Friday, 1 August 2014

Now there's DBT for BPD



Borderline personality disorder (BPD) is characterised by problems with regulating emotions and thoughts, impulsive and reckless behaviour and unstable relationships with other people. Depression, anxiety, self-harm and suicidal behaviours can also be part of the picture. I can't help but think that these symptoms sound remarkably like those of addiction - any addiction - and therein lies the difficulty with classifying mental health with any precision.

But one thing that's certain is that living with BPD (or any addiction, for that matter) is no bed of roses. So it's good to know that a relatively new form of therapy, Dialectical Behavioural Therapy (DBT), is helping people with BPD.

DBT was developed by Marsha Linehan, as an adaption of Cognitive Behavioural Therapy (CBT), to meet the emotional needs of people with BPD. CBT typically focuses on changing behaviour through rationalisation, but DBT brings something new to the process: so-called 'acceptance techniques'.

Acceptance techniques direct the attention to understanding and making sense of one's actions - for example a therapist working with DBT might help the patient to understand how engaging in painful, destructive behaviour of one kind or another made absolute sense in the context of their difficult formative experiences - which ultimately leads to self-acceptance and prepares the ground for CBT-style change techniques.

New UK research suggests that DBT is, indeed, proving successful in treating patients with BPD. Patients were allocated to DBT at two-monthly intervals and others to treatment as usual (TAU). During the 12-month intervention period, significantly fewer patients allocated to DBT than to TAU were hospitalised. A regression analysis showed that the odds of hospitalisation during the intervention period were significantly higher in the TAU than the DBT group and this held true after adjusting for whether patients had been hospitalised in the year prior to intervention.

The positive trend was continued into the 6-month follow-up period and the authors concluded:
"DBT should be considered an effective treatment for keeping self-harming patients with BPD out of hospital and that positive effects on self-harm and hospitalisation are sustained once treatment is over."
Have you worked with DBT? How does it compare with CBT and have you found it helpful for patients? Or perhaps you're a patient who has experienced DBT? Either way, we'd love to hear from you; please leave your comments below.

Written by Jacqui Hogan

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