Dialectical Behaviour Therapy and Borderline Personality Disorder.第1页，共15页。Presentation OutlinePsychoanalysis and BPD.Dialectical Behavior TherapyStudiesPositive and Negative aspects of DBTEvaluation第2页，共15页。Borderline Personality DisorderFive or more of the following to be present for a significant period of time:Frantic efforts to avoid real or imagined abandonment. Not including suicidal or self-mutilating behavior covered in Criterion 5 A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Identity disturbance: markedly and persistently unstable self-image or sense of self. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, promiscuous sex, eating disorders, substance abuse, reckless driving, binge eating). Again, not including suicidal or self-mutilating behavior covered in Criterion 5 Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) Chronic feelings of emptiness. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). Transient, stress-related paranoid ideation or severe dissociative symptoms. 第3页，共15页。Psychoanalysis and BPDTraditional psychoanalytic treatments of BPD required longer hospitalization periods. They relayed on patients being in a controlled environment. Long hospitalization periods are rarer nowadays. Psychoanalysis requires longer periods of commitment to treatment, which is incompatible with Borderline Personality Disorder.第4页，共15页。Dialectical Behaviour Therapy-Dialectical Behaviour Therapy(DBT) is a form of cognitive behavioural therapy for borderline personality disorder patients developed by Marsha Linehan. It was developed in the 1990s.-DBT was first developed for “chronically suicidal individuals”.-This form of therapy is called “Dialectical” because it deals with emotional and rational aspects, and with acceptance and change. -DBT mixes cognitive behavior therapy with mindfulness techniques. -Individual Therapy and Group Therapy.第5页，共15页。Reasoning behind DBT- BPD has a biological basis, which affects emotional regulation. Social environments may reinforce their dysfunctional behaviour (Biosocial theory). DBT encourages clients to be aware of the current moment and accept reality.DBT tries to replace rigid/dichotomous worldviews. It emphasizes the importance of a more holistic approach to life. DBT also stresses that balance is important in life. Clients should achieve a middle ground between reason and emotion. 第6页，共15页。Four ModulesMindfulnessInterpersonal effectivenessDistress enduranceEmotion regulation第7页，共15页。Pre- treatment stage1)Agreeing on goals1.Individualized treatment lists :decrease behaviours which prolong hospitalization (parasuicidal, therapy interfering behaviour), decrease behaviours that affect quality of life, increase life skills, decrease stress, increase self-esteem.2)Committing to treatment plans- Most patients enter the hospital involuntarily. 第8页，共15页。StagesStage one-Decrease behaviour which prolong hospitalization-Increase skills for getting out and staying out of the hospital. - Crisis survival skills : distress tolerance moduleStage 2-Deal with stress related problemsStage 3-Increase self- esteem -Treatment goalsStage 4 第9页，共15页。Diary Cards第10页，共15页。第11页，共15页。Effectiveness of dialectical behavior therapy forBorderline personality disorder in an inpatient setting-Fifty inpatients diagnosed with BPD were evaluated at three different points in time. The patients were screened for substance abuse, bipolar I, dementia and schizophrenia. - Each patient went to individual therapy sessions once a week and group sessions three times a week-Sixty-two percent of patients also received anti-depression medication. Benzodiapines were also used.-Symptoms were reduced, but not eliminated.-Findings confirmed the effectiveness of DBT. It was also proved that DBT can be used in an inpatient setting.第12页，共15页。Positive aspects of DBTReduced-suicidal behaviour -Hospitalizations-Length of hospitalization- treatment dropout-Depression scores-Anger-Dissociation-Substance useIncreased -interpersonal functioning-Global functioning第13页，共15页。Negative aspects of DBT-The first stage alone takes one year at least.-Expensive-Long- waiting lists第14页，共15页。EvaluationThere are few studies about DBT. Most studies use small samples. There were no follow-up studies of the original research. Personality disorders are difficult to treat. Parasuicidal behaviours are hard to control. However, DBT seems to help most patients. It is possible to adapt DBT to other situations and settings.第15页，共15页。