BPD: Treatments, Cures, and Recovery

[MagentaOrchid]

I see alot of reference to DBT as the preferred method to treatment of BPD.  And I have researched it a little, it seems like it is more intensive (phone calls, groups, extra visits) and involves some tools like cards.  But how does a DBT session differ from a standard CBT session? 

[UKannie]

Hey MagentaOrchid

This is weird - before I saw your message I stumbled upon this kind of by accident at work when I was looking up something else. But this is the best explanation I've seen - it explicitly addresses how DBT differs from CBT.

http://www.mind.org.uk/help/medical_and_alternative_care/dialectical_behaviour_therapy

Bear in mind that it tends to stereotype BPDs as young women who self-harm, I don't know if that is just a UK thing but it really annoys me.

Hope the factsheet helps

Annie xoxo

[Randi Kreger]

DBT is under the umbrella of CBT. CBT therapy is talking to your therapist who tried to explain that your thoughts affect your feelings, which affect your behavior. That is CBT in essence.

DPT is an entire program based on that theory as well as many other theories such a the dialectic, mindfullness, radical acceptance, and others. There is once a week meeting with a therapist, but the skills classes are really central to the therapy. The diary cards are one way to track the thoughts, feelings, and behaviors.

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[lbjnltx]

My question is: What should a "whole program" include?

a true dbt program will consist of individual therapy weekly + group skills therapy weekly accompanied by access via telephone to their therapist for support in the event of severe dysregulation.  therapists who practice dbt and work with pwbpd also need to have support for themselves to prevent "burn out".

due to our geographic location we were unable to get dbt for our teen daughter.  once i found a t who had experience w/bpd and bpd adolescents (he is also on staff at the state hospital) i asked him to learn about dbt and bought him the books he would need.  i also paid for 1/2 of the online training offered by behavioraltechllc. (you can learn all about dbt on that site).

my daughter refused to use any of the skills taught in the dbt program and we did not have access to group skills for teens.  since she refused to work at it...we made the decision to send her to a residential treatment facility.  at this facility her individual therapist has been successful in teaching her the coping skills taught in the dbt program.  she has group therapy (PPC) not dbt which has helped her immensely as well.  she also does equine therapy...that has also been very very helpful. 

the bottom line...dbt is great if you can get it! 

lbjnltx

[crazyinlove]

Thank you for answering my question. My bpd GF gets everything but the group which is available to her but she stopped going. How effective is dpt without the group componant? To me it seems that once she stopped going to group things got much worse in terms of dysregulation frequency and intensity.

[lbjnltx]

in my opinion group therapy is just as important (especially for teens as their peer group has the most influence over them) as the individual therapy.

if your gf won't attend group there is an alternative.  this online support group for pwbpd teaches and reinforces dbt skills. www.dbtselfhelp.com  perhaps she would participate there...it is better than nothing.

non's are also welcome on that site.

lbjnltx

[crazyinlove]

Thank You! I greatly appreciate your help. We are currently in no contact and things have not been and are not good between us. If I ever do decide to talk to her about this I would recommend that site to her. It is and has always been difficult for me as she forbids me from being on any of these sites and does not understand how important they are to us. Every recommendation I have made every book I have purchased have all been ignorred as though she doesn't need to be bothered with any of it.

We moved her bed out a few months ago to reattach the head board and the box of books I bought for her was under the bed never opened even though I gave them to her a year ago. I think it scares her to read about what she may do to me and if she reads that it is wrong then she can no longer pretend that I should just suck it up and deal with it. That's just my opinion.

Thanks Again!

[lbjnltx]

bpd...the disorder that exists to be denied.

all the disordered behaviors of a bpd are survival techniques.

lbjnltx

[Randi Kreger]

<<My question is: What should a "whole program" include?




The web site www.NEABPD.org I THINK has a list of questions to ask any DBT program. One other thing a real program has is a weekly meeting where the therapists get together to share info on patients and support each other. That's a critical component.

Also look to the site www.behavioraltech.com. There is a list of DBT therapists.

[SunflowerFields]

Does anyone know if there are comprehensive studies, statistics somewhere on the success of BDP recovery of those that are in treatment? Broken down by age, gender, years of therapy, kind of therapy, etc?

[Skip]

There are numerous studies out there.  Here a few;

The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder
Mary C. Zanarini, Ed.D., Frances R. Frankenburg, M.D., John Hennen, Ph.D., and Kenneth R. Silk, M.D.
Of the subjects with borderline personality disorder, 34.5% met the criteria for remission at 2 years, 49.4% at 4 years, 68.6% at 6 years, and 73.5% over the entire follow-up. Only 5.9% of those with remissions experienced recurrences.


Progress in the treatment of borderline personality disorder
PETER FONAGY, PhD, FBA
University College London and The Anna Freud Centre, London

After 6 years, 75% of patients diagnosed with borderline personality disorder severe enough to require hospitalization, achieve remission by standardized diagnostic criteria.  Recurrences are rare, perhaps no more than 10% over 6 years.


Effectiveness of Psychotherapy for Personality Disorders
J. Christopher Perry, M.P.H., M.D., Elisabeth Banon, M.D., and Floriana Ianni, M.D.

All studies reported improvement in personality disorders with psychotherapy. The mean pre-post effect sizes within treatments were large: 1.11 for self-report measures and 1.29 for observational measures. Among the three randomized, controlled treatment trials, active psychotherapy was more effective than no treatment according to self-report measures. In four studies, a mean of 52% of patients remaining in therapy recovered—defined as no longer meeting the full criteria for personality disorder—after a mean of 1.3 years of treatment. A heuristic model based on these findings estimated that 25.8% of personality disorder patients recovered per year of therapy, a rate sevenfold larger than that in a published model of the natural history of borderline personality disorder (3.7% recovered per year, with recovery of 50% of patients requiring 10.5 years of naturalistic follow-up).

[SunflowerFields]

Skip, that was very helpful, thank you. I found all three, downloaded, and skimmed through them (will read in detail later on). From the first glance, they don't appear to include the breakdown by age, gender, etc. Are you aware of studies that reveal "demographics" on those recovered, as well as those not?

For example: Is someone who is 50 less likely to recover than someone who is 30? Does the substance abuse history matter? Does gender matter? What is the difference between success rates for DBT vs CBT?

[officer1618]

But my question is...what percent of pwbpd get this help? My money is on not many. What's the drop out rate even if they do start therapy?

[TheSomberlain]

But my question is...what percent of pwbpd get this help? My money is on not many. What's the drop out rate even if they do start therapy?

Now that is the real question. Look at how many of us have undiagnosed BPDs. For one to not be so narcissistic or stuck in their own ways enough to even admit to going to therapy would seem rare to me. It would appear those would be the higher functioning BPDs or those that barely meet the criteria with less co-morbidity.

[Skip]

For one to not be so narcissistic or stuck in their own ways enough to even admit to going to therapy would seem rare to me. It would appear those would be the higher functioning BPDs or those that barely meet the criteria with less co-morbidity.

Aren't there really only two important points. 

(1) If our ex-partners got into treatment and engaged that there is hope but that didn't happen on our watch (for whatever reason). 

(2) 74% of us are depressed and if got we got into treatment and engaged that the recover rate and treatment time is significantly shorter, but many of us are not seeking treatment - for whatever reason - can't afford it - don't believe in the medications - don't have time - are not motivated.

It is true - the best therapies on earth ate useless unless the people that need them are willing to engage them.

[SunflowerFields]

Aren't there really only two important points.  

(1) If our ex-partners got into treatment and engaged that there is hope but that didn't happen on our watch (for whatever reason).  

(2) 74% of us are depressed and if got we got into treatment and engaged that the recover rate and treatment time is significantly shorter, but many of us are not seeking treatment - for whatever reason - can't afford it - don't believe in the medications - don't have time - are not motivated.

It is true - the best therapies on earth ate useless unless the people that need them are willing to engage them.

It is (1) that is giving me the most grief - my ex did get diagnosed on my watch - as a result of depression and high emotional stress experienced due to US. The diagnosis happened in December. But... 3 years of mounting stresses, things getting even more worse for him, my not being willing to live with more lies and setting more boundaries didn't exactly give us the perfect time to benefit from years of therapy. We broke up by February. I cannot help but wonder... what if I waited... what if I had stuck somehow...

[Skip]

I cannot help but wonder... what if I waited... what if I had stuck somehow...

This is one of the top reasons members of the leaving/detaching board gravitate more toward a pessimistic view of BPD and people with BPD than say partners working on it or parents... because it is hard to deal with the "what if".

Recovery often requires someone in the life of the pwBPD that they trust as unconditionally loving them - not a pus - but someone that has that trust.

When our relationship cratered, most likely a lot of damage was done - it would not be likely we could fill this role - or be seen as the person of trust by the pwBPD.

If I had known what I know now before the relationship started, I could have handled it much better.  But, if I had know it was BPD, I probably would have exited.

I only say this to point out that a lot of things have to align to make it work.  We have members that have done that. 

I know that I have skills now for the next relationship - and they are good skills -  and that is where I am focused.   

[Skip]

Most of us will never be so lucky to get our BPD hospitalized.

You're past the point of this being relevant, right?  How to get a BPD partner into treatment is really a topic for the Staying board.

[SunflowerFields]

Recovery often requires someone in the life of the pwBPD that they trust as unconditionally loving them - not a pus - but someone that has that trust.

Are you sure about this? Do they ever really trust someone unconditionally?

[united for now]

One of the most painful (and difficult) facts to accept - that "our" response typically enables the pwBPD to stay sick and not seek treatment.

~ Our walking on eggshells gives them a false view of life.

~ Our weak boundaries gives them a false belief that they have control and power over others.

~ Our inability to take care of ourselves (our sacrifices for love) feeds the spoiled inner child in them.

~ Our tendency to focus on them and their needs ensures that our own issues stay buried.

~ Our perpetual forgiveness after they hurt us sends the message that it is OK for them to hurt us.

~ Since their unhealthy ways of coping (emotional blackmail, raging, playing the victim/waif, etc) work, they continue to use them.


Everything in life has a action - reaction - action - reaction cycle to it. Nothing happens in a vacuum. When we change our reactions to their dysfunctional ways of behaving we are breaking our end of the cycle, thus forcing them to respond in different ways.  

The perception that age makes things worse is because like a spoiled child without rules or boundaries, it's easy to lose track of what's appropriate and what's not.

We teach people how to treat us by the behavior we accept from them