Therapies Used To Treat Borderline Personality Disorder
Borderline personality disorder is characterized by instability, whether it’s your self-image, relationships, or mood. Currently, the prevalence rate in the general population is about 1.6 percent. Although it’s lower than other psychiatric disorders, it doesn’t necessarily imply that very few people have the condition. It can also be attributed to misdiagnosis and a lack of awareness about BPD.
Part of the Cluster B class of personality disorders, BPD is marked by dramatic and sudden emotionality in response to distress. This difficulty in managing your emotions makes it harder to think rationally or stay calm. When your actions are controlled by intense emotions, you can behave in dangerous ways or say hurtful things to others. It creates a self-perpetuating cycle that takes a toll on your relationships. But even though it feels difficult to escape, there’s still hope in the form of therapy. Therapeutic interventions can help you build coping skills and allow you to gain control of your thoughts and feelings. So, let’s take a look at how psychotherapy is an important aspect of BPD treatment and the types of therapy you can expect.
The Role of Psychotherapy in Treating BPD
Today, psychotherapy is regarded as the primary mode of treatment for BPD, with studies showing that it’s highly effective at managing symptoms. The comprehensive psychosocial treatments for BPD include psychodynamic therapies like mentalization-based treatment and transference-focused psychotherapy. They also include cognitive-behavioral treatments, such as schema-focused therapy and dialectical behavior therapy.
Numerous studies on the efficacy of psychotherapy for BPD have found that treatments like DBT cause a major reduction in hospitalizations and self-harming behavior. Similarly, psychotherapy also helped reduce feelings of anger and improve psychosocial functioning. In fact, one study found that as many as 77 percent of participants no longer met the criteria for BPD.
Of course, not all types of psychotherapy are designed the same way, even if they are specialized for people with BPD. So, it’s worth taking a look at the different types of therapies and how they’re effective for addressing borderline personality disorder.
1. Cognitive Behavioral Therapy (CBT)
The most commonly used approach to psychotherapy is CBT, which is based on the idea that how you feel and think influences your behavior. And because BPD is characterized by emotional reactivity, the goal is to improve your reasoning and critical thinking skills to view stressful events in a more logical way. While traditional CBT is certainly an effective way of addressing BPD symptoms, most practitioners prefer using DBT. It’s based on similar cognitive-behavioral principles but is specialized to address BPD.
2. Dialectical Behavior Therapy (DBT)
According to the founder of DBT, Marsha Linehan, the core aspect of BPD is emotional dysregulation. It’s why you become upset easily, can get extremely upset very quickly, and take a long time to calm down. This difficulty in regulating your emotions is what causes impulsive behavior and interpersonal turbulence that’s common in BPD. The modules of DBT include skills training, individual therapy, phone-based coaching (intersession contact), and peer consultation team meetings.
The main skills you learn over the course of DBT sessions are mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. The goal is to help you realize that you can be in need of improvement and accepting of who you are at the same time. Improvement involves learning the aforementioned skills so that it’s easier to cope with stressful situations and manage intense emotions.
3. Mentalization-Based Treatment (MBT)
MBT is an evidence-based practice designed to treat BPD. It stems from traditional psychoanalytic concepts and combines it with newer research related to attachment and social cognition. Here, mentalization refers to the process you use to understand mental states, such as your emotions, desires, and beliefs that affect interactions.
The purpose of MBT is to increase your curiosity about your internal states, feelings, and thoughts, as well as those of others. This way, you’ll get better at identifying people’s thoughts and feelings, including your own. The underlying theory speculates that this poor mentalization is the result of difficulties in early attachment.
4. Transference-Focused Psychotherapy (TFP)
TFP is a psychoanalytic therapy based on Kernberg’s object relations theory and relies on the concept of transference. This is when you project emotions and expectations onto someone else, especially your therapist. Kernberg theorized that people with BPD are unable to merge their own positive and negative images to form a more realistic view of themselves or others. The goal of TFP is to reduce symptoms and self-destructive behavior. This is where your therapist will use transference to deconstruct unhelpful behavioral patterns.
Your therapist will treat interactions during a session as a reflection of your unhelpful behaviors outside the therapy setting. This is the first step to recognizing and developing better alternatives to destructive or unhelpful behavior as it occurs. In a study on the efficacy of TFP for BPD, researchers found that it was associated with reduced suicidality, anger, and impulsivity.
5. Schema-Focused Therapy
An integrative approach, schema-focused therapy is founded on the principles of CBT but expanded to include aspects of other psychotherapies as well. The purpose of this psychotherapy is to help you change your self-defeating thought patterns, also known as schemas, with behavioral and emotion-focused techniques.
It’s based on the concept that people with BPD have four main dysfunctional schemas that perpetuate psychopathology and dysfunction. These are punitive parents, detached protectors, abandoned children, and angry children. Over the course of your sessions, your therapist will apply behavioral and cognitive techniques that focus on your therapeutic relationship, past experiences, and life outside therapy.
Ultimately, the goal is to not be controlled by dysfunctional schemas. In a study comparing the effectiveness of schema-focused therapy, researchers found that it led to a greater reduction in symptoms like self-destructive behaviors, impulsivity, and identity disturbance.
What About Medication?
Currently, there’s no medication that’s been specifically formulated for the treatment of BPD. Nevertheless, studies show that prescribing medication to tackle associated symptoms like depression can make you more responsive to psychotherapy. At the same time, medication is usually only prescribed in combination with psychotherapy, and it’s used as a short-term method to improve the effectiveness of therapeutic approaches.
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