Dialectical Behavior Therapy (DBT)

Q: Dear Frank, A survivor wrote to me and said “My therapist and I have been using a form of therapy called Dialectic Behavior Therapy. I like some of it and I’m confused about the rest. We just started. The handouts refer to Borderline Personality Disorder. What I know about the diagnosis leads me to think it is a BS, catch-all diagnosis. Maybe cause I had a lot of incorrect diagnosis before someone said “you have PTSD.”
What can Dr. Ochberg tell me about this? Thanks.

A: Dear reader, DBT has been around for a while and there are many good references on the web, e.g., https://www.verywellmind.com/dialectical-behavior-therapy-dbt-for-bpd-425454. Although Linehan developed the approach for Borderline Personality Disorder, it can be effective with PTSD, dissociation and other conditions. There are several concepts involved. “Mindfulness” means you learn to be aware of your state of mind, and you try to avoid being ruled by emotion, but also to understand where your emotion is originating and what it signifies. Mindfulness is, in a way, the opposite of dissociation. You learn to control and perfect your “state of mind.” By being aware and in the moment, you avoid drifting off and being likely to be gripped by painful or shameful memories. “Emotional regulation” involves conscious modulation of strong feelings. Some people are easily “triggered” and when stimulated by a comment or a negative attitude from another person, they become quite offended or anxious or angry. And they may obsess about that person who causes negative feelings. When you accept the fact that you are a person who over-reacts, you can learn to react in moderation. You take responsibility for dialing down your feelings. You learn ways to do this, through trial and error. The break through comes when you say to yourself, “I can’t change that other person, but I can learn to reduce my feelings of rejection, irritation and anxiety.” The DBT therapist should be a good “coach,” modeling these methods and training the client to be better and better at mastering them.

Borderline Personality Disorder is a valid diagnosis, not a “catch-all,” but before DBT, many therapists were ill equipped to help people diagnosed as “borderline.” Now there are more therapists who treat BPD effectively and a better prognosis for the condition. There is an overlap between BPD and PTSD. If you have survived child abuse or neglect, there is a good chance that you will be sensitive to rejection, hungry for acceptance, and unsure of whom to trust. You may also have swings of emotion and difficulty managing intimate relationships. The DBT approach helps, even you are not “borderline” but you are vulnerable to the symptoms of PTSD –especially the symptoms that are now called “complex PTSD.” There are good sites for complex PTSD. See this link for Judith Herman’s overview.