Therapy of borderline syndrome
- 1. (Outpatient) individual therapy
- 2. (Outpatient) skills training (skills)
- 3. Telephone contact / telephone advice
- 4. If necessary medication
- 5. Therapist supervision
The therapy of choice for borderline nowadays is certainly the so-called DBT (Dialectical Behavioral Therapy). This form of therapy, which was developed by the American professor Marsha M. Linehan, combines a wide variety of elements from different therapeutic approaches, such as hypnosis and behavior therapy.
One of the fundamental thoughts beyond that is borrowed from ZEN meditation. He describes the balancing act between acceptance of oneself and the simultaneous desire for change. The actual therapy consists of various components:
1. (Outpatient) individual therapy
Strictly structured discussions take place here, in which, according to the motto “worst first”, various problem areas in the patient's life are asked.
2. (Outpatient) skills training (skills)
In this training, patients are taught different modules within a group:
- Inner mindfulness
- Stress tolerance
- Interpersonal skills
- Dealing with feelings
3. Telephone contact / telephone advice
During telephone contact, the therapist should act as a companion for the patient if he gets into situations in which he threatens to lose control. In this context, there is no telephone therapy, but an advisory focus on what has already been learned.
4. If necessary medication
The society has made drug recommendations for research into and treatment of personality disorders. It must be noted that these drugs usually only have a supportive effect. For this reason, they often, but not always, have their place in borderline disorder management.
5. Therapist supervision
In the therapist supervision, all employees involved in the therapy should meet once a week in order to secure the necessary support and the necessary professionalism in dealing with their patients.
How can you treat mood swings?
Rapidly changing mood, moodiness and emotional outbursts are symptoms that can occur with borderline illness.
As for the treatment of the other symptoms, psychotherapy comes into play in the first place. It is the most important component in the treatment of patients with borderline personality disorder. There are several different types of therapy in the field of psychotherapy. Dialectical-behavioral therapy (DBT) has established itself in particular for borderline disease.
There are three other psychotherapeutic methods used on a regular basis: Mindfulness-based therapy (MBT), Young schema therapy and transference-focused therapy.
Dialectical-behavioral therapy, in particular, aims at learning to improve behavior control and emotion regulation.
Your goal is, among other things, to control fluctuating moods and moodiness.
In addition to psychotherapy, drugs are often used. This is where active ingredients from the group of mood stabilizers are most likely to have established themselves. These include active ingredients such as lamotrigine, valproate / valproic acid and topiramate.
Smaller studies have also found evidence of effectiveness for the antipsychotic aripiprazole. Mood stabilizers are intended to reduce impulsive outbursts and strong states of excitement and thus serve to alleviate extreme emotional states.
However, none of the drugs mentioned have not yet been officially approved for the treatment of borderline disease due to insufficient results from large studies. The deployment takes place off-label. Nevertheless, drug therapy shows an additional positive effect in many patients.
Dialectical Behavioral Therapy
Dialectical behavioral therapy is a form of psychotherapy developed by psychologists that is often used in patients with borderline syndrome.
In principle, it is a cognitive behavioral therapy, but it also works with meditation exercises to help the patient acquire new ideas.
Read more on the subject at: meditation
Basically one can say that the therapy has two starting points.
First of all, the dialectical starting point, which is about recognizing opposing viewpoints, accepting them and trying to find a middle path.
This can mean that patients have to perceive that in difficult situations they cannot invariably react with excessive anger, but that they accept the situation as such and try to have a fact-based conversation.
The second approach, namely the behavioral approach, relates to such a change in behavior.
For example, this is about rewarding good behavior and thus promoting it.
Dialectical-behavioral therapy is used not only in borderline patients but also in patients with eating disorders.
The therapy can be inpatient or outpatient, in individual therapy or in group therapy. In addition, there is a pharmacotherapy that works with the use of drugs.
Neuroleptics or antidepressants, for example, are administered to enable the patient to start the upcoming therapy more easily. Otherwise, the use of such drugs in borderline patients is not recommended.
First of all, individual therapy is more important.
During this time the patient should deal with his problems and try to fix them. In individual therapy, it is important that the patient and therapist make an agreement in which the patient undertakes to cooperate in the best possible way and not to interrupt the therapy (unfortunately, this is often the case with borderline patients) and the therapist in turn undertakes to do what he can to help the patient.
The patient should then keep a diary for a certain point in time in which negative events and suicidal thoughts are recorded, but also positive experiences.
In addition to individual therapy, an emergency telephone service should always be available, as situations can arise during therapy in which there is no therapist and the patient feels overwhelmed.
In these moments there should be the opportunity to contact the therapist or another person who is familiar with borderline therapy. After the individual therapy, there is a group therapy that contains five modules.
On the one hand, this includes inner mindfulness.
The point here is that the patient can describe and realize what he feels. If the patient feels happy, he should be able to show this (for example by smiling) and also be able to communicate to the environment if he feels sad he should verbalize this sensation and so on.
The next module is the so-called stress tolerance.
The point here is that the patient does not immediately overreact emotionally in stressful situations, but rather lets the situation affect him first and then realistically thinks about whether the situation is not manageable.
The third module deals with dealing with feelings.
The point here is that the patient can classify the feelings that will arise in him. He should be able to differentiate between happy, hopeful, angry, sad and all other feelings.
This enables the patient to control every situation and every emotion.
The fourth module deals with the development of a social network, i.e. with interpersonal skills.
Here, the patient should learn how best to approach people, how to get involved with them and how to suffer a setback or disappointment, which can be forgiven due to a friendship.
It is important here that the patient learns that he himself is in the background for one time in order to maintain a friendship.
The last module deals with self-worth.
The patient has to learn that he himself is a person whom others and above all himself should appreciate. That he can allow positive thoughts about himself and that he can do something good for himself.
All of these modules should be developed and internalized in group therapy.
Lithium is one of the mood stabilizers. This group of drugs is used in borderline personality disorder off label usewithout the drugs being officially approved for use in this disease.
However, there are hardly any empirical data on the effectiveness of lithium in borderline patients; a positive effect only appears to be possible in individual cases.
For other mood stabilizers such as lamotrigine, valproate, and topiramate, several studies have shown a positive effect on impulsivity and anger, so they are used more frequently.
Duration of therapy
In total, dialectical behavioral therapy lasts around 12 weeks if it is accompanied by an inpatient.
However, since a completed therapy is usually followed by a weekly meeting with the therapist or in a support group, the subsequent therapy can also take longer.
After the 12 weeks, however, the inpatient part is initially over.
With the help of dialectical behavioral therapy moderate successes could be achieved. Since patients with borderline syndrome in particular tend to discontinue therapy, it can be assumed that patients who discontinue therapy achieve far better results.
It should be noted that dialectical behavioral therapy achieves by far the best successes in this area. Other therapeutic approaches, such as conventional behavioral therapy, do not have such good long-term results as dialectical behavioral therapy.
In particular, integration into social and professional life seems to work best with the dialectical behavioral approach.
This is why this form of therapy has established itself as the gold standard, i.e. the best therapy in this area.
Inpatient or outpatient therapy
At the beginning of dialectical behavioral therapy, the therapy was carried out exclusively on an outpatient basis.
There are now clinics that specialize in patients with borderline syndrome and one 12-week inpatient Offer dialectical behavioral therapy.
Nevertheless, an inpatient therapy is always followed by an outpatient therapy because it is important to care for the patient familiar environment to accompany and support him in everyday situations.
Each patient has to decide for himself which therapy is better. For some patients, it is good to be completely removed from everyday life and instead to go to an inpatient facility where trained staff is available day and night should a problem arise.
Nonetheless, outpatient therapy is very important to give the patient a boost Daily routine and one Everyday life to enable.
That is why outpatient Group therapies especially good after an inpatient stay because the patient can talk openly with other patients about his experiences and feelings.
In addition, after inpatient and outpatient therapy, there is always the possibility of the Telephone service to use. Usually this is the therapist who, in an emergency (before a suicide attempt or before the patient injures himself) can be called.
However, this should only be used if all other learned skills have failed.