What is the most effective treatment for borderline personality disorder?
Dialectical Behavior Therapy (DBT) began as a way to help manage crisis behavior, such as suicidal behavior or self-harm. It is the most commonly recommended therapy for BPD.Apr 21, 2021
What works in the treatment of borderline personality disorder Choi Kain?
Five major treatments—DBT, mentalization-based treatment (MBT) [1], schema-focused therapy (SFT) [2], transference-focused psychotherapy (TFP) [3], and systems training for emotional predictability and problem solving (STEPPS) [4]—have been established as evidence based treatments (EBTs) for BPD [5].Feb 3, 2017
Why does DBT work for BPD?
Introduction to Dialectical Behavior Therapy 6 Dialectical behavior therapy aims to address the symptoms of BPD by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.Mar 8, 2016
What is the gold standard treatment for borderline personality disorder?
DBT is recognized as the “gold standard” for people with BPD.Jun 7, 2017
Why is BPD important?
These findings are particularly important given that BPD is a disorder for which significant stigma may introduce barriers to successful treatment. The success of treatment dissemination depends in large part on whether clinicians are willing to use treatments and feel competent to do so.
What is mentalization in BPD?
Mentalization refers to the complex capacity human beings develop to imagine the thoughts and feelings in one’s own and other’s minds to understand interpersonal interactions [ 41 ]. Therein lies its mechanism of change. MBT proposes that BPD symptoms arise when a patient stops mentalizing, leading patients to operate from pathologically certainty about other’s motives, the disconnection from grounding influence of reality, and a desperate need for proof of feelings through action. Attachment interactions become hyperactivated, feeding into distress and difficulty coping, rather than providing safety and security, rendering the therapeutic process with BPD difficult.
Who declares royalties from Springer?
Dr. Lois W. Choi-Kain declares book royalties from Springer, outside of the submitted work. Ellen F. Finch, Dr. Sara R. Masland, Dr. James A. Jenkins, and Dr. Brandon T. Unruh declare that they have no conflicts of interest.
Is SCM the same as GPM?
SCM has considerable similarity to GPM in terms of training requirements , structure, and general principles. However, descriptions of therapeutic techniques employed in SCM suggest that in some respects, it may appear more similar to MBT than GPM in practice. GPM is less psychotherapeutically oriented than other evidence-based treatments for BPD [ 29 ]. The general therapeutic stance includes responsivity, appropriate self-disclosure, flexibility, and pragmatism. The nonspecific techniques and therapeutic stance employed in SCM are generally rooted in psychodynamic principles consistent with MBT. These include authenticity and openness, the adoption of a “not knowing” stance, a focus on misunderstandings in the relationship, and generation of curiosity about belief and intentions.
What is schema therapy?
Schema-focused therapy (SFT) is an integrative cognitive therapy focused on generating structural changes to a patient’s personality. In twice weekly individual therapy sessions, the clinician uses a variety of behavioral, cognitive, and experiential techniques that focus on the therapeutic relationship, daily life outside therapy, and past traumatic experiences. Unlike the more neutral stances of other therapies, SFT encourages an attachment between therapist and client, a process described as “limited re-parenting”. Therapy focuses on four schema modes of BPD: detached protector, punitive parent, abandoned/abused child, and angry/impulsive child. Its mechanism of change occurs through changing negative patterns of thinking, feeling, and behaving and developing healthier alternatives to replace them so that these dysfunctional schemas no longer control a patient’s life.
Is there a medication for BPD?
To date, no medication has been approved by the FDA for BPD or proven to definitively manage its cardinal symptoms, interpersonal impairments, and functional difficulties. Clinical applicability of the available evidence is hampered by a limited number of studies, small sample sizes, non-overlapping batteries of outcome measures, brief observation periods, and exclusion of co-morbidities in a population for whom both psychiatric and medical co-morbidity are the rule rather than an exception.
What is open access?
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author (s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
What is the treatment for borderline personality disorder?
Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder. Your therapist may adapt the type of therapy to best meet your needs. The goals of psychotherapy are to help you: Focus on your current ability to function. Learn to manage emotions that feel uncomfortable.
What is DBT therapy?
DBT includes group and individual therapy designed specifically to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships. Schema-focused therapy. Schema-focused therapy can be done individually or in a group.
How to reduce impulsiveness?
Reduce your impulsiveness by helping you observe feelings rather than acting on them. Work on improving relationships by being aware of your feelings and those of others. Learn about borderline personality disorder. Types of psychotherapy that have been found to be effective include: Dialectical behavior therapy (DBT).
How to deal with a substance abuse problem?
Manage intense emotions by practicing coping skills, such as the use of breathing techniques and mindfulness meditation.
What to do before a doctor appointment?
Before your appointment, make a list of: Any symptoms you or people close to you have noticed, and for how long. Key personal information, including traumatic events in your past and any current major stressors. Your medical information, including other physical or mental health conditions.
What is the practice guideline for borderline personality disorder?
This practice guideline offers treatment recommendations based on available evidence andclinical consensus to help psychiatrists develop plans for the care of adult patients with border-line personality disorder. This guideline contains many sections, not all of which will be equallyuseful for all readers. The following guide is designed to help readers find the sections that willbe most useful to them.
What is psychodynamic therapy?
Psychodynamic psychotherapy has been defined as a therapy that involves careful attention tothe therapist-patient interaction with, when indicated, thoughtfully timed interpretation oftransference and resistance embedded in a sophisticated appreciation of the therapist’s contri-bution to the two-person field. Psychodynamic psychotherapy draws from three major theo-retical perspectives: ego psychology, object relations, and self psychology. Most therapeuticapproaches to patients with borderline personality disorder do not adhere strictly to only oneof these theoretical frameworks. The approach of Stevenson and Meares (20, 138), for example,encompasses the self-psychological ideas of Kohut and the object relations ideas of Winnicott,whereas the technique of Kernberg et al. (4, 13, 28) is based on an amalgamation of ego psy-chology and object relations theory.
How long does cognitive behavior therapy take?
Dialectical behavior therapy consists of approximately 1 year of manual-guided therapy(involving 1 hour of weekly individual therapy for 1 year and 2.5 hours of group skills trainingper week for either 6 or 12 months) along with a requirement for all therapists in a study or pro-gram to meet weekly as a group. Linehan and colleagues (8) reported a randomized controlledtrial of dialectical behavior therapy involving patients with borderline personality disorder whosesymptoms included “parasuicidal” behavior (defined as any intentional acute self-injurious behav-ior with or without suicide intent). Control subjects in this study received “treatment as usual”(defined as “alternative therapy referrals, usually by the original referral source, from which theycould choose”). Of the 44 study completers, 22 received dialectical behavior therapy, and 22 re-ceived treatment as usual; patients were assessed at 4, 8, and 12 months. At pretreatment, 13 ofthe control subjects had been receiving individual psychotherapy, and 9 had not. Patients whoreceived dialectical behavior therapy had less parasuicidal behavior, reduced medical risk due toparasuicidal acts, fewer hospital admissions, fewer psychiatric hospital days, and a greater capacityto stay with the same therapist than did the control subjects. Both groups improved with respectto depression, suicidal ideation, hopelessness, or reasons for living; there were no group differenc-es on these variables. Because there were substantial dropout rates overall (30%) and the numberof study completers in each group was small, it is unclear how generalizable these results are.Nonetheless, this study is a promising first report of a manualized regimen of cognitive behaviortreatment for a specific type of patient with borderline personality disorder.
What is psychiatric management?
Psychiatric management forms the foundation of treatment for all patients. The primary treat-ment for borderline personality disorder is psychotherapy, complemented by symptom-targetedpharmacotherapy [I]. In addition, psychiatric management consists of a broad array of ongoingactivities and interventions that should be instituted by the psychiatrist for all patients withborderline personality disorder [I]. Regardless of the specific primary and adjunctive treatmentmodalities selected, it is important to continue providing psychiatric management throughoutthe course of treatment. The components of psychiatric management for patients with border-line personality disorder include responding to crises and monitoring the patient’s safety, estab-lishing and maintaining a therapeutic framework and alliance, providing education aboutborderline personality disorder and its treatment, coordinating treatment provided by multipleclinicians, monitoring the patient’s progress, and reassessing the effectiveness of the treatmentplan. The psychiatrist must also be aware of and manage potential problems involving splitting(see Section II.B.6.a) and boundaries (see Section II.B.6.b).
Can borderline personality disorder be diagnosed in the elderly?
Virtually no treatment studies have been done in adolescentsor elderly persons with borderline personality disorder. Although treatments effective in adultswould be expected to be efficacious in these age groups, research that demonstrates this efficacyis needed, especially in adolescents. It should be kept in mind that elderly patients are particu-larly prone to certain medication side effects (e.g., orthostatic hypotension and anticholinergiceffects) and therefore may tolerate certain medications less well than younger adults.
Can psychodynamic therapy help with borderline personality disorder?
Psychodynamic therapy for patients with borderline personality disorder is uncommonly de-manding. Consultation from an experienced colleague is highly recommended for all therapistsduring the course of the therapy. In some situations, personal psychotherapy can help the cli-nician develop skills to manage the intense transference/countertransference interactions thatare characteristic of these treatments.
What is interpretation therapy?
In its simplest form, interpretation involves making something con-scious that was previously unconscious. An interpretation is an explanatory statement that linksa feeling, thought, behavior, or symptom to its unconscious meaning or origin. For example, atherapist might make the following observation to a patient with borderline personality dis-order: “I wonder if your tendency to undermine yourself when things are going better is a wayto ensure that your treatment with me will continue.”
Specialized Evidence-Based Treatments (Ebts) For BPD
- Dialectical Behavioral Therapy
The most well-known, well researched, and widely available EBT for BPD is DBT [39, 40]. Informed by clinical experience with suicidal personality disordered patients who did not improve with standard cognitive behavioral therapy intervention, Linehan developed DBT by incorporating the … - Mentalization-Based Treatment
Mentalization refers to the complex capacity human beings develop to imagine the thoughts and feelings in one’s own and other’s minds to understand interpersonal interactions [41]. Therein lies its mechanism of change. MBT proposes that BPD symptoms arise when a patient stops mental…
Generalist Approaches to BPD
- General Psychiatric Management
Given the limitations of treatment models that require significant training and significant clinic resources, there is a need to develop, test, and disseminate less intensive treatments. One of these new EBTs is general psychiatric management (GPM) [8•]. GPM is based on a case manag… - Structured Clinical Management
Structured clinical management (SCM) was developed in the UK, similar to GPM, reflects “best general psychiatric treatment” that is feasible for use by “generalist mental health clinicians” with minimal additional training [47, p. 57]. It was developed based on “expert consensus” about wha…
Dismantling Studies
- Now that several evidence-based treatments for BPD have been tested, their most essential ingredients can be discerned from dismantling studies. A major advance in the last 5 years for understanding what works in BPD treatment comes from Linehan’s dismantling study of DBT. DBT in its standard form involves an intensive package of weekly individual therapy, weekly two and …
Other Brief Cost-Effective Options
- Systems Training for Emotional Predictability and Problem Solving
Designed to supplement ongoing treatments such as medication, individual therapy, and case management, systems training for emotional predictability and problem solving (STEPPS) consists of cognitive behavioral elements, skills training, and a systems component. The STEPP…
Treatments For BPD and Major Co-Morbidities
- BPD’s usual complex pattern of co-morbidity [49, 50] is another challenging factor in its clinical management. While depression is its most common co-morbidity, co-occurring with BPD in the majority of cases [50], evidence from RCTs presented here suggest it responds to specialist and generalist approaches, and tends to improve when BPD improves [51]. Other common co-morbi…
Pharmacology
- Compared with the growing evidence base for effective psychological treatments, pharmacologic treatments for BPD remain less well-studied. To date, no medication has been approved by the FDA for BPD or proven to definitively manage its cardinal symptoms, interpersonal impairments, and functional difficulties. Clinical applicability of the available evidence is hampered by a limite…