Mindfulness-Based Approach to Cognitive Therapy in Borderline Personality Disorder

Among the many treatments and therapies used today to treat the variety of psychological problems present in today's society, mindfulness-based cognitive behavioral theory incorporates meditative properties into an already effective cognitive-behavioral program. Eating disorders, mood disorders, anxiety disorders, and personality disorders are all diagnoses that can benefit from mindfulness-based elements to cognitive therapy, yet the approach appears to be especially effective in those suffering from borderline personality disorder (BPD).

Dialectical Behavioral Therapy (DBT) is a mindfulness-based CBT developed by Dr. Marsha Linehan that integrates cognitive-behavioral techniques with awareness and mindfulness practices to treat all components of BPD. The well-established components of CBT involve identifying and then changing negative thought patterns underlying and contributing to the manifestation of problem behaviors, which in BPD can include: fear of abandonment, suicidal behavior, impulsivity, unstable social relationships, and a loss of identity. Midfulness based techniques apply the ideas of awareness and meditative-focus of Eastern philosophy to help patients deal with the reasons commonly reported for parasuicidal behavior such as intent to express anger, punish oneself, and generate normal feelings. The integration of mindfulness techniques in BPD populations is often implemented when self-mutilating, parasuicidal behavior, or substance abuse is present in the diagnosis, because it compliments the CBT by reinforcing adaptive, change behavior and balancing acceptance and change with the goal to prevent suicidal behavior and build a healthy life. DBT is a goal directed therapy that identifies interpersonal effectiveness skills, emotion regulation skills, distress tolerance skills, and core mindfulness skills as behaviors to increase while simultaneously identifying impulsivity, cognitive distortion, and interpersonal chaos as behaviors to decrease. DBT is an effective treatment when applied property, yet it is important for the therapist to set boundaries and limits on the therapeutic relationship so as not to reinforce the negative behaviors of the client/patient. DBT favors a friendlier, more sympathetic therapeutic relationship in contrast to some other popular therapy techniques.

Borderline personality disorder is a pervasive condition that lacks the acute symptoms characteristic of Axis I populations. Along with Dialectical Behavior Therapy, Transference-focused Psychotherapy, and Schema Focused Therapy are other treatments commonly applied to the BPD diagnosis. If you or someone you know are experiencing difficulty in treating their BPD, ask your therapist about mindfulness-based CBT as a possible alternative approach.

Sources:

Brown, Milton Z., Comtois, Katherine A., Linehan, Marsha M. (2002). Reasons for Suicide Attempts and Nonsuicidal Self-Injury in Women With Borderline Personality Disorder. Journal of Abnormal Psychology, 111, 198-202.

Linehan, Marsha M., et al. (2006). Two-Year Randomized Controlled Trial and Follow-up of Dialectical Therapy vs. Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry, 63, 757-766.