Black and White- Why DBT Works Best for Folks with Borderline Personality Disorder
What is Dialectical Behaviour Therapy
The go-to evidence-based therapeutic approach to manage the symptoms of Borderline Personality Disorder is Dialectical Behaviour Therapy (DBT). Since its conception in the late 1980s by psychologist Marsha Linehan, DBT’s aim has been to equip individuals and groups with practical skills that help them achieve emotion regulation and reduce the occurrence and intensity of distress.
What makes DBT different from more traditional therapeutic approaches is the inclusion of mindfulness and other Zen principles and reframing the model through which clinicians viewed Borderline Personality Disorder (BPD). DBT emphasizes that BPD is a disorder of the emotion regulation system explained through the Biosocial Theory (source).
Biosocial Theory
The biosocial theory explains that some of us are more sensitive to our environment and that our emotional vulnerability is biological. In my previous post, I shared that genetics play an important part in someone having BPD. This explains why some people experience more difficulty in regulating their actions and are more susceptible to depressive episodes than others.
Marsha Linehan explains that our social environment also plays an integral part in the way we are able to regulate our emotions and build relationships. An invalidating and ineffective social environment is a big problem when you want to learn to regulate emotions and actions. So if others around you ask you to change certain behaviours and actions but do not coach or support you on how to do that, it will be hard and isolating to keep on trying to change.
The social environment includes the bigger picture as well. So if you are trying to develop these skills and are experiencing racism, sexism or any other form of discrimination at the systemic level, it will be very difficult to practice grounding skills. You are constantly up against barriers in an invalidating & ineffective environment. Having this knowledge can help us figure out best suited options to deal with our problems.
Why it works
DBT works for folks with BPD for a number of reasons.
It teaches folks to link their triggers to their problem behaviours.
It coaches individuals to practice making decisions in wise-mind which is the balance between our rational, more mechanical mind and the emotional, more vulnerable mind.
DBT provides a robust list of hands-on tips you can try when you’re in distress.
The basic assumption of DBT is that you are doing the best you can in any given situation. This can act like a cooling splash of water on a very hot pan and can take the edge of off skills-training
Learning DBT in group settings can accelerate skill-building and sharing validation among group members.
The dictionary meaning of ‘dialectical’ is ‘concerned with or acting through opposing forces.’ DBT highlights the importance of the co-existence of opposing emotions and events. You can enjoy being at a party because the music is great and you can miss your friends if you’re by yourself. You can be excited about going on a trip and feel nervous about exploring a new place.
This is also why DBT works especially well with individuals with BPD because it targets the black or white thinking that is synonymous with BPD. Through consistent practice, folks are able to embrace the dialectical nature of our world.
DBT in Individual Therapy Sessions
While much of DBT is offered through group work and skills-training, continuing to work on it in individual therapy sessions can really cement the foundational work.
We take all of your group work into individual sessions and apply it to the very specific circumstances of your day-to-day life and practice together.
For example, if one of your goals is to be more assertive at your workplace or school, we will work on developing a strategy together on practicing the interpersonal effectiveness skills. We do role-play, go through various scenarios and multiple situations to assess which interpersonal skill will be best suited.
In another instance, if you are working on managing your triggers and anxiety, we work on identifying which events lead to those triggers and how to identify whether its requires a distress tolerance skill or an emotion regulation skill.
If you have not attended a DBT group in the past, we will do that foundational work in our individual sessions by integrating other therapeutic approaches like CBT, somatic experiencing and/or trauma-informed techniques. We go on a pace that feels most right to you and adjust accordingly.
Not Just for People with BPD
DBT is not just for people with BPD or other personality disorders. Its skills are helpful for anyone going through a difficult mental health situation, including PTSD, anxiety and depression. One shortcoming of DBT skills is that it can be a lot of information all at once, especially for neurodiverse folks. If you are on the autism spectrum or have ADHD, we will tailor these skills by breaking them into smaller, less dense formats so you get the most out of them.
One of my favourite DBT skills is from the Emotion Regulation category- ABC PLEASE.
Accumulate Positive Emotions- both in the short and the long term to build a life worth living
Build Mastery- do things that make you feel competent and effective to combat helplessness and hopelessness
Cope Ahead of Time with Emotional Situations- rehearse a plan ahead of time so that you are prepared to cope skillfully with emotional situations.
PLEASE- Take care of your mind by taking care of your body
If you would like to know more about how we work with clients from a DBT lens, you can contact us via WhatsApp, email or phone call. You can also book a time for a 20-minute free consultation here.
