Transcript Dialectical Behaviour Therapy and Borderline Personality Disorder.

Dialectical Behaviour Therapy
and Borderline Personality
Disorder.
Presentation Outline
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Psychoanalysis and BPD.
Dialectical Behavior Therapy
Studies
Positive and Negative aspects of DBT
Evaluation
Borderline Personality Disorder
Five or more of the following to be present for a significant period of time:
• Frantic efforts to avoid real or imagined abandonment. [Not including
suicidal or self-mutilating behavior covered in Criterion 5]
• A pattern of unstable and intense interpersonal relationships characterized
by alternating between extremes of idealization and devaluation.
• Identity disturbance: markedly and persistently unstable self-image or sense
of self.
• Impulsivity in at least two areas that are potentially self-damaging (e.g.,
spending, promiscuous sex, eating disorders, substance abuse, reckless
driving, binge eating). [Again, not including suicidal or self-mutilating
behavior covered in Criterion 5]
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
• Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours and only
rarely more than a few days)
• Chronic feelings of emptiness.
• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent
displays of temper, constant anger, recurrent physical fights).
• Transient, stress-related paranoid ideation or severe dissociative symptoms.
Psychoanalysis and BPD
• Traditional psychoanalytic treatments of BPD
required longer hospitalization periods. They
relayed on patients being in a controlled
environment.
• Long hospitalization periods are rarer nowadays.
• Psychoanalysis requires longer periods of
commitment to treatment, which is incompatible
with Borderline Personality Disorder.
Dialectical Behaviour Therapy
- Dialectical Behaviour Therapy(DBT) is a form of
cognitive behavioural therapy for borderline personality
disorder patients developed by Marsha Linehan. It was
developed in the 1990´s.
- DBT was first developed for “chronically suicidal
individuals”.
- This form of therapy is called “Dialectical” because it
deals with emotional and rational aspects, and with
acceptance and change.
- DBT mixes cognitive behavior therapy with mindfulness
techniques.
- Individual Therapy and Group Therapy.
Reasoning behind DBT
- BPD has a biological basis, which affects emotional
regulation. Social environments may reinforce their
dysfunctional behaviour (Biosocial theory).
- DBT encourages clients to be aware of the current
moment and accept reality.
- DBT tries to replace rigid/dichotomous worldviews. It
emphasizes the importance of a more holistic approach
to life.
- DBT also stresses that balance is important in life.
Clients should achieve a middle ground between reason
and emotion.
Four Modules
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Mindfulness
Interpersonal effectiveness
Distress endurance
Emotion regulation
Pre- treatment stage
1)
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Agreeing on goals
Individualized treatment lists :decrease behaviours
which prolong hospitalization (parasuicidal, therapy
interfering behaviour), decrease behaviours that affect
quality of life, increase life skills, decrease stress,
increase self-esteem.
2)Committing to treatment plans
- Most patients enter the hospital involuntarily.
Stages
Stage one
- Decrease behaviour which prolong hospitalization
- Increase skills for getting out and staying out of the hospital.
- Crisis survival skills : distress tolerance module
Stage 2
- Deal with stress related problems
Stage 3
- Increase self- esteem
- Treatment goals
Stage 4
Diary Cards
Effectiveness of dialectical behavior therapy for
Borderline personality disorder in an inpatient
setting
- Fifty inpatients diagnosed with BPD were evaluated at
three different points in time. The patients were screened
for substance abuse, bipolar I, dementia and
schizophrenia.
- Each patient went to individual therapy sessions once a
week and group sessions three times a week
- Sixty-two percent of patients also received antidepression medication. Benzodiapines were also used.
- Symptoms were reduced, but not eliminated.
- Findings confirmed the effectiveness of DBT. It was also
proved that DBT can be used in an inpatient setting.
Positive aspects of DBT
Reduced
- suicidal behaviour
- Hospitalizations
- Length of hospitalization
- treatment dropout
- Depression scores
- Anger
- Dissociation
- Substance use
Increased
- interpersonal functioning
- Global functioning
Negative aspects of DBT
- The first stage alone takes one year at
least.
- Expensive
- Long- waiting lists
Evaluation
• There are few studies about DBT. Most studies
use small samples.
• There were no follow-up studies of the original
research.
• Personality disorders are difficult to treat.
Parasuicidal behaviours are hard to control.
However, DBT seems to help most patients.
• It is possible to adapt DBT to other situations
and settings.