Effective structured & intensive outpatient treatments for BPD often involve psychotherapy, such as:
- Cognitive-behavioral therapy (“CBT”) – works to change negative thoughts to reduce bad behaviours and improve emotional problems.
- Dialectical behavior therapy (“DBT”) – DBT was created in 1993 and is the main treatment internationally recognized as being effective to treat BPD from evidence-based clinical trials. DBT is a type of CBT that teaches mindfulness (pay attention non-judgementally in the moment – experience what happening without feelings or outside worries, then let it pass), self-awareness (of their connection with other people and the world and their essential “goodness” and validity), interpersonal skills, distress tolerance (tolerate distress without impulsive harmful behaviours), & emotion regulation to improve relationships and reduce conflict.
- Mentalization-based therapy – “thinking about thinking” helps manage emotional dysregulation, feel more understood, and better understand the intentions of people around them through individual and group therapy that emphasizes learning to recognize one’s own mental states (feelings/attitudes) and those of others as ways of explaining behaviors.
- Schema therapy.
- Systems training for emotional predictability and problem solving.
- Transference-focused psychotherapy – increase awareness of interpersonal issues and self-destructive behaviour though twice-weekly individual psychotherapy that emphasizes the interpretation of the meaning for the patient’s behaviors (self) within relationships (significant others) and acceptance of anger.
There is current research about treating BPD with General Psychiatric Management (GPM), which can be administered by any physician with no special training and has been shown to be effective.
- Diagnose – properly diagnose and tell patient about the diagnosis.
- Educate – teach about BPD, behaviour patterns, causes of BPD, and positive prognosis.
- Life – Provide guidance about life outside of the treatment. Advise them to work part-time and volunteer rather than focus on love or alcohol.
- Avoid Medications.
- Prioritize – Manage and treat the most serious comorbid mental health conditions first, which is usually BPD.
- Safety plan – What to do when they are having an emotional crisis, actions they can take to calm down, friends and family they can call for support, emergency numbers to crisis lines and mobile crisis units, and specific information on when it is appropriate to call 911 or go to the hospital.
- Expect change – Different from most psychological disorders, the clinician can’t fix the patient. Instead, the patient must understand that the clinician can only provide information about the disorder & treatment options. The patient must commit to make a big, personal effort to change (the change has to come from the patient).
Some recent research suggests that CBT combined with periodic doses of psilocybin or ketamine (administered through a nasal spray in a doctor’s office) has been successful in treating depression & PTSD and may also work to treat BPD, possibly by increasing glutamate, an amino acid and the main neurotransmitter encouraging growth/re-growth of synapses in the brain.