Dialectical Behavior Therapy Treating Borderline Personality Disorder
Dialectical Behavior Therapy (DBT) is a type of psychotherapy developed by psychologist Marsha Linehan for the treatment of Borderline Personality Disorder (BPD). While DBT skills were primarily developed for people diagnosed with BPD, the skills may be useful in treating various mental health disorders in which clients struggle with poor coping and problematic emotional regulation.
Mindfulness Based Treatment
DBT utilizes behavior therapy principles in conjunction with Eastern philosophical practices of mindfulness meditation. A DBT client has specific behavioral goals achieved by utilizing skills to handle emotional and cognitive dysfunction. A general goal of DBT is to learn skills that change behavioral, emotional and cognitive patterns associated with the client's problematic living and distress, decreasing interpersonal chaos, labile moods (depression, anger), impulsiveness and confusion about oneself, while increasing interpersonal effectiveness, emotional regulation, distress tolerance and mindfulness. DBT involves group therapy, individual therapy, family sessions as needed and crisis intervention.
Mindfulness DBT Skill
Mindfulness is one of the DBT skills. Marsha Linehan explains the theory behind mindfulness by identifying the differences between “reasonable mind,” “emotional mind,” and “wise mind.” Reasonable mind is the scientific/analytical part of the mind (useful for paying bills or planning a schedule, less useful for enjoying a play if you keep thinking “this could never happen in real life”). Emotional mind is the creative part (useful in empathizing or writing a love sonnet, less useful in budgeting finances, and may be affected by sleep deprivation or low blood sugar). Wise mind, per Linehan, is an integration of reasonable mind and emotional mind, the intuitive mind taking experience in as a whole, using both mind and body. Mindfulness-based DBT skills attempt to foster the client's use of wise mind.
DBT teaches mindfulness meditation skills as the “what” skills, clients are taught to identify and notice “what” is occurring in each moment:
- Observe one's experience without judging or reacting, noticing thoughts, feelings and sensations come and go, “like leaves in an ocean,” and noticing what enters the body through the senses.
- Describe, without evaluation or judgment, the experience, putting feelings, sensations and thoughts into words (“I am having a thought,” “I am having a feeling”).
- Participate in one's experience, completely forgetting yourself and becoming one with the experience, letting go of rumination and being fully immersed in the moment, acting intuitively from wise mind, accepting the situation as it is while changing harmful situations and reactions.
Clients are taught to identify situations where they used wise mind, emotional mind or reasonable mind, giving examples from recent or remote past for each.
For an updated, more in-depth look at this topic, see DBT Skills Training – Mindfulness.