How DBT Can Help
People with BPD have problems regulating emotions. They are often intensely distressed, and stuck in unhelpful ways of interacting with others and their lives. Often, their distress is so great that they engage in self-harm or suicidal behaviours.
Because of the severity of the distress, self-harming and suicidality experienced by people with BPD, progress made through treatment can be derailed by ongoing crises. DBT targets these crisis behaviours, emotional regulation and other factors as key components of treatment.
The techniques used in DBT overlap with both Cognitive Behavioural Therapy (CBT), from which it stemmed, and Acceptance and Commitment Therapy (ACT), which emphasises mindfulness. It differs somewhat in that it uses “dialectical” approaches that influence both the techniques the therapist uses, and how they interact with their clients in session.
In its full form DBT is intensive. It consists of:
- individual therapy;
- group skills training;
- between-session calls with therapists; and
- high-levels of self-monitoring and ongoing homework in the client’s own time.
Full DBT programs are time consuming, demanding and require a high level of client motivation. It is also a long-term treatment and can be expensive. However, for people with BPD this commitment, time and effort can make a lot of sense when the alternative is to remain in their state of crisis and distress. There is good evidence that DBT is effective for treating people with BPD. If you have BPD, and actively engage in self-harming behaviours or become suicidal at times then DBT may be a good option for you to consider.
Frequently Asked Questions
What are the alternatives to DBT?
Some people have partial features of BPD, or a diagnosis of BPD but don’t self-injure or often contemplate suicide. For these people DBT, which emphasises the management of these behaviours, may not be the best match. As with any approach, some patients also simply don’t like some or all of the DBT approach.
So what are the alternatives? There is increasing evidence that Schema Therapy is efficacious in treating people with BPD. Schema Therapy is also a form of therapy that focuses on helping people to understand and manage their emotional distress, and to identify more helpful ways of coping and behaving. Schema Therapy can be conducted for individuals in private practice settings and does not require either group work, or out of session contact with the therapist, although sometimes these services are offered. It is important to note, however that Schema treatments for BPD, like DBT, tend to be lengthy.
I don’t have BPD – what are the alternatives?
For conditions other than BPD, there are a range of therapies that may be a better fit for your symptoms, less intensive and less costly. Although there is some support for the use of DBT in substance use disorders, bulimia and binge eating disorder, there is currently less evidence for its use in all other conditions.
Many therapists have received training in more than one approach, enabling them to tailor therapy to meet your needs, or to change approaches if something is not working well for you. Your psychologist will work with you to identify the priorities for your treatment, and methods that work best to address your specific issues.
If you want to know what the evidence says about the treatment your psychologist suggests, ask them – as a “scientist-practitioner” your psychologist’s choices should be supported by good science.
The Australian Psychological Society (APS) produces a guide (https://www.psychology.org.au/Assets/Files/Evidence-Based-Psychological-Interventions.pdf), which is periodically updated to inform people of the evidence behind many major forms of treatment.
But elements of DBT appeal to me…
If you feel that the integration of DBT techniques would be useful for your therapy then talk to your treating psychologist. They may have the training to implement some DBT-style work into your treatment, or to offer alternatives that may be more suited to your specific situation.
If you are experiencing emotional distress and think you would benefit from seeing a psychologist then consider coming to see us at M1 Psychology.
Author: Kelly Gall, BSc (Hons), M Psych (Health), M Clin Psych, MAPS, MCHP.
Kelly Gall is a Health Psychologist who is passionate about helping clients improve their physical and emotional wellbeing. Kelly develops tailored, holistic and evidence-based treatment plans that incorporate psychological, physical and social strategies aimed at empowering her clients to achieve relief from psychological symptoms and improve their health. Find out more on her website, Healthy Inside and Out.
To make an appointment with Health Psychologist Kelly Gall, call (07) 3067 9129 or you can book online today.
- Australian Psychological Society (2010). Evidence-based psychological interventions in the treatment of mental disorders. Australian Psychological Society. Melbourne.
- Jacob, G. A., & Arntz, A. (2013). Schema therapy for personality disorders-A review. International Journal of Cognitive Therapy, 6(2), 171-185
- Linehan, M.M. (1993) Cognitive Behavioural Treatment of Borderline Personality Disorder. The Guilford Press. New York.
- Linehan, M.M. (2014) DBT Skills Training Manual. 2nd Edition Revised. Guilford Publications. New York.
- Nadort, M., Arntz, A., Smit, J. H., Giesen-Bloo, J., Eikelenboom, M., Spinhoven, P., … & van Dyck, R. (2009). Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial. Behaviour Research and Therapy, 47(11), 961-973.