There are many abnormal psychological disorders in the DSM-IV along with various treatment options for them. The American Psychological Association’s (APA) lists that these types of disorders are genetic and learned. The main focus is of one of the possible treatments for the Axis II disorder known as borderline personality disorder (BPD) and that is Dialectical Behavior Therapy (DBT). Through a discovery of its usefulness for individuals with this disorder, the defining data will either prove or disprove DBT as a viable treatment for BPD.
By focusing on BPD as a known learned disorder we find that the discovery of which patients benefit from this certain type of treatment is important. Exploring if this treatment eases the existing symptoms of BPD is necessary and so is finding if there are some, who do not benefit from this treatment or find ease from it. We will discuss borderline personality disorder, the symptoms, and typical treatments. Research Question The goal of our experiment is to find out which treatment is most effective.
The two treatments we are administering will be Cognitive Behavioral Therapy, and Dialectical Behavioral Therapy. Which one is most effective? Are they the same? Should they both be utilized? Do some people benefit from one therapy, while others benefit from another? Let’s form a hypothesis, and try to find some answers. Hypotheses With this research question poised, there are 2 hypotheses to look at: the null and alternative. The null hypothesis is that there is no difference in the effectiveness of DBT versus cognitive therapy in treating borderline personality disorder.
The alternative hypothesis is that DBT is more effective than cognitive therapy in treating borderline personality disorder. Let us look at some background information regarding BPD and DBT. Literature Review Borderline Personality Disorder is a mental illness that affects about 75 percent of women during adolescence of early adulthood (Proctor, 2010). BPD is traditionally known for displaying patterns of emotional instability, impulsive behavior, a distorted self-image, and unstable relationships. (Kivi, 2012). We will discuss causes, diagnosis, and treatments for individuals that have BPD.
The exact cause of BPD is still unknown; however, there have been a few links to show which individuals would be at risk for this illness. Researchers believe that genetics, serotonin abnormality, and a person’s environment play a part with developing BPD. If someone in the family has been diagnosed with BPD the risk increases for all family members. If there is a decrease in the amount of serotonin the body produces, a person might become susceptible to develop BPD. If someone was exposed to an abusive, unstable, or neglected environment at an early age that could be a potential risk factor for emotional disorders such as BPD.
Diagnosis of BPD comes from a provider with a questionnaire based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, you must meet at least five of the following criteria to be diagnosed with BPD: have a family member diagnosed with BPD, felt emotionally unstable or emotionally vulnerable as a child, people in your household were impulsive when you were a child, you were emotionally abused as a child Unstable and impulsive behaviors are displayed, intense interpersonal relationships veering between idealization and devaluation affective instability and reactivity of mood inappropriate intense anger frantic efforts to avoid abandonment, identity disturbance; unstable self-image suicidal and self-mutilating behaviors chronic feelings of emptiness or transient stress-related paranoid ideas (Kivi, 2012). After a diagnosis is made, treatment options are presented and discussed. Treatment options can vary from person to person based on their level of BPD and can include psychotherapy, cognitive behavioral therapy, dialectical behavior therapy, schema-focused therapy, hospitalization, medication, and alternative therapy.
It is important for individuals to receive treatment for BPD, as symptoms can increase with certain stressful situations such as financial, relationship, or work problems. Untreated BPD could also lead to other disorders such as depression, anxiety, eating, bipolar, and substance abuse. We will discuss similarities and differences with cognitive therapy and dialectical behavior therapy as treatment options for BPD. Dialectical Behavior Therapy Dialectical Behavior Therapy (DBT) is a psychosocial treatment initially developed by Marsha Linehan as one of the many different treatment options for BPD (Rizvo, Steffel, Carson-Wong, 2012). DBT is composed of four treatment modes that address five functions.
This comprehensive treatment program focuses on promoting the motivation for change by detailed chain analyses, validation strategies, and management of reinforcement contingencies in individual therapy twice a week; increasing target-oriented and appropriate behavior by teaching skills in a weekly group format training, fostering mindful attention and cognition, emotion regulation, acceptance of emotional distress, and interpersonal effectiveness; ensuring the transfer of newly learned skills to everyday life by telephone coaching and case management; and supporting therapists’ motivation and skills with a weekly consultation team (Kliem, Kroger, Kosfelder, 2010). As we can see DBT covers a vast amount of information within its treatment regimen. Fictitious Data
Persons diagnosed with borderline personality disorder (BPD) have been found to be difficult to treat effectively. Since frequently to be unsuccessful or reply to therapeutic efforts makes it hard for the therapist to know the best route. Dialectical behavior therapy (DBT) and cognitive therapy refers to set of procedures that work to attain the goals for treatment. DBT is very useful to help reduce symptoms and helps to teach more behavioral skills. Individuals with BPD need a specialized treatment that is designed around their symptoms. The most important aspect is having a clear and focused treatment shows that it is possible to live with this disorder. Experimental Design
The experiment is an independent study, and the hypothesis is directional. The sample consisted of 100 patients with a new diagnosis of BPD. Participants were randomly selected from 4 different behavioral health clinics in Sacramento, California, Phoenix, Arizona, New York City, New York, and Detroit, Michigan. Twenty five participants from each clinic were enrolled into the experiment to include different genders, race, ethnic and cultural backgrounds, age, socioeconomic groups and religions. Each participant had a new diagnosis of BPD that was untreated at the time of the experiment, and was not diagnosed with any other psychological or psychiatric disorder unrelated to BPD. Each participant signed a consent orm and was debriefed consisting of information addressing that the study was to determine which type of therapy is most effective in the treatment of BPD. Each participant was informed their participation and results would not be shared among their peers or anyone else, and they also were informed of the risks pertaining to the experiment. Two of the participating clinics offered each participant nine months of DBT (population 1) while the other two clinics offered nine months of cognitive therapy (population 2). After completing nine months of the selected therapy, the therapists and participants complete an evaluation using a 5 point system with lower scores reflecting a decrease in self destructive behavior and depression.
To maintain confidentiality, each evaluation was unnamed, but information such as gender, age, race, culture, ethnicity, religion and socioeconomic status were requested on each evaluation. Results To study the results of therapy progress over a 9 month period of time we took 100 randomly selected individuals with BPD and used 4 clinics total. In our study 2 of the 4 clinics were to participate with cognitive therapy (50 individuals) and 2 clinics to participate with DBT (50 individuals). The result of clinic a (cognitive therapy) was very positive and overtime all 50 people showed mood improvements. We were able to directly work with the patients by identifying a self-fulfilling way to change the negative thought patterns and dysfunctional behaviors.
For these 50 individuals we would meet daily and work on skills such as changing the thought process, how you cope with your feelings, as well as changing overall actions. Clinic b (DBT) seemed to have the strongest positive form of management with BPD. These 50 individuals focused more strongly on techniques for emotion regulation and concepts of distress patience. After 9 months of research it was proven to be effective in helping relief symptoms and behaviors. The self-injury rate had also gone down greatly in this group with 15 of the 17 individuals not doing any personal harm. All of the individuals except 4 were able to overcome difficulties by identifying and altering negative thinking, actions, and emotional responses with great success. Discussion
The results have spoken for themselves, and it seems that both of these methods are effective in treating people with BPD. While cognitive therapy helps the sufferer identify the roots of their disorder, dialectical therapy helps them control their emotions and behaviors. Identifying the problem should always be the first step, which is why we conclude that cognitive therapy should be utilized first, and in conjunction with dialectical therapy. Often times, BPD is not something that was acquired through genetics, but through experiences in one’s life. Because of this, we don’t believe BPD has anything to do with a chemical imbalance, and medications are not usually recommended.
It is best to acknowledge the root causes of one’s emotions and behaviors, and work on a daily basis to put them into perspective. At the same time, the individual must take the conscious initiative to behave in a manner that is acceptable in society, and not act on their impulses. Conclusion Nevertheless, while investigating the possibility that the form of therapy known as Dialectical Behavior Therapy (DBT), as a treatment that eases the symptoms of borderline personality disorder, to be encouraging. After conducting research, finding available data on the disorder, and performing a diagnostic test through a study of DBT on patients, it will be possible to create a hypothetical determination.
Through conclusive data it may even be proven that through a thorough exploration and analysis, that the usefulness of DBT for patients with borderline personality disorder is probable; by witnessing if the therapy eases the symptoms. If this is proven possible, then it may be a potential form of management, for borderline personality disorder with this form of treatment; thus, becoming supplementary to the current first choice available, which is cognitive behavioral therapy.
Andion, O. , Ferrer, M. , Matali, J. , Gancedo, B. , Calvo, N. , Barral, C. , & … Casas, M. (2012). Effectiveness of combined individual and group dialectical behavior therapy compared to only individual dialectical behavior therapy: A preliminary study. Psychotherapy, 49(2), 241-250. doi:10. 037/a0027401 Kivi, R. (2012). Yahoo. Retrieved from http://health. yahoo. net/health/borderline-personality- disorder Kliem, S. , Kroger, C. , & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal Of Consulting And Clinical Psychology, 78(6), 936-951. doi:10. 1037/a0021015 Proctor, G. (2010). BPD: mental illness or misogyny?. Therapy Today, 21(2), 16-21. Rizvi, S. L. , Steffel, L. M. , & Carson-Wong, A. (2012). An Overview of Dialectical Behavior Therapy for Professional Psychologists. Professional Psychology: Research And Practice, doi:10. 1037/a0029808
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