r). Dialectical Behavior Therapy (DBT) in the Treatment of Borderline Personality Disorder. Journal of Psychiatric & Mental Health Nursing, 21 (6), 518–525. http://doi.org/10.1111/jpm.12116
This article begins with setting the stage that Dialectical Behavior Therapy (DBT) is a form of Cognitive Behavior Treatment (CBT) for borderline personality disorder (BPD). Borderline personality disorder is a compound psychological disorder that is shaped by the influence of dysregulation of emotion, behavior and cognition. Dialectics is the way in which someone with BPD might be able to understand changes with his or her contradictory views of these emotion, behavior, and cognition concretely. The purpose of understanding dialectics is to realize that there are two different opposing points of view at hand. DBT is a process of bringing these two points together and making the patient aware of these two opposing views and to fuse the two together.
DBT was first developed with the intention of looking at a person with BPD as an emotionally vulnerable person combined with a living environment that was not undermining those emotions (Harned, Banawan, & Lynch, 2006). Taking this into consideration, DBT uses multiple treatment tactics such as chain analysis, mindfulness, opposite action and validation, which all use emotional validation.
The therapist helps patients learn problem-solving skills in place of his or her unwanted behavior by using Chain analysis. Mindfulness is considered the key skill of DBT. Mindfulness is a skill that is taught to teach the person dealing with BPD to experience their emotions, thoughts, or what is going on in the environment around them in a non-judgmental way. Opposite action works in two different ways: behavioral exposure and cognitive modification. An example from another article to describe the behavioral exposure is to make the patient aware that when the emotion of anger is present and justified, the natural reaction is to attack. Instead, the skill taught to avoid the reaction to attack, is to avoid attacking mentally and physically. In place, the person might be able to use a new taught skill such as empathy (Harned, Banawan, & Lynch, 2006). Cognitive modification aids opposite action by changing the view of his or her emotional experience. Together behavioral exposure and cognitive modification comes together to change not only behaviors, but also the emotion associated with the behavior to create opposite action. Finally, one of the main keys for being a good therapist is validation of one’s thoughts and feelings. When the therapist does this, the patient feels accepted and produces a positive and trusting environment for change.
The study in this article was to look at the five personality traits of those with BPD. The five personality traits are: neuroticism, extraversion, openness to experience, agreeableness and conscientiousness. Two groups of participants were chosen. The first group was on the waiting list to begin DBT or had just begun their 8-week skill-building module. The second group had already completed their DBT program within the past three years. The study was conducted by a questionnaire and was sent to all participants. The study showed that those who had not had DBT scored higher in neuroticism and lower consciousness than those who had undergone DBT. The conclusion is that further evidence is needed to determine the true effectiveness of DBT for those with BPD.
Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., & Palmer, S. (2006). The Effectiveness of Cognitive Behavior Therapy for Borderline Personality Disorder: Results From the Borderline Personality Disorder Study of Cognitive Therapy (boscot) Trial. Journal of Personality Disorders, 20 (5), 450–465. http://doi.org/10.1521/pedi.2006.20.5.450
This article’s hypothesis is that Cognitive Behavioral Therapy (CBT) can bring about quick and important changes in a patient suffering with Borderline Personality Disorder (BPD) in clinical settings. A randomized study was conducted between the dates of January 2002 through February 2005 at three United Kingdom locations. The patients were chosen based on eligibility, which was if they were between the ages of 18 and 65 years old and fit the criteria of BPD by showing at least 5 signs of BPD. The study was conducted using treatment as usual in addition to CBT.
Treatment as usual may have varied based on the therapist’s abilities and each patient’s needs and also included a wide variety of resources, including inpatient and outpatient programs, nurses and other qualified clinical services. CBT was used in addition in these patients to mature and change beliefs about themselves and others. Meanwhile, CBT was also used to help patients grow immature behavioral actions into behavior that would support social functioning.
The primary outcome was to determine if the suicidal acts, emergency related accidents, and psychiatric hospitalization was lessened. The secondary outcome was to determine if self-harm acts and acts not caused by accidents were lessened by combining CBT with treatment as usual. The primary outcome showed no significant differences using CBT and treatment as usual versus treatment as usual in regards to suicide attempt, hospitalization, or emergency related accidents. However, there was a significant reduction of suicidal acts due to CBT combined with treatment as usual, as opposed to just treatment as usual. The secondary outcome showed some significant differences with the addition of CBT in therapy.
Since that particular study, there have been others that do in fact prove that CBT in addition to treatment as usual has reduced suicidal behavior and levels of anxiety. CBT also may have brought about a change in beliefs but not a change in depression levels. It was determined by this article of study that further research might be conducted to explain under what conditions CBT might be most effective.
Jørgensen, C. R., Freund, C., Bøye, R., Jordet, H., Andersen, D., & Kjølbye, M. (2013). Outcome of Mentalization-Based and Supportive Psychotherapy in Patients with Borderline Personality Disorder: a Randomized Trial. Acta Psychiatrica Scandinavica, 127 (4), 305–317. http://doi.org/10.1111/j.1600-0447.2012.01923.x
This article started off by describing what BPD is. It is known to be one of the most difficult disorders to treat because of the complexity of psychosocial skills a person with BPD has. Often a person with BPD is very unstable in every aspect of life including relationships and work. This disorder is commonly found in women and is coupled with other personality disorders. Over time, however, no single treatment model has been used. The article does make mention that DBT was superior to all treatment as usual thus far.
The purpose of the study that was conducted tested two years worth of Mentalization based therapy (MBT) and two years of supportive group therapy in patients who were diagnosed with BPD. The study was conducted of 111 patients who were randomly assigned to either MBT or supportive group therapy. MBT consisted of 45 minute sessions weekly of therapy while supportive group therapy consisted of 1 ½ hour weekly sessions. Both groups of patients also participated in psycho-educational programs once a month for six months.