Borderline Personality Disorder Evidence-Based Treatments (EBT)

To date there are several evidence based treatments for Borderline Personality Disorder that have shown to be effective in decreasing BPD symptomatology. The best results seem to result from a combination of these therapies. This is equivalent to treating cancer with surgery, radiation, chemotherapy, and now, immunotherapy. Unfortunately for patients, the only widely implemented therapy for BPD in the United States is Dialectic Behavioral Therapy (DBT). Presently, the supply of trained EBT BPD therapist is inadequate to meet the patient demand for treatment. Other treatment such as Mentalization Based Therapy (MBT), Compassion Focused Therapy (CFT), Schema Therapy are readily available in other countries, primarily in Europe. Transference Focused Psychotherapy is available in America however it is expensive and not widely available. General Psychiatric Management was developed by John Gunderson to educate clinicians about BPD so as to encourage accurate and early diagnosis, decrease stigma, and avoid iatrogenic treatment. It is presently being disseminated in the US.

DIALECTICAL BEHAVIOR THERAPY

DBT is a method of cognitive behavioral therapy that treats people with Borderline Personality Disorder (BPD) developed by Marsha Linehan, PhD. at the University of Washington. In DBT, behavioral change is balanced by acceptance, compassion and validation. Developed by Marsha Linehan, is a behavioral EBT based on dialectics; opposites can coexist and be integrated, both points of view are valid. DBT balances change with acceptance; aims to replace maladaptive coping methods with more effective means of achieving goals. DBT skills teaches help the person get what they want or need, mindfulness and modules on distress tolerance, emotional regulation and interpersonal relationships. It aims to help the person develop a life worth living. DBT is an outpatient treatment: once weekly individual psychotherapy, two-hour weekly psychoeducation skills groups, therapist consultation meetings, and therapist availability for phone coaching. DBT focuses on the individual. DBT was not designed as an inpatient treatment.

MENTALIZATION (MBT)

Developed by Bateman and Fonegy, it is an EBT that MBT focuses on connection and communication; on make sense of our own actions, behaviors and feelings and simultaneously those of others. It enhance the ability to make sense of our own and other’s actions and feelings by understanding your own and other people’s minds. MBT explores relationship ruptures, develops empathic understanding, examines misunderstanding the intentions of others, especially those closest to the person (attachment relationships) MBT develops awareness aware of thinking and feeling in the moment, when you’re relating to each other. What we think and feel can trigger intense reactions.

TRANSFERENCE FOCUSED THERAPY

Developed by Otto Kernberg, TFP is an intensive manualized outpatient EBT psychodynamic psychotherapy. The goals of TFP are to develop better behavioral control, increase affect regulation, develop more intimate gratifying relationships, and to achieve satisfactory life goals. It aims to reduce suicidality, self-injurious behavior, impulsivity and anger and to decrease ER visits, hospitalizations, and relationship difficulties. It is a lengthy treatment requiring 2-4 weekly sessions over a long period of time. TFP can reduce the feeling of shame in people with BPD. It requires committed participation by patients.

COMPASSION FOCUSED THERAPY

Developed by Paul Gilbert, it integrates cognitive behavioral therapy, evolutionary psychology, social and developmental psychology, Buddhist principles, & neuroscience. It uses compassionate mind training to help develop experiences of inner warmth, safeness and soothing, via compassion & self-compassion. CFT is especially helpful for those with high levels of shame and self-criticism and who have great difficulty feeling warmth or kindness to themselves or others. It originated in the United Kingdom. The Center for Compassion Focused Therapy and Mindfulness is located in New York City.

DBT FOR COMPLEX PTSD

Complex PTSD shows a great overlap with borderline personality plus co-occurring PTSD. At the subjective level, they experience this as intermittent, explosive high levels of tension which seem to be unbearable. They also suffer from a very negative self-concept, seeing themselves as unworthy, ugly, bad, as not having a life worth living. They have difficulties with intimacy and trusting others, often misinterpreting neutral situations, and have trouble perceiving and processing positive social signals. The trauma network is an association between emotions, cognitions, pictures, sensory inputs and physical inputs and is closely related to traumatic experience. If you activate one node of this network, all the other nodes will become activated. Patients often don’t know that this network is activated. They simply think they are stupid or that something is completely out of control.

SCHEMA THERAPY

Developed by Jeffrey Young, Schema Therapy integrates elements of cognitive therapy, behavior therapy, object relations, and gestalt therapy. It helps change enduring negative (“maladaptive”) & self-defeating patterns or schema a person has lived with for a long time. The targeted schemas typically begin early in life. Schema Therapy is widely available in Europe, predominantly in the Netherlands and has outcome studies showing its’ efficacy. It is minimally available in United States.

GENERAL PSYCHIATRIC MANAGEMENT

This is an empirically validated treatment approach to borderline personality disorder (BPD) known as Good or General Psychiatric Management (GPM). While multiple evidence-based treatments for BPD exist, most are resource intensive and, therefore, difficult to implement. However, GPM is an evidence-based intervention for BPD that can be flexibly implemented in nonspecialized, resource-constrained environments. This principle-driven alternative to more intensive BPD-focused treatments is a generalist approach, good enough for most clinicians and most patients in the management of this prevalent, disabling and sometimes fatal but treatable diagnosis. Management strategies using practicality, good sense, and flexibility are emphasized. Listening, validation, judicious self-disclosures, and advisement to build a life rather than focus on being a patient create a positive relationship in which both a mental health professional’s concerns and limitations are explicit.

TARA Method of Family Psychoeducation

This educational program was developed to help family members cope with the capricious, often difficult behaviors of a loved one with BPD. It incorporates latest neurological research findings that help understand BPD behaviors. It integrates techniques from Dialectic Behavior Therapy (DBT), Cognitive Behavior Therapy, Emotion Recognition training, Mentalization Based Therapy (MBT) and Compassion Focused Therapy (CFT). This collaborative approach to BPD empowers family members, training them to be therapeutic partners. It teaches how to actually apply BPD Evidence Based Treatments (EBT) methods in the moment, in their day-to-day environment, whenever a crisis may occur.

Evidence Based BPD Treatment