Borderline Personality Disorder and the Efficacy of Dialectical Behavior Therapy

Borderline Personality Disorder and the Efficacy of Dialectical Behavior Therapy

Borderlines and Dialectical Behavior Therapy

According to the National Institutes of Mental Health (2017), Borderline Personality Disorder (which will be referred to as BPD for the remainder of this paper) is a mental illness characterized by extremes, changes in mood, disturbed self-image and suicidal ideation just to name a few. Borderlines are often impulsive, have abandonment and trust issues and typically self-harm. Most borderlines tend to display an “all or nothing” belief (NIMH, 2017). One day a person may be a best friend, the next, a mortal enemy. For a proper diagnosis of BPD, practitioners must positively identify five out of nine markers. Dialectical Behavior Therapy (which will be referred to as DBT for the duration of this paper) is a type of psychotherapy custom designed around 1990 for people suffering

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from BPD by Dr. Marsha Linehan (May, Richardi & Barth, 2016).  DBT is composed of 4 different elements that include both private and group therapy focused solely upon recognition of and coping with negative behaviors, particularly those that lead to self-harm and suicidal ideation (May, Richardi & Barth, 2016). The mindfulness component is modeled after techniques utilized in achieving Zen in Buddhism (Reddy & Vijay, 2017). This helps build confidence, deter the symptoms of post-traumatic stress disorder, and correct unwanted behaviors (Reddy & Vijay, 2017).

PICOT Question

 The question formulated for the basis of this paper is “In persons diagnosed with borderline personality disorder (Population), is regular attendance in Dialectical Behavior Therapy (DBT) (Intervention) more effective in managing manifestations of the disorder (Outcome) compared to those individuals with BPD that do not choose to attend DBT (Comparison Group) over a period of 6 months’ time?” Borderline Personality Disorder sufferers have a difficult time coping with the array of negative emotions that bombard their lives. Is DBT a truly effective solution in a timely manner to give relief to those who are plagued by their symptoms?

Evidence

        As we have learned over the course of our nursing program, prioritizing is directly related to Maslow’s hierarchy of needs. This would make self-harm and suicide prevention intervention the very highest priority in the case of most clients with BPD. In a study performed in the United Kingdom in 2009, patients were separated into two groups. One group attended normal psychotherapy sessions, the other group attended DBT. These results were over one year, but patients were evaluated, and data collected at 6 months and then again at the year mark. No significant data was noted that DBT was more effective than traditional psychotherapy (Feigenbaum, Fonagy, Pilling, Jones, Wildgoose & Bebbington, 2012). However, a more recent study with 240 participants in Canada found that clients not only had a reduction in self-harming behaviors but also had better adherence to the program with 6 months of therapy versus one year of treatment (McMain, Chapman, Kuo, Guimond, Streiner, Dixon-Gordon, Isaranuwatchai & Hoch, 2018).  In my own personal experience with a group of women diagnosed with BPD living in a group home setting, clients were urged to attend 2 weekly sessions of DBT both lasting an hour in duration, as well as follow up with their personal therapists. These women were given the choice to attend these therapy sessions or not. 4 attended every session, 2 did not. Of the 4 regular attendees, 3 maintained regular jobs, had increasingly stable relationships with family and even with significant others. They followed the rules of their group home and two eventually moved out into independent living. One went on to move completely out of the social service system and became a registered nurse! However, of the 2 who chose not to attend as they could not be forced to do something against their will, 1 was constantly in trouble with the house and with the law. She had very little control over her emotions and as a result her relationships greatly suffered. She ended up in a state facility and evicted from the group home after attempting to harm her housemate’s rabbit and destroying a living suite. The other waxed and waned in her daily behaviors. She intermittently held a job. There was no real improvement or motivation.

Evaluation and Conclusion

       The most effective methods to ensure efficacy would be re-evaluation, especially for self-harm and suicide. While I am encouraged at what I witnessed in the workplace with this population and means of therapy, true evaluation would likely involve collaboration with practitioners with specialties in the mental health field and would include evaluation tools. A reduction or elimination of self-harming and suicidal behaviors would indicate that the therapy was effective, as well as ability to cope through negative situations that continuously exist in their microcosm.

References

• Feigenbaum, J. D., Fonagy, P., Pilling, S., Jones, A., Wildgoose, A., & Bebbington, P. E. (2012). A real-world study of the effectiveness of DBT in the UK National Health Service…Dialectical behavioral therapy. British Journal of Clinical Psychology, 51(2), 121–141. https://doi-org.ezproxy.rasmussen.edu/10.1111/j.2044-8260.2011.02017.x
• McMain, S. F., Chapman, A. L., Kuo, J. R., Guimond, T., Streiner, D. L., Dixon-Gordon, K. L., … Hoch, J. S. (2018). The effectiveness of 6 versus 12-months of dialectical behaviour therapy for borderline personality disorder: The feasibility of a shorter treatment and evaluating responses (FASTER) trial protocol. BMC Psychiatry, 18. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2018-35548-001&site=eds-live
• National Institute of Mental Health (2017). Borderline Personality Disorder. Retrieved from: https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml#part_145390
• May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The mental health clinician, 6(2), 62-67. doi:10.9740/mhc.2016.03.62
• Reddy, M. S., & Vijay, M. S. (2017). Empirical Reality of Dialectical Behavioral Therapy in Borderline Personality. Indian journal of psychological medicine, 39(2), 105-108.