Cognitive behavioral therapy is an overarching umbrella of different types of techniques, which are helpful for a lot of individuals dealing with various types of borderline personality disorder symptoms. CBT helps people change the way they think about experiences, reframing negative thought patterns with positive actions. This approach is the gold standard for therapy modalities for many issues, including BPD.
What Is Cognitive-Behavioral Therapy?
Cognitive behavioral therapy (CBT) is one of the most common types of therapy. In CBT, the therapist helps you identify thought patterns which negatively impact your behaviors and emotions. By getting to the root of the thought, CBT empowers you to reshape your experience. CBT, when used consistently for at least two months, can help relieve feelings of stress and anxiety related to underlying negative emotion.1
How Does CBT for BPD Work?
Cognitive behavioral therapy is particularly helpful in the treatment of BPD when combined with focus on understanding of thought distortions related to self and others.2 Borderline personality disorder includes symptoms that change thought patterns, and CBT can reframe these thoughts to manage those symptoms. While BPD may not be completely curable, many see relief from symptoms through CBT.
Shannon Sauer-Zavala, Ph.D. and Assistant Professor, Department of Psychology, University of Kentucky explains, “People with BPD struggle with negative schemas (i.e., core beliefs) about themselves and others, as well as problematic behaviors used to regulate strong emotions. CBT includes cognitive skills to help patients identify and challenge their core beliefs, along with behavioral skills that help patients learn to tolerate strong emotions.”
There are a number of components in CBT treatment which can help those dealing with BPD, including:
1. Setting SMART Goals
SMART stands for goals that are specific, measurable, achievable, relevant and timely. These are great for those with BPD as it helps to give structure for individuals. SMART goals help to keep individuals accountable to the goals they create in therapy.
2. Cognitive Restructuring
Cognitive restructuring is helpful as it gives individuals an understanding of how thoughts, feelings and behaviors are all linked. This technique involves various strategies which help individuals recognize how their thought leads to an action. Additionally, individuals learn how to stop or change the thought before it turns into a behavior. The goal here is to change thoughts, actions and behaviors.
3. Skills Training
This helps individuals handle unhelpful thoughts and better manage social situations. By working with their therapist on breathing exercises and relaxation skills, individuals can learn to stop reinforcing negative patterns and change the way they think.
4. Mindfulness and Meditation
Mindfulness and meditation help people learn to pull their attention away from unhelpful thoughts and to be more present. Mindfulness skills and formal meditation also have powerful emotional regulation capabilities, and these skills are often integrated into therapy.
Other cognitive-behavioral therapy types that can be used to treat BPD include:3,4,5
- Schema-Focused Therapy: Schema-focused therapy focuses on helping people with BPD identify their needs and understand how they have learned to get those needs met. Those with BPD who participated in schema-focused therapy reported better self-understanding and improved emotional regulation.
- Humanistic Therapy Approaches: Humanistic therapies can be helpful in facilitating good outcomes in those with BPD, particularly due to the focus on the client-therapist relationship. Humanistic approaches can be useful in helping the client find meaning in their life, which has been shown to decrease BPD symptoms.
- Family Therapy: Due to the social discord present in this disorder and the genetic/environmental causes, family therapy can be an important approach for long-term success of those living with BPD. Researchers have encouraged better use of support systems in the client’s life, and attending therapy together is one way for loved ones to become more involved.
Acceptance and Commitment Therapy (ACT): ACT can be helpful at
distinguishing thoughts and behaviors from self and establishing parameters around identity. This can help those with BPD establish new boundaries and help make thoughtful decisions about their actions.
CBT vs. DBT for Borderline Personality Disorder
BPD has been found to respond well to dialectical behavioral therapy (DBT). DBT is emerging as a new frontline approach for treating BPD. This includes both group and individual psychotherapy with a specific approach aimed at helping those with BPD learn how to navigate and handle their feelings. These skills help teach those with BPD how to better relate to others and handle challenges.
“DBT is a specific form of cognitive behavioral therapy,” Sauer-Zavala says. “DBT is long-term; usually one year of intensive, weekly individual therapy and skills group sessions are recommended.”
DBT skills used to treat BPD include:6,7
- Mindfulness Meditation Skills: Mindfulness meditation requires individuals to stay grounded in the here and now. It focuses on being very conscious about the present and not focusing on the past or future. Those with BPD tend to have extreme emotions and can feel trapped in those emotions. Mindfulness meditation can help to manage BPD symptoms and find new ways to cope.
- Interpersonal Effectiveness Skills: These skills are aimed at ensuring that needs are met, relationships flourish, and self worth is improved. These skills help those with BPD to draw boundaries that are appropriate for the situations and relationships they may be in.
- Distress Tolerance Skills: These are skills aimed at helping you cope in healthy ways when facing very strong feelings of anger. The goal is to prevent engaging in risky behaviors by coming up with a toolbelt of coping mechanisms. Those with BPD tend to engage in a lot of risky behaviors so distress tolerance skills help to mitigate reacting in the midst of extreme anger, or BPD rage.
- Emotion Regulation Skills: Emotional regulation skills involve controlling your own thoughts, feelings and behaviors, especially negative thoughts, feelings and behaviors. For those with BPD, self regulating emotions is challenging, often due to poor childhood experiences, trauma or abuse. Using these skills for BPD can make a big difference in how they deal with the stressful emotions as well as potential triggers.
Deciding the Best Fit for a Borderline Personality Disorder Treatment Plan
It’s important to work with your therapist to understand the causes and severity of your symptoms before determining the best individual treatment plan together. Taking an active role in formulating your treatment plan is also important, so it can be helpful to think about and discuss your goals and what you’d like to achieve in therapy with your counselor.
These goals can be determined by examining areas of your life that you are trying to improve. Some of the common areas of BPD treatment plan goals include: relationships, fears, substance use, self-harm behaviors, anger, impulsivity and general wellbeing.
Sauer-Zavala further notes that, “BPD presentations are varied; for some patients, more intensive treatment is warranted. Others may see improvement with weekly outpatient therapy in a few months. I think the biggest consideration patients with BPD should take into account is how disruptive their symptoms are and whether they need intensive care.”
Examples of CBT for Borderline Personality Disorder
CBT for BPD is versatile and can be tailored to an individual’s unique situation. Given the variability of CBT techniques and the ways in which the modality can help, it can be used as a framework for adolescents and adults, to help them manage relationship issues as well as more serious thoughts of self-harm.
CBT for BPD Relationship Issues
CBT has been shown to be effective in managing BPD in relationships. In a study, it revealed that those in CBT treatment for a year had better outcomes. CBT helped these couples reduce feelings of hopelessness and impulsivity, a big factor of BPD behavior.8
CBT for BPD & Suicide
Self-harm thoughts and behaviors are common symptoms for people struggling with BPD, and is often very discouraging for those dealing with it. CBT has been shown to help individuals with BPD who have suicidal thoughts. In these cases, CBT works by uncovering negative inner monologues to improve self-esteem and self-worth. Evidence shows that CBT has been helpful in reducing self-harm behaviors and beliefs within months of treatment.9
CBT for BPD in Adolescents
Parental involvement in family CBT can be helpful for treatment for adolescents with BPD. This type of therapy also shows improved outcomes for parents and their ability to provide consistency and stability for the adolescent during treatment. 10
Is CBT Effective in Treating Borderline Personality Disorder?
CBT has been shown to be extremely effective at treating BPD. It manages symptoms and is also helpful for children, parents, and relationship partners impacted by an individual’s BPD diagnosis.
CBT is very effective in treating BPD by:8,9,10,11,12
- Helping couples with a partner who has BPD work through relationship issues by reducing hopelessness and impulse behaviors.
- Helping individuals reduce suicidal thoughts and behaviors by working to unlearn negative thought processes and relearn positive ways of managing difficult emotions.
- Helping children with BPD symptoms by providing psychoeducation about how thoughts become actions, and helping parents by integrating their support in sessions to improve overall family functioning and cohesion.
- Helping those with BPD who are severely struggling with overall functioning. CBT for this population of individuals with BPD showed improvement in psychosocial functioning.
- Helping those dealing with eating disorders with a diagnosis of BPD. Those with an eating disorder and BPD showed lower dysfunctional behavior around emotions, lower feelings of depression and lower dysfunctional eating behaviors.
Finding a Cognitive Behavioral Therapist
“CBT involves learning new skills to apply to negative thoughts and problematic behavioral urges. Learning any new skill requires practice,” says Sauer-Zavala. “CBT therapists will help you apply these skills to the situations their patients bring to session – and patients need to practice if they want to see improvement outside of their 50 minute sessions.”
One great way to find a therapist is by searching an online therapist directory to find a therapist. All licensed therapists are equipped to help people struggling with mental health issues such as BPD and may have formal training in CBT as it is a leading therapeutic modality. Reading reviews and looking at clinician bios to understand the scope of their practice can give you an idea of whether their experience suits your situation. Many therapists offer a free phone consultation to help you know if you’ll be a good fit.
Another way to locate a therapist is by referral, which can come from a trusted loved one or a physician. Healthcare providers often have access to a network of other providers who can be helpful. Going through your physician or specialist is also a great way to keep them in the loop about any treatment options or trauma experienced.
How Much Does CBT for BPD Cost?
In some cases, when BPD is diagnosed by a licensed professional, CBT can be covered by health insurance. There is usually a copay for mental health services with most insurance providers, which can range from $40 to upwards of $100. Looking at “in-network” providers might be able to help with the out-of-pocket costs with copays. In situations where health insurance does not cover CBT, sessions can range from $60-$200 per hour per session. It’s important to consider therapists and practices which may offer sliding scale prices for sessions.
Final Thoughts
What you’re struggling with may be unique to you, but you’re not alone. If you are dealing with BPD, the first step is to give yourself some compassion and reach out to a therapist. Talking to a therapist who specializes in this issue can make a big difference in how you feel, how you’re able to cope and what you’re able to do long term to manage and heal. Together, you and your therapist can develop a plan to get you through this time and help you grow into a more fulfilled version of yourself.
