The Use of DBT in Groups of Clients with Borderline Personality Disorder

Treating patients who suffer from borderline personality disorder can be a daunting task. Most health practitioners and providers refer to these patients as troublesome due to the nature of their behavior. There is a generally high incidence of suicides among individuals, who suffer from Borderline Personality Disorder (BPD) due to stigmatization. It is estimated that almost 75% of individuals with BPD have either contemplated or attempted suicide (Barlow, 2007). More so, each of the individuals has an average of 3.4 suicide attempts. The high number of suicide attempts prompted Marsha Linehan and her fellow clinicians to seek for an effective intervention to deal with BPD. Linehan developed Dialectic Behavior Therapy (DBT) which is a therapeutic approach that combines a range of medical and cognitive approaches (Barlow, 2007). A burgeoning body of studies has found DBT to be effective in parasuicidal women with BDP, patients with substance use disorder, binge eating disorder as well as elderly patients (Barlow, 2007) . In this light, this essay seeks to highlight the effectiveness of Dialectical Behavior Therapy on women with suicidal tendencies. Moreover, the essay will highlight DBT interventions and outcomes.  

Population Description 

Generally, parasuicidal women experience emotional dysregulation. These women are easily irritated and have reactive emotional responses. Moreover, they may express fits of anger from time to time these women are also susceptible to depression due to being stigmatized by people who do not understand them (Brown, Comtois, & Linehan, 2002). What is more, these women have shown some behavioral problems that are evidenced by their impulsive behavior (Koons, et al., 2001) . A nother important characteristic of parasuicidal women is that they tend to engage in self-destructive behavior such as attempts tom injure, mutilate or kill themselves (Barlow, 2007). More so, actual suicides feature prominently in this population. Moreover, Barlow mentions that this group of women sometimes experience cognitive dysregulation. These women often depersonalize, dissociate and delude themselves. These feelings are heightened by stressful situations and they dissipate as soon as the stressful situation is dealt with.  

It bears noting that parasuicidal women who suffer from BPD report that they feel empty most of the time and they barely recognize who they are. Additionally, Barlow found out that these women often experience interpersonal dysregulation (Barlow, 2007) . They may struggle in relationships due to the chaotic nature of their behavior (Brown, Comtois, & Linehan, 2002). Even so, they rarely let go of their relationships. Instead, they may be overly protective and engage in frantic efforts to prevent their significant others from leaving them.  

DBT Techniques 

It has been established that DBT is superior to all other methods when it comes to reducing suicidal tendencies among women with BPD (Chapman, 2006). The first randomized clinical trial for DBT found that DBT was effective because it was conducted in the community. Moreover, DBT was found to be effective in reducing the frequency of suicide attempts among women with DBT. In the same vein, Chapman notes that DBT is effective at managing anger and improving social functioning (Chapman, 2006). Chapman conducted an experiment where 101 parasuicidal women were placed under rigorous control conditions supervised by community practitioners considered as BPD specialists. The study established that DBT patients experienced reduced suicidal thoughts and attempts, angry behavior, risk of hospitalization, and emergency room visits in the 12-mont treatment and 12 months follow up period. Several studies have also investigated the effectiveness of DBT for women in VA hospitals and community mental health centers. Chapman established that both of these patients experienced reduced suicidal ideation, deliberate self-harm inpatient days, and impulsivity. Additionally, Koons et al. noted that women veterans with BPD experienced substantial reductions in hopelessness, fits of anger and depression (Koons, et al., 2001).  

Also noteworthy is the fact that DBT is a multifaceted therapy. Unlike other therapies where a physician attends to a patient in isolation, DBT is handled by a team of physicians who handle the patients at different stages (Chapman, 2006) . A team compo0sing of physicians, medical practitioners, nurses and consultants ensure that DBT is used as a program of treatment as opposed to other forms of interventions. Most clinicians agree that DBT is effective. However, they find it difficult to use a comprehensive approach because it involves a lot of daunting steps.  

DTB can be categorized into four main components: “skills training group, individual psychotherapy, telephone consultation, and therapist consultation team” (May, Richardi, & Barth, 2016). Skills training groups are target parasuicidal women with behavioral skills deficits including chaotic relationships, unstable sense of self, impulsivity, and emotional liability. The individual psychotherapy component focuses on parasuicidal behavior, behavioral skills acquisition, self-respect behaviors, and therapy-interfering behaviors. In this stage, the team of physicians explore the patients’ parasuicidal behaviors in detail and emphasize on DBT management, problem-solving and active coping. Telephone consultations enable the patient to contact a therapist whenever they are in a situation that requires guidance. Lastly, the therapist consultation team meets weekly to deliberate on the challenges of dealing with DBT patients. Given the challenging and stressful nature of dealing with BPD patients, therapists can be stressed and demotivated. For this reason, the weekly consultative meetings promote therapy within the therapists and maintain motivation and commitment among the providers.  

Rational for DBT Application 

As demonstrated by a substantial body of literature, DBT is more effective than any other community-based intervention especially in managing parasuicidal behaviors among women with BPD (Koons, et al., 2001; Riffer et al., 2019). Furthermore, Dialectic Behavior Therapy is a flexible treatment that varies depending on a patient’s level of disorder. Across studies, DBT has received positive reviews especially due to its role in reducing suicide attempts, depression, hopelessness, self-injury and bulimic behavior (Chapman, 2006). Additionally, DBT has undergone various tests and trials for the duration it has been in application. A considerable number of evidence based studies have been conducted to establish the effectiveness of the approach and so far the results have been nothing but encouraging. 

A Typical Plan for a DBT Group Session 

Physicians who deal with BPD patients are encouraged to focus on the emotions of the parasuicidal women. The biosocial theory of BPD stipulates that individuals with BPD are born with a disposition towards emotional weakness or vulnerability (Chapman, 2006) . It is for this reason that they often display intense emotional responses. A child born with this vulnerability requires help from parents to cope with these intense emotional reactions. It is unfortunate that most parents do not understand children born with this condition. As such, they will punish the children, ignore them or dismiss them in an attempt to make them calm them. However, what they do not know is that doing so only exacerbates the situation and makes it difficult or the children to learn how to manage their emotions. As such, the children’s risk of developing BPD is heightened. 

Koons et al. emphasize on the fact that DBT is an emotion focused treatment (Koons, et al., 2001) . Koons et al. note that the primary goal of DBT is to help a patient manage her emotions and improve the quality of her life. As such, DBT interventions teach patients how they can understand their various emotions and regulate them. During the DBT sessions, the patients can interfere with the program. In such a case, the physician is expected to intervene and help the patient to regulate her emotions. It is for this reason that Koons et al., emphasize the importance of educating therapists on emotions and emotion regulation. Furthermore, the therapists should be able to notice and interpret BPD patients’ body language, facial expressions, and voice tone among other red alerts (Chapman, 2006) . In the same breath, BPD patients should be helped to accept their condition. One important intervention in this endeavor is mindfulness. BPD patients are taught how to be mindful by not being overly judgmental and fully participating in current events. Additionally, the patients are encouraged to accept their current state without struggling to change it. 

Conclusion 

Individuals who suffer from Borderline Personality Disorder are among the most difficult lot of patients to deal with. Clinicians who deal with BPD patients require patience and self-restraint to succeed in their job posts. Most individuals with BPD experience suicidal thoughts or even attempt suicide in some instances. In an attempt to curb the number of suicide attempts in women as a result of BPD, Marsha Linehan and her fellow clinicians developed Dialectic Behavior Therapy (DBT). DBT has surpassed all the other BPD interventions due to its effectiveness in helping individuals with different disorders to manage their conditions. In particular, therapy has been considered effective in parasuicidal women.  

Undoubtedly, medication can provide alternatives or additional treatment for parasuicidal women. Even so, DBT is the only treatment that is supported by empirical evidence. It is therefore important for are providers to familiarize themselves with the treatment approach. More so, pharmacists are in a unique position to educate patients and providers in formal and informal contexts about the benefits of DBT. Lastly, medical practitioners should pay attention to patients’ behavior such as uncontrolled anger, impulsivity, interpersonal conflicts, substance abuse, and parasuicidal tendencies to provide the appropriate medical care by referring the patient to a canter that offers DBT therapy.  The other DBT intervention is validating patients’ opinions, experiences and emotional reactions. In a few words, therapists are supposed to be knowledgeable enough when it comes to managing BPD patients’ emotions in order to apply the most effective acceptance oriented intervention . 

References 

Barlow, D. H. (2007). Clinical Handbook of Psychological Disorders, Fourth Edition: A Step-by-Step Treatment Manual. New York: Guiford Press. 

Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for Suicide Attempts and Nonsuicidal Self-Injury in Women With Borderline Personality Disorder. Journal of Abnormal Psychology, 111 (1), 198-202. doi:10.1037//0021-843X.111.1.198 

Chapman, A. L. (2006, September). Dialectical Behavior Therapy: Current Indicatins and Unique Elements. Psychiatry , pp. 62-67. 

Koons, C. R., Robins, C. J., Tweeds, J. L., Lynch, T. R., Gonzales, A. M., Morse, J. Q., & Bishop, G. K. (2001). Efficacy of Dialectical Behavior Therapy in Women Veterans With Borderline Personality Disorder. Behavior Therapy, 32 , 171-390. 

Linehan, M. M. (1996). Interpersonal and Emotional Problem Solving Skills and Parasuicide among Women with Borderline Personality Disorder. Journal of Personality Disorders , 153-160. doi:10.1521/pedi.1996.10.2.153 

May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality. Mental Health Clinician, 6 (2), 62-67. doi:10.9740/mhc.2016.03.62 

Riffer, F., Farkas, M., Streibl, L., Kaiser, E., & Sprung, M. (2019). Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines. International Journal of Psychiatry in Clinical Practice, 23 (3), 178-188. doi:10.1080/13651501.2019.1576904