagnosing borderline personality disorder. Borderline personality disorder is a mental health disorder that is treated by teaching an individual how to manage his or her symptoms. Hence, there is no known treatment for borderline personality disorder that fully eliminates or cures an individual from its diagnosis. 

Dialectical Behavior Therapy

Individuals who are diagnosed with borderline personality disorder tend to view things in extremes (i.e. all good or all bad). This can greatly impact the way one subsequently behaves which can make it challenging to function in one’s everyday life. The American Psychological Association assert that individuals who have undergone DBT as a component of treatment for borderline personality disorder have displayed notable improvements in the following areas:

  • Shorter hospitalizations
  • Reduced anger
  • Less frequent and/ or less severe suicidal ideations
  • Improved social functioning
  • More likely to remain in treatment

It is highly common for individuals with borderline personality disorder to be unable to adequately cope with the sudden experience of surging of emotions, which is a typical symptom of the disorder. DBT helps teach clients learn and integrate coping mechanisms to help with changing unhealthy behaviors. DBT is made up of four modules. The modules are intended to shed light on situations where the objective is to change something (i.e. asking someone to do something) or to resist changes someone else is attempting to make (i.e. saying no). The four modules of dialectical behavior therapy treatment are:

  1. Mindfulness: active practice of being fully aware and present in the moment
  2. Interpersonal effectiveness: learning to advocate for one’s wants as well as say “no” while maintaining self-respect and outside relationships
  3. Distress tolerance: learning to tolerate (not change) pain in challenging situations
  4. Emotional regulation: learning to decrease vulnerability to painful emotions and change unwanted emotions

It is important to note that many individuals with borderline personality disorder have substantial interpersonal skill, but they are unable to properly apply their skills within the appropriate context. Obtaining treatment is essential in providing an individual with borderline personality disorder the needed tools to manage his or her disorder.

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