Borderline Personality Disorder (BPD) Treatments
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Psychotherapy, or talk therapy, is usually the first line of treatment for people with mental health issues, including BPD.
Therapy is usually conducted one-on-one with a therapist, but it may also be conducted in a group. It can help people with BPD better manage their emotions, reduce impulsiveness, and improve their relationships, among other things.
BPD can be treated with various types of therapies.
Dialectical Behavioral Therapy (DBT)
This therapy was developed specifically to treat BPD and is a form of cognitive behavioral therapy, or CBT (more on that below).
- Better manage emotions
- Build tolerance to distress
- Improve interpersonal abilities
- Practice mindfulness, or being attentive to (and aware of) current situations and emotions
“DBT is unique in its focus on balancing acceptance and change,” Lazarus adds.
Cognitive Behavioral Therapy (CBT)
Another common type of therapy treatment for BPD is general CBT, which is also used to treat numerous other mental health issues, including post-traumatic stress disorder (PTSD).
For people with BPD, treatment with CBT can help them identify and change core beliefs about themselves, others, and the world, ultimately leading to a reduction in negative thoughts and behaviors.
CBT generally is anchored in the present, rather than focused on exploring the past, Ochoa says, noting that CBT focuses on examining links between thoughts, feelings, and behaviors.
“In general, CBT focuses on the development of new and more adaptive core beliefs about oneself, the world, and the future,” Lazarus says.
Schema-Focused Therapy (SFT) While not commonly used for BPD, this treatment combines aspects of various other types of psychotherapy to help people recognize and change maladaptive schemas, or negative patterns of thoughts, feelings, and behaviors toward themselves and others.
Typically, SFT involves two weekly individual therapy sessions, Lazarus says. It encourages an attachment between patient and therapist, a process called “limited reparenting,” she says. Lazarus notes that the treatment aims to help patients alter negative patterns of thinking, feeling, and behaving to reduce the power of more dysfunctional patterns.
Mentalization-Based Therapy (MBT) Also less common than treatments like DBT, MBT as a treatment for borderline personality disorder aims to help patients stabilize their symptoms by increasing the patient’s capacity to imagine thoughts and feelings in their own and others’ minds — especially under stress, Lazarus says.
Outpatient MBT generally involves 50 minutes of individual weekly therapy, 75 minutes of group therapy, and a team meeting for therapists, Lazarus says. She notes that the therapy aims to help improve mentalization abilities (the imagination of thoughts and feelings) under duress.
Transference-Focused Therapy (TFT) A type of psychodynamic psychotherapy, this treatment uses the developing relationship between the patient and therapist to help patients understand their emotions and interpersonal problems.
TFT generally involves two weekly individual therapy sessions but no group therapy, and it allows clinicians to work individually (though supervision is encouraged), Lazarus says. She notes that TFT aims to help patients by having them develop a more balanced and coherent view of themselves and others.
Systems Training for Emotional Predictability and Problem-Solving (STEPPS) This 20-week, group-based treatment aims to involve family members, caregivers, friends, or significant others.
Lazarus emphasizes that STEPPS is designed to supplement other treatments and that some of its benefits include its cost-effectiveness and its relative brevity.
Dialectical Behavior Therapy Family Skills Training This form of DBT treatment incorporates family members into DBT sessions.
DBT generally includes things like one hour of weekly individual therapy, two hours of group skills training, and a consultation team for the therapist, Lazarus says. She notes that the full DBT model can be resource-intensive, given its intensity and structure.
DBT aims to treat patients by helping them develop skills that improve emotional regulation, mindfulness, and effectiveness within interpersonal relationships, Lazarus says.
General Psychiatric Management This is a structured treatment that includes case management, symptom-targeted medication, and psychodynamic psychotherapy to target mood instability, impulsivity, and aggressiveness.
This treatment is designed to be less intensive, and it is more easily accessible to the generalist clinician, Lazarus says. General psychiatric management focuses on the patient’s life outside of therapy and typically involves one session per week, along with group and family therapy and medication management, she says. Lazarus notes that this treatment aims to help patients by facilitating the natural course of BPD’s improvement.
Understanding the Pros and Cons of Psychotherapy for BPD
For all the above treatments, people with BPD can benefit from having a person to go to when they feel hopeless or desperate, building strong relationships with their therapist and treatment team, and educating themselves about their condition, Ochoa says.
But cons include the length of treatment, sometimes requiring multiple visits a week, the cost of these longer-term treatments, and the demanding nature of therapy, especially if it requires the patient to face uncomfortable feelings, Ochoa notes.
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