borderline personality disorder

The role of DBT in the treatment of BPD

Dialectical behaviour therapy was developed by Marsha Linehan, at the University of Washington and is a type of psychotherapy used to treat borderline personality disorder. DBT is a cognitive behavioural therapy, meaning it’s a therapy that focuses on the role of cognition (e.g., thoughts and beliefs) and behaviours in the development and treatment of BPD.

DBT is based on Dr. Linehan’s theory that the core problem in BPD is emotion dysregulation, resulting from both genetics and an emotionally unstable childhood where caregivers punish, trivialize or respond inconsistently to the child’s expression of emotion. The focus of DBT is on helping the sufferer learn and apply skills that will decrease emotion dysregulation and damaging attempts to cope with strong emotions.

I began a course of DBT about one year ago but gave up half way through. A lot of what I learned made sense and bits of it I found useful in my day to day life. However, as a stand-alone treatment for long-term sufferers of BPD I found it inadequate in itself. Many sufferers who began the treatment dropped out, (over 50% in fact) so it has to be missing something in my opinion.

‘Mindfulness’ is certainly the new buzzword in psychiatry.

So what is mindfulness?

Mindfulness is a way of paying attention to, and seeing clearly whatever is happening in our lives. It does not eliminate life’s problems, but it can help us respond to them in a calmer manner. It helps to reduce stress as well as to develop more focus and mental clarity.

But is this concept actually setting us up for further failure. After all mindfulness urges us to “live in the present moment” and to try to live mindfully, by “being here now.” However, this emphasis on controlling our mind places us in a perpetual mode of self scrutiny, checking up on our selves, gauging our progress and ability (or, more often than not, our inability) to remain in control?

Focusing on the moment may temporarily calm the anxiety of what the future may hold or take our attention from past pain but I am not sure that it offers any long-term solutions or brings about any significant therapeutic change within the sufferer of BPD.

In its current form, therapeutic minfulness fails to address the deeper levels of consciousness and our underlying, pervasive thoughts in any permanent way.