Improve Borderline Personality Disorder with Dual Diagnosis with Mindfulness
By John M. de Castro, Ph.D.
“The pain, emotional instability and impulsive behavior of borderline personality disorder place these individuals at risk of drug or alcohol abuse.” – Foundation Recovery
Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.
One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.
Borderline Personality Disorder (BPD) frequently occurs with other problems, particularly drug and alcohol abuse. This dual diagnosis increases the issues presenting with the patient. It is therefore important to establish if Dialectical Behavior Therapy (DBT) is effective in the dual diagnosis patients. In today’s Research News article “Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694661/?report=classic), Flynn and colleagues examine the effectiveness of Dialectical Behavior Therapy (DBT) skills training for patients with dual diagnosis.
They recruited patients diagnosed with Borderline Personality Disorder (BPD) and substance abuse (primarily alcohol abuse). The patients were treated with a 48-week program of skills training adapted from Dialectical Behavior Therapy (DBT); mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. They were measured before and after treatment and 6 months later for mindfulness, emotion regulation, coping behavior, and the frequency and severity of substance abuse. At the end of the program they were interviewed regarding their experiences with the program.
They found that compared with baseline, at the end of the program there were significant increases in mindfulness and Dialectical Behavior Therapy (DBT) skills use and significant reductions in dysfunctional coping behavior and emotional dysregulation that were maintained at the 6-month follow-up. Substance abuse was also significantly reduced after treatment. There was still a reduced use at the 6-month follow-up but it was no longer statistically significant. In the interviews the patients reported that the program improved their self-assurance and confidence, but there was a need for continued care after the end of the program.
These results are important as Borderline Personality Disorder (BPD) is extremely difficult to treat and when it is combined with substance abuse it is even more difficult to treat. It is very encouraging that training in Dialectical Behavior Therapy (DBT) skills of mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness is effective in improving emotion regulation and coping behavior and reducing substance abuse in BPD patients with dual diagnosis. This suggests that this skills training may be an acceptable and effective treatment for patients with both BPD and substance abuse.
So, improve borderline personality disorder with dual diagnosis with mindfulness.
“[Dialectical Behavior Therapy] DBT is reported to reduce suicidal behavior, non-suicidal self-injurious behavior, other impulsive behaviors strongly linked with borderline personality disorder, and significantly reduce psychiatric hospitalization (relapse), self-injury, and depression among adolescents and adults.” – Burning Tree
CMCS – Center for Mindfulness and Contemplative Studies
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Flynn, D., Joyce, M., Spillane, A., Wrigley, C., Corcoran, P., Hayes, A., … Mooney, B. (2019). Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study. Addiction science & clinical practice, 14(1), 28. doi:10.1186/s13722-019-0156-2
Treating severe emotional dysregulation and co-occurring substance misuse is challenging. Dialectical behaviour therapy (DBT) is a comprehensive and evidence-based treatment for borderline personality disorder (BPD). It has been hypothesised that the skills training, which is a facet of the full DBT programme, might be effective for people with severe emotional dysregulation and other co-occurring conditions, but who do not meet the criteria for BPD. However, there is limited research on standalone DBT skills training for people with substance misuse and emotional dysregulation.
A mixed methods study employing an explanatory sequential design was conducted where participants with a dual diagnosis (n = 64) were recruited from a community-based public addiction treatment service in Ireland between March 2015 and January 2018. DBT therapists screened potential participants against the study eligibility criteria. Quantitative self-report measures examining emotion regulation, mindfulness, adaptive and maladaptive coping responses including substance misuse, and qualitative feedback from participants were collected. Quantitative data were summarised by their mean and standard deviation and multilevel linear mixed effects models were used to estimate the mean change from baseline to post-intervention and the 6-month follow-up period. Thematic analysis was used to analyse the qualitative data.
Quantitative results indicated reductions in binge drinking and use of Class A, B and C drug use from pre-intervention (T1) to the 6-month follow-up (T3). Additionally, significant improvements were noted for mindfulness practice and DBT skills use from T1 to T3 (p < 0.001). There were also significant reductions in dysfunctional coping and emotional dysregulation from T1 to T3 (p < 0.001). Significant differences were identified from pre to post intervention in reported substance use, p = 0.002. However, there were no significant differences between pre-intervention and 6-month follow up reports of substance use or at post-intervention to 6 month follow up. Qualitative findings indicated three superordinate themes in relation to participants’ experiences of a DBT skills training programme, adapted from standard DBT: (1) new lease of life; (2) need for continued formal aftercare and (3) programme improvements. Participants described reductions in substance misuse, while having increased confidence to use the DBT skills they had learned in the programme to deal with difficult emotions and life stressors.
This DBT skills training programme, adapted from standard DBT, showed positive results for participants and appears effective in treating people with co-occurring disorders. Qualitative results of this mixed methods study corroborate the quantitative results indicating that the experiences of participants have been positive. The study indicates that a DBT skills programme may provide a useful therapeutic approach to managing co-occurring symptoms.