Tuesday, June 16, 2009

Dialectical Behaviour Therapy and Borderline Personality Disorder

Borderline personality disorder (BPD) usually involves unstable moods, "black and white" thinking (or splitting), unstable personal relationships and a disturbance in an individual's sense of self. One of the main ways of treating BPD is with dialectical behaviour therapy (DBT). This was first developed by Marsha Linehan from the University of Washington and draws its principles from cognitive behaviour therapy (CBT), dialectical philosophy and Zen Buddhism. The treatment aims to balance acceptance of things that cannot be changed with changing things that can and aims to help people not just survive but to build a worthwhile life. There are four stages of treatment with self-harm and other life-threatening behaviours being given priority. In the second stage patients are encouraged to experience the painful emotions they have been avoiding. Stage three addresses job and relationship problems while stage four focuses on helping people to feel complete and on reducing feelings of emptiness and boredom. Researchers from Brown University in the U.S. studied 47 women who had had a five-day, partial-hospitalization programme of DBT. They found that after three months the women's levels of depression, helplessness, anger, dissociation and mental-health problems had significantly decreased. Those who had felt emptiness, been impulsive and suffered from disturbed relationships showed improvement on a number of outcomes. However, those who had disturbed identities and a fear of abandonment showed less improvement.

Yen, Shirley ... [et al] - A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder: predictors of outcome from a 3-month follow-up study Journal of Psychiatric Practice May 2009, 15(3), 173-182

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