Dialectical behaviour therapy and borderline personality disorder
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Dialectical Behaviour Therapy and Borderline Personality Disorder. Presentation Outline. Psychoanalysis and BPD. Dialectical Behavior Therapy Studies Positive and Negative aspects of DBT Evaluation. Borderline Personality Disorder.

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Presentation Transcript

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Presentation Outline Disorder.

  • Psychoanalysis and BPD.

  • Dialectical Behavior Therapy

  • Studies

  • Positive and Negative aspects of DBT

  • Evaluation


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Borderline Personality Disorder 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 paranoidideation or severe dissociative symptoms.


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Psychoanalysis and BPD Disorder.

  • 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.


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Dialectical Behaviour Therapy Disorder.

  • 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.


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Reasoning behind DBT Disorder.

- 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.


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Four Modules Disorder.

  • Mindfulness

  • Interpersonal effectiveness

  • Distress endurance

  • Emotion regulation


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Pre- treatment stage Disorder.

  • 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.


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Stages Disorder.

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


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Diary Cards Disorder.


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Effectiveness of dialectical behavior therapy for Disorder.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 anti-depression 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.


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Reduced Disorder.

suicidal behaviour

Hospitalizations

Length of hospitalization

treatment dropout

Depression scores

Anger

Dissociation

Substance use

Increased

interpersonal functioning

Global functioning

Positive aspects of DBT


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Negative aspects of DBT Disorder.

  • The first stage alone takes one year at least.

  • Expensive

  • Long- waiting lists


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Evaluation Disorder.

  • 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.


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