DBT for Borderline Personality Disorder (BPD): What to Expect & How It Works

What Is DBT for BPD?

Dialectical behavior therapy (DBT) can help people with borderline personality disorder (BPD) improve their lives and relationships by teaching them to manage emotions and decrease impulsive actions. DBT therapists work to validate their clients’ feelings and hold them accountable for their actions through positive and negative reinforcement.

A DBT inpatient or intensive outpatient program (IOP) provides more opportunities for positive attachment and intensive therapy.¹ Both individual and inpatient approaches require one weekly individual session (sometimes two) and one weekly group session.

Is DBT for BPD Effective?

In the early 1990s, Marsha Linehan established DBT as an effective treatment for BPD.² Dialectical behavior therapy is considered the frontline treatment for BPD suicidality and self-harming behaviors.³ Substantial empirical research, including random control trials, has further supported the effectiveness of DBT for BPD.³

Recent MRI brain studies on women with BPD showed significant changes in participants’ gray matter after 12 weeks of DBT therapy.⁴ This important development demonstrates the future possibility of using neurobiologically-informed therapy to treat borderline personality disorder.⁴

How DBT for BPD Works

DBT for borderline personality disorder consists of several skill-building modules, including mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. These techniques aid in the treatment of common symptoms of borderline personality disorder.

DBT treatment for BPD includes four stages:

• Reducing negative behaviors and improving behavioral skills
• Treating issues related to past trauma
• Developing self‐esteem
• Finding a higher purpose

Initially, the therapist and client will sign a contract for treatment outlining specific expectations. Individuals in DBT therapy will also complete weekly diary cards documenting their behaviors. At this point, DBT therapists begin preparing their clients for group sessions. Once placed in a group, participants must attend weekly individual therapy.

4 DBT Techniques for BPD

The four core techniques of DBT help individuals manage the emotional and interpersonal challenges associated with BPD. Each of these skills—mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation—targets a different aspect of coping with BPD. Together, they offer a comprehensive approach to handling intense emotions, improving relationships, and developing healthier responses to stress.

Four DBT coping techniques for BPD include:

1. Mindfulness Meditation Skills

Mindfulness meditation teaches individuals to stay grounded in the here and now by remaining aware of the present, not the past or future. Those with BPD tend to have extreme emotions and can feel trapped in those emotions. Mindfulness for BPD can help individuals manage and cope with symptoms.⁵

2. Interpersonal Effectiveness Skills

Interpersonal skills help individuals fulfill their needs, nurture relationships, and improve their self-worth. Those with BPD can practice these when establishing appropriate boundaries for the situations and relationships they may be in.⁶

3. Distress Tolerance Skills

The distress tolerance skills used in DBT for BPD help clients cope when facing anger or turmoil. The goal is to prevent individuals from engaging in risky behaviors by developing a coping mechanism toolbelt. DBT distress tolerance skills help to mitigate reacting amid extreme anger, also known as borderline rage.⁶

4. Emotional Regulation Skills

Emotional regulation skills involve controlling one’s thoughts, feelings, and behaviors. For those with BPD, self-regulating emotions are challenging, possibly because of poor childhood experiences, trauma, or abuse. Using these DBT skills for BPD can make a big difference in how clients deal with stressful emotions they may have, as well as potential triggers.⁶

How Long Does DBT for BPD Last?

DBT for BPD can last anywhere from six months to two years. However, individuals may stay in treatment even longer if they find it helpful when working on goals and managing symptoms of BPD.

How Does DBT Help Those With BPD?

DBT for borderline personality disorder teaches skills to help manage symptoms and build a healthy life. Emotion regulation skills allow them to process extreme emotions, while interpersonal effectiveness skills can help improve their relationships and self-respect.

Once individuals develop distress tolerance, they can approach challenging situations in healthy, productive ways. Finally, DBT mindfulness techniques can help reduce stress and connect to self and others. Those with BPD can learn to avoid black-and-white thinking, which often contributes to increased emotional dysregulation.

Below are some ways in which DBT can improve symptoms of BPD:

• Decreased suicidal thoughts and behaviors: Suicidal thoughts and behaviors may be an attempt to escape intolerable emotional suffering. DBT skills offer individuals new, more effective ways of coping with these intense emotions.
• Improved anger management skills: Intense anger can feel impossible to manage when you do not know how or when your environment reinforces your rage. Understanding, validating, and managing your anger with DBT skills can help reduce its intensity over time. These techniques offer more effective ways to act when you experience this emotion.
• Improved overall functioning: DBT techniques for BPD help improve overall functioning by teaching tools to tolerate inevitable challenges in life. DBT also helps assess your values and what may hinder you from pursuing them. You can then take action toward a fulfilling life.
• Improved ability to maintain relationships: Interpersonal effectiveness skills in DBT help patients identify their relational goals and communicate effectively to achieve those goals. DBT for BPD also teaches you how to manage your emotions and act more skillfully, which can help improve your relationships with yourself and others.

What If DBT for BPD Doesn’t Help?

There are many other BPD treatment options if you are not benefiting from dialectical behavior therapy for BPD. Interventions and therapies for borderline personality disorder can be beneficial, singularly or in tandem with DBT.

Below are alternative therapy options that can help improve BPD symptoms:

How to Find a DBT Therapist for BPD

Asking for a referral from your primary care physician or using an online therapist directory can help you find the right therapist. You can filter your search for a DBT therapist based on price, experience, and more. Feel free to ask a therapist about their education, training, certifications, and personal treatment philosophy. A good therapist can help you accomplish treatment goals in a safe, honest, and trustworthy environment.

You can also receive therapy through online therapy platforms. For individuals needing more intensive care, Charlie Health offers virtual intensive outpatient programs using DBT for teens and adults.

Questions to Ask a Therapist About DBT for BPD

Before choosing a therapist, try to spend time getting to know them during an initial phone consultation. Doing so will help you gauge the experience they have with BPD, as well as figure out if they’re a good personality fit for you.

Here are questions to ask a new therapist before starting DBT for BPD:

• How long have you been practicing DBT for BPD?
• How often do you meet with individuals, and how long are appointments?
• Do you have a crisis line or resources available?
• Do you offer contact between sessions? Phone sessions?
• What specialized DBT training do you have in treating BPD?
• On average, how long do you see individuals with BPD before they report improvements?
• Do you give therapy homework, and what might this look like?
• What struggles do people encounter when receiving DBT for BPD, and what do you encourage them to do when these happen?