For decades, a considerable body of research has demonstrated that a number of psychotherapies are highly effective in the treatment of depression and anxiety disorders. Cognitive behavioral treatments have received the most attention from researchers, but other treatments such as interpersonal psychotherapy have also shown significant promise. The treatment of Borderline Personality Disorder has been another matter. Marsha Linehan developed a treatment known as Dialectical Behavior Therapy (DBT) which utilizes cognitive behavioral principles in conjunction with acceptance, emotional regulation skills, and principles of validation to the treatment of Borderline Personality Disorder (DBT). Significant research supporting its efficacy did not start showing up until the 1990’s or so. And, for a while, DBT virtually stood alone as an empirically validated treatment for BPD. This treatment is fairly intensive and requires at least a full year of treatment, but a growing number of studies have supported its value.
Nonetheless, we have needed more ideas for treating BPD. Dialectical Behavior Therapy, as effective as it is, sometimes fails to improve life satisfaction and quality of life as much as one would hope. And in the past few years, new treatment ideas have begun to emerge. These include:
- Mentalization-Based Therapy (MBT)
- Transference-Focused Psychotherapy (TFP)
- Schema Therapy (ST)
- Cognitive Behavioral Therapy (CBT) tailored specifically to BPD
Research has just started to support these new approaches to BPD treatment. Schema Therapy and Mentalization-Based Therapy look especially promising, but we need more studies before anything definitive can be concluded. Interestingly, having reviewed these approaches, we have failed to discover much that seems especially incompatible among them. Therefore, we suspect that ultimately, an integrated approach to treating BPD may ultimately emerge as the best strategy. Whether or not our hunch is right, the next ten years promise to be quite exciting in the treatment of BPD.
In a future blog, we’ll discuss the role of medications in the treatment of BPD. Although most prescribers of medications recommend multiple medications for the majority of people with BPD, research has demonstrated surprisingly little value from medications for this problem. As we said, more to come…