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Dialectical behavior therapy (DBT) is considered the gold standard of treatment for borderline personality disorder. An evidence-based treatment, it addresses the extreme emotional reactivity, the relationship difficulties, and the acts of self-harm that create so much distress for BPD patients. DBT is a comprehensive program that includes both regular individual psychotherapy sessions and weekly group sessions of skills training.

Treatment typically consists of weekly individual therapy sessions that last an hour and group skill-focused instructional sessions that may last up to two hours. Patients are typically given homework “assignments” in which they are asked to practice in their daily life the skills they acquire in therapy. Patients also keep a diary tracking their emotions and impulses as a way to know which situations are most problematic and to help them gain control over their own behavior. Difficult situations and feelings are typically reviewed in therapy sessions and more constructive solutions found.

DBT was initially developed to dampen the self-destructive impulses of chronically suicidal patients. It is now the treatment of choice for borderline personality disorder, a serious condition marked by extreme emotional reactivity, relationship instability, and self-injurious behaviors. Treatment of BPD helps patients tolerate the flux of emotions without acting on them, often with a specific focus on tolerating negative emotions. DBT addresses the core problems of BPD—fear of abandonment, low self-esteem, and impulsivity.

The goal of treatment for borderline personality disorder (BPD) is to relieve the extreme emotional distress that patients experience—to curb their emotional reactivity, to minimize their inclination to self-harm, and to reduce their impulsivity. Toward these ends, patients are not only taught an array of new coping skills and techniques for emotional regulation, they are given opportunities to practice them. Another major goal of treatment is interpersonal effectiveness; patients learn and problem-solve ways to effectively communicate in relationships, especially how to ask for what they need as a way to minimize hurt feelings.