Dialectical behaviour therapy (DBT) in the treatment of borderline personality disorder


  • B. O'Connell RGN, RPN, PGD in Nursing (Mental Health), MHSc (Specialist Nursing),

    Community Mental Health Nurse
    1. Shannon Day Hospital, HSE, Shannon
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  • M. Dowling PhD, MSc, BNS, RGN, RNT

    Lecturer, Corresponding author
    1. School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
    • Correspondence:

      M. Dowling

      School of Nursing and Midwifery

      Áras Moyola

      National University of Ireland



      E-mail: maura.dowling@nuigalway.ie

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Accessible summary

  • Borderline Personality Disorder (BPD) is a complex disorder that is difficult to treat. Five psychotherapeutic approaches are used in the management of BPD. These include cognitive behavioural therapy, mentalization-based therapy, schema-focused therapy, transference-focused therapy and dialectical behaviour therapy (DBT). Of the five approaches used to manage BPD, DBT has been studied the most extensively.
  • Dialectical behaviour therapy (DBT) is a multi-pronged approach comprising of skills-based training, individual psychotherapy, telephone calls and consultation team meetings.
  • DBT can have a positive effect on therapists, shifting therapeutic pessimism towards one of optimism with DBT therapists also describing personal changes resulting from their work with clients.
  • A considerable number of trials have been conducted as DBT was developed in the early 1990s, and most support the usefulness of BPD in the treatment of BPD. However, two Cochrane reviews conclude that more research is needed to provide stronger evidence in support of DBT for the management of BPD.


Borderline personality disorder (BPD) is a complex disorder that is difficult to treat. However, dialectical behaviour therapy (DBT), developed by Dr. Marsha Linehan in the early 1990s, has emerged as a promising treatment option for those diagnosed with BPD. DBT is a multi-pronged treatment approach delivered normally in outpatient settings over 12 months and requires highly skilled and trained therapists. Many trials have provided evidence to support the use of DBT in the treatment of BPD. However, outcome measures vary and are mostly limited to measurable behavioural outcomes such as incidences of deliberate self-harm or suicidal thoughts. Two recent Cochrane reviews conclude that DBT does benefit those with BPD, but more robust evidence is needed. DBT training for health care professionals also has the potential to shift health care professionals' attitudes from one of therapeutic pessimism to one of optimism.