What is Dialectical Behavior Therapy?

Why and How DBT works in addiction treatment.

What is Dialectical Behavior Therapy?

Why and How DBT works in addiction treatment.

What is Dialectical Behavior Therapy?

Dialectical behavior therapy is an effective treatment for individuals with borderline personality disorder, and it is particularly successful when used with women who have made suicidal gestures, according to a 2006 report in Psychiatry.

Numerous rigorous studies have found that dialectical behavior therapy improves symptoms of borderline personality disorder.1 It is sometimes used to treat other mental health conditions, such as substance use disorders, and there are numerous benefits associated with this form of therapy.

Brief History of Dialectical Behavior Therapy

Marsha Linehan designed dialectical behavior therapy, first aiming to develop a treatment that works for women showing suicidal behaviors. She researched various treatments and developed a form of cognitive behavioral therapy that was not effective and lead to treatment dropout. 

Linehan then conducted additional research and incorporated acceptance of the client into her treatment program, and dialectical behavior therapy was created as a program that contained a balance of accepting the client and helping the client to change.

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Dialectical Behavior Therapy and Borderline Personality Disorder

Dialectical behavior therapy is a type of cognitive behavioral treatment used with patients with borderline personality disorder.

Borderline Personality Disorder (BPD)

This mental health condition is characterized by unstable emotions and behaviors and difficulties with self-image. Intense mood swings are common with this condition. People with borderline personality disorder tend to have conflicted relationships, because they fear abandonment and may either make attempts to avoid abandonment or cease communication with someone when they feel abandonment is a possibility. They also tend to swing between extremes of loving someone and viewing that same person as an enemy.

People diagnosed with borderline personality disorder also have difficulty controlling anger and may have intense angry outbursts. In addition, they find it challenging to trust others, and they may engage in self-harming behaviors or have thoughts of suicide.2

BPD Risk Factors

Per the research, multiple factors can contribute to the development of borderline personality disorder. For example, people with this condition may show differences in structure and function in the brain. There is also some evidence that child abuse, neglect, and trauma can increase the risk of borderline personality disorder. Genetics can also play a factor in borderline personality disorder.3

Who Develops BPD?

According to a 2018 report in Brain Sciences, about 5.9 percent of people will experience borderline personality disorder at any point during their lives, and 1.6 percent of the population has borderline personality disorder at any given time. 

In treatment settings, there are three times more females than males with borderline personality disorder, but in the general population, the occurrence of borderline personality disorder is similar in males and females, suggesting that women with this condition are more likely to seek treatment.3

BPD Prevalence

To understand how common borderline personality disorder is, it is helpful to compare its prevalence to that of the other personality disorders. According to the National Comorbidity Survey Replication, published in 2007, borderline personality disorder has a lifetime prevalence of 1.6 percent, compared to the following rates for other personality disorders:4

  • Paranoid Personality Disorder- 2.3 percent
  • Schizoid Personality Disorder- 4.9 percent
  • Schizotypal Personality Disorder- 3.3 percent
  • Antisocial Personality Disorder- 1 percent
  • Avoidant Personality Disorder- 5.2 percent
  • Dependent Personality Disorder- 0.6 percent
  • Obsessive-Compulsive Personality Disorder- 2.4 percent

This survey found that the rates of narcissistic personality disorder and histrionic personality disorder were so low, that they were reported as having a 0 percent prevalence.

BPD Treatment

Treatment is available for borderline personality disorder, but unfortunately, a majority of people with this condition go without treatment. According to data presented by the National Institute of Mental Health, just 42 percent of people with borderline personality disorder indicate that they have received treatment within the previous year.8

Dual Diagnosis

Another treatment consideration for borderline personality disorder is the fact that it often co-occurs with other mental health conditions. The research shows the following comorbidity rates between borderline personality disorder and other mental health diagnoses:8

  • Anxiety disorders- 60.5 percent
  • Mood disorders- 34.3 percent
  • Impulse control disorders- 49 percent
  • Substance use disorders- 38.2 percent
  • Any mental health condition- 84.5 percent

Because borderline personality disorder frequently co-occurs with other mental health conditions, it is important that treatment is comprehensive and addresses all of a person’s mental and emotional needs.

Dialectical behavior therapy may be especially helpful for people who have co-occurring conditions, since it has been shown to improve a variety of symptoms, such as anger and depression. It is also worth noting that the research has found dialectical behavior therapy to be especially effective for promoting long-term abstinence among people with addictions, making it a viable treatment option for the 38.2 percent of people who also have a substance use disorder.

 (%) of personality disorders in the United States

How Dialectical Behavior Therapy Works

Individuals with borderline personality disorder have an inherent difficulty processing emotions; they demonstrate intense emotional reactions and struggle to return to a neutral state after an emotional outburst. The aim of dialectical behavior therapy is therefore to help clients learn the skills necessary for identifying and regulating emotions. This is achieved through a thorough treatment plan that includes weekly individual counseling, group skills training, and therapist consultation meetings in which the lead clinician meets with other clinicians to discuss challenges, develop solutions, and receive support. While the focus of dialectical behavior therapy is on helping clients to regulate emotions, in cases where a client is suicidal, this challenge takes precedence, as it can be life-threatening.1

5 Aims of DBT

There are five aims of dialectical behavioral therapy:1

  1. Enhancing a client’s ability to manage emotions, cope with distress, focus on the present, and engage in healthy interpersonal relationships
  2. Generalizing the skills developed in therapy so the client can apply them in everyday life
  3. Increasing motivation for change and reducing problematic behaviors
  4. Enhancing clinician motivation through training, support, and skill building
  5. Modifying environments so that clients can be successful

Throughout the course of treatment, the therapist helps the client to meet these aims of therapy. For instance, a therapist may help a client reduce problematic behaviors by having the client keep a diary and reviewing with the client what has triggere