Empirical Reality of Dialectical Behavioral Therapy in Borderline Personality

Byline: M. Reddy, M. Vijay Introduction Borderline personality disorder (also known as emotionally unstable personality disorder) is a complex mental condition consisting of affective, cognitive-perceptual, anxiety, and stress-coping domains. Mental health professionals understand the problems in delivering required care and to a varying degree feel the pessimism with regard to its treatment. In this background, past two decades have witnessed various therapeutic attempts which over time have instilled much-needed optimism with the condition's treatment and prognosis. One such therapeutic attempt is dialectical behavioral therapy (henceforth, DBT), which was introduced in the early 1990s by Linehan et al . [sup][1] DBT has ever since garnered support of guidelines of many countries and has also been included in the American Managed Care system. While there are also other evidence-based therapies such as mentalization-based therapy, transference-focused therapy, schema-focused therapy, and dynamic deconstructive psychotherapy, none have found such popular appeal and encouragement by the professional guilds of psychiatry and psychology as did DBT. Hence, in this article, we will review the empirical evidence about DBT and examine whether its reputation equals its scientific basis. What Is Dialectical Behavioral Therapy? DBT is an integrated psychotherapy comprising change techniques based on behavioral therapy on the one hand and acceptance techniques based on Zen Buddhism on the other hand. Both these techniques are used in a dialectic way to help patients handle and navigate through their complex affective and cognitive states. [sup][2] The therapist has to move constantly between these two approaches, and to traverse this dialectic terrain, a personal practice of Zen Mindfulness and regular skills training is needed. Unlike cognitive behavioral therapy (CBT) which has a near-complete integration of its component cognitive and behavioral theories, DBT lacks such a good fit between the behavioral and dialectic theories because of their radically different philosophical presuppositions; for example – the behavioral stance would like to change a “problem behavior” to an “adaptive behavior” while the other stance might suggest a nonjudgmental acceptance of the same behavior and thereby leading to a stalemate. Acceptance techniques are taught through the practice of various components of mindfulness. Dialectical theory presupposes that there is no one truth and therefore works toward an integration of multiple perspectives within a particular complex human problem. [sup][3] DBT model has four stages in the treatment of borderline personality. Each Stage (I–IV) has certain specific goals,[sup][2] such as: *Reducing suicidal, therapy-interfering, and quality-of-life-interfering behaviors, and improving behavioral skills *Treating issues related with past trauma. For example, exposure techniques for posttraumatic stress disorder *Development of self-esteem, reclaiming ordinary happiness, and improving day-to-day behavioral skills *Development of capacity for optimum experiencing and finding a higher purpose. Stage I may take anywhere from 3 to 12 months (usually, it takes at least a year [sup][4]) and then the therapy moves onto Stages II–IV. The patient has to attend one individual therapy session and a group skills training session in a week and also has to do the regular homework such as diary records. There are two important components during the therapy which are central–regular group supervision for individual and group therapists, and 24/7 patient access to the therapist by telephone to handle emergencies. Empirical Evidence DBT is the only available therapy which led to creation of a large research data in patients with borderline personality. [sup][5] There are multiple studies done by Linehan over the last three decades. …