Improve Borderline Personality Disorder with Mindfulness
By John M. de Castro, Ph.D.
“Mindfulness meditation training may help individuals with BPD be more effective in applying healthy coping skills in the midst of emotional pain. Mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.” – Kristalyn Salters-Pedneault
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.
It is not known if Dialectical Behavior Therapy (DBT) is effective for a subset of patients with Borderline Personality Disorder (BPD) who are not suicidal or self-harming. In today’s Research News article “Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993331/), Kells and colleagues recruited patients with Borderline Personality Disorder (BPD) who had never attempted suicide or engaged in any self-harming and who had high levels of emotional dysregulation. They received a 24-week Dialectical Behavior Therapy (DBT) program that met once a week for 2.5 hours. They were measured before, during, and after treatment and 6 months later for emotion regulation, mindfulness, and DBT skills.
There was a 49% drop-out rate. They found that for those that completed the program at each time point during and after treatment including the 6-month follow-up there were significant reductions in dysfunctional coping and increases in emotion regulation, mindfulness, and DBT skills. The effects were quite large with changes of 22% to 50% from baseline.
The study has a number of interpretive problems as there wasn’t a control condition. Previous controlled research, however, has demonstrated that Dialectical Behavior Therapy (DBT) is effective for the treatment of Borderline Personality Disorder (BPD). So. the present results were probably due to the treatment and not a confounding influence. The drop-out rate in this study was very high. BPD is a very difficult condition to treat and high drop-out rates are common. Hence it is reasonable to conclude that the present study successfully demonstrated that DBT is an effective treatment for BPD in patients without a history of suicide attempts or self-harming behaviors.
These findings suggest that Dialectical Behavior Therapy (DBT) affects a core symptom of Borderline Personality Disorder (BPD), an inability to cope with and regulate emotions. The patients improved markedly in their ability to regulate their emotions and cope with them. It is possible that the observed improvements in mindfulness may have been responsible for the improvements as mindfulness has been shown repeatedly to improve emotion regulation and coping behavior. It remains for future research to investigate this idea.
So, improve Borderline Personality Disorder with mindfulness.
“Strong emotions disrupt a person’s ability to think and to be mindful. This is true for all of us. An inability to think can lead to even stronger and more dysregulated emotions. This is of particular concern in people with BPD, who often experience strong and difficult to control emotions.” = Blaise Aguirre
CMCS – Center for Mindfulness and Contemplative Studies
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Kells, M., Joyce, M., Flynn, D., Spillane, A., & Hayes, A. (2020). Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours. Borderline personality disorder and emotion dysregulation, 7, 3. https://doi.org/10.1186/s40479-020-0119-y
Dialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. Access to DBT can sometimes be restricted due to limited resources. Positive results have been reported for the use of DBT skills training (DBT-ST), one of the four modes of standard DBT, in the treatment of individuals with BPD who self-harm. This study evaluates DBT-ST for a subgroup of individuals attending community mental health services who may have a diagnosis of BPD (or emerging BPD traits) but who are not actively self-harming.
Participants in this study were 100 adults attending community mental health services with a diagnosis of BPD, emerging BPD traits or emotion dysregulation who were not actively self-harming. The majority of participants were female (71%), aged 25–34 years (32%), single (48%) and unemployed (34%). Participants partook in a 24-week DBT-ST intervention delivered by DBT therapists. Outcome measures included the Difficulties in Emotion Regulation Scale (DERS), the DBT Ways of Coping Checklist (DBT-WCCL) and the Five Facet Mindfulness Questionnaire (FFMQ). Measures were administered at pre-intervention, at the end of each skills module, and at post-intervention.
Significant reductions in emotion dysregulation (DERS) and dysfunctional coping (DBT-WCCL) scores were reported from pre- to post-intervention (p < .001). A significant increase in mindfulness scores (FFMQ) and DBT skill use (DBT-WCCL) was also observed (p < .001). However, the drop-out rate was high (49% at post-intervention).
The results of this uncontrolled study suggest that a standalone 24-week DBT-ST intervention may have a beneficial impact in terms of a reduction in emotion dysregulation and dysfunctional coping, and an increase in mindfulness and DBT skills use in patients with BPD/ emerging BPD traits who are not currently engaging in self-harm. Adequately powered randomised controlled trials are required to determine treatment efficacy in comparison to standard DBT for this population.