Dialectical Behavior Therapy (DBT) Defined

According to the DSM-IV-TR, psychology's premier diagnostic manual, Borderline PD is a type of psychological personality disorder that interferes with an individual's ability to regulate emotion. The characteristic emotional instability results in dramatic and sudden shifts in mood, impulsivity, poor self-image, turbulent relationships, and often threats of and attempts at suicide. Prevalence of Borderline Personality Disorder is estimated at 1% to 2% of the general population.

In addition to appropriate drug therapy, psychotherapy has proven to be the most effective means of treating BPD, and in recent years, new therapies such as Dialectical Behavior Therapy (DBT) and Transference-Focused Psychotherapy (TFP) have been designed specifically to treat this disorder (Clarkin 2007).

What Is Dialectical Behavior Therapy?

DBT Theory

Marsha M. Linehan, Ph.D. created DBT for the treatment of chronically suicidal borderline clients. The theory behind Dialectical Behavior Therapy is based on the belief that BPD is a combined result of the patient's emotional vulnerability, lack of skills in controlling emotions, and unsupportive interpersonal environment. These factors cause the patient to be emotionally "dysregulated," at the mercy of wildly vacillating feelings and unpredictable behaviors.

Linehan believes that the disorder is the result of an emotionally vulnerable individual growing up in an invalidating environment. She defines 'emotionally vulnerable' as someone whose autonomic nervous system reacts in extreme to relatively low levels of stress and then takes longer than would be expected to return to normal, once the stress is removed.

The term 'invalidating environment' is considered a setting in which the personal experiences and responses of a child are discredited or 'invalidated' by the significant others in her life. When the child voices her feelings, these feelings are deemed invalid or inappropriate by those around her. In this environment, the authority figures also tend to place a high value on characteristics of self-control and self-reliance.

The result is an emotionally vulnerable child who may learn not to trust her own feeling and reactions, and, therefore, never develop effective coping mechanisms for dealing with stressful situations. Borderlines often look to others for indications of how they should be feeling, as well as expecting others to solve their problems (Linehan 2003).

DBT Method

DBT focuses directly on helping the patient develop new skills for regulating emotion and reducing symptoms. The five specific components of treatment DBT described by psychologist Cynthia Sanderson are: "1) individual therapy to address and maintain the patient's motivation for treatment; 2) group skills training to increase the patient's capacities; 3) brief weekly phone calls to insure generalization of new skills; 4) therapist consultation team to provide supervision and prevent burnout; 5) administrative function to structure the environment so effective treatment can take place" (Borderline Personality Disorder Resource Center).

New Research into Treatment of Borderline Personality

A study of BPD treatments, recently published in The American Journal of Psychiatry, examined the efficacy of Dialectical Behavior Therapy in comparison with two other therapeutic options used to treat BPD: Transference-Focused Psychotherapy (TFP) and Dynamic Supportive Treatment. The results indicated that all three therapeutic approaches were effective in fostering global improvement in the symptoms of BPD. However, each approach was found to have specific strengths for treating different aspects of the disorder (Clarkin 2007).This article features a description of one type of therapy used to treat Borderline Personality Disorder. The content is not meant to be a substitute for professional help and counseling.

Additional BPD Resources

Personality Disorders: Brief Summary of the Ten Disorders of Personality.

Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., and Kenberg, O.F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. The American Journal of Psychaiatry. Vol. 164, 6.

Linehan, M. (2003) Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder. The Journal of the NAMI California, Vol. 8, 1.

American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)