Dialectical Behavior Therapy for Borderline Personality Disorder

Dialectical behavioral therapy (DBT) (1) is a comprehensive, multimodal cognitive-behavioral treatment initially developed to treat highly suicidal women. Dialectical behavioral therapy evolved into a treatment for borderline personality disorder (BPD), primarily due to the prevalence of suicidal behaviors among individuals with this diagnosis. The first study of DBT was described in the first volume of the Journal of Personality Disorders (2). Subsequently, DBT was described and illustrated in detail as a treatment for BPD in a set of published manuals (1,3). The difficulties BPD patients have in tolerating distress and in accepting themselves and others spawned the development of acceptance-oriented skills, such as mindfulness, willingness, and radical acceptance. Distilled from Zen principles and practice (4), these strategies are taught as skills for both the patient and the therapist. Changebased strategies in DBT draw primarily from behavioral and cognitive behavioral therapy (CBT) approaches and from psychological science in the areas of learning, emotions, social psychology, and empirical findings on behavioral change processes. Strategies for conveying validation and acceptance of the patient are very similar to those used in both client-centered and emotionfocused therapies. As the foundation of DBT, a dialectical philosophy provides a world view that maintains the balance and synthesis of acceptance and change strategies (1,5).