Skip to main content
Log in

Addressing Treatment Motivation in Borderline Personality Disorder: Rationale for Incorporating Values-Based Exercises into Dialectical Behavior Therapy

  • Original Paper
  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract:

Dialectical behavior therapy (DBT) is one empirically supported treatment for individuals diagnosed with borderline personality disorder (BPD), and has demonstrated efficacy in reducing distress and behaviors that are often utilized by those with BPD to manage that distress. Treatment dropout rates of those with BPD receiving DBT are high, with serious deleterious effects. Increasing motivation for treatment, including treatment adherence, homework completion and skill use, in those with BPD is a critical factor in improving daily functioning and overall quality of life for these individuals. As described in ACT, values work in the service of increasing values-consistent behavior, or valued or committed action, may be one way to improve treatment motivation both in-session and out of session. This paper outlines the theoretical rationale for adding values components to existing DBT skills, including suggestions for where and how values work might be done in this population and potential difficulties.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Ansell, E. B., Sanislow, C. A., McGlashan, T. H., & Grilo, C. M. (2007). Psychosocial impairment and treatment utilization by clients with Borderline Personality Disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Comprehensive Psychiatry, 48(4), 226–329.

    Article  Google Scholar 

  • Bennett, J. A., Lyons, K. S., Winters-Stone, K., Nail, L. M., & Scherer, J. (2007). Motivational interviewing to increase physical activity in long-term cancer survivors: A randomized controlled trial. Nursing Research, 56, 18–27.

    Article  PubMed  Google Scholar 

  • Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., et al. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42(5), 487–499.

    Article  PubMed  Google Scholar 

  • Boisseau, Christina L., Yen, S., Markowitz, J. C., Grilo, C. M., Sanislow, C. A., Shea, M. T., et al. (2013). Individuals with single versus multiple suicide attempts over 10 years of prospective follow-up. Comprehensive Psychiatry. doi:10.1016/j.comppsych.2012.07.062.

    PubMed Central  PubMed  Google Scholar 

  • Bricker, J., & Tollison, S. (2011). Comparison of motivational interviewing with acceptance and commitment therapy: A conceptual and clinical review. Behavioural and Cognitive Psychotherapy, 39(5), 541–559. doi:10.1017/S1352465810000901.

    Article  PubMed Central  PubMed  Google Scholar 

  • Dahl, J. C., Plumb, J. C., Stewart, I., & Lundgren, T. (2009). The Art and Science of Valuing in Psychotherapy: Helping Clients Discover Explore and Commit to Valued Action Using Acceptance and Commitment Therapy. Oakland: New Harbinger Publications.

    Google Scholar 

  • Dimaggio, G., Salvatore, G., Popolo, R., & Lysaker, P. H. (2012). Autobiographical memory and mentalizing impairment in personality disorders and schizophrenia: Clinical and research implications. Frontiers in Psychology,. doi:10.3389/fpsyg.2012.00529.

    PubMed Central  PubMed  Google Scholar 

  • Forman, E. M., Butryn, M. L., Hoffman, K. L., & Herbert, J. D. (2009). An open trial of an acceptance-based behavioral intervention for weight loss. Cognitive and Behavioral Practice, 16(2), 223–235.

    Article  Google Scholar 

  • Fossati, A., Madeddu, F., & Maffei, C. (1999). Borderline Personality Disorder and childhood sexual abuse: A meta-analytic study. Journal of Personality Disorders, 13, 268–280.

    Article  CAS  PubMed  Google Scholar 

  • Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., et al. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry, 69(4), 533.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gratz, K., Rosenthal, Z., Tull, M., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in Borderline Personality Disorder. Journal of Abnormal Psychology, 115(4), 850–855.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.

    Google Scholar 

  • Interian, A., Martinez, I., Rios, L. I., Krejci, J., & Guarnaccia, P. J. (2010). Adaptation of a motivational interviewing intervention to improve antidepressant adherence among Latinos. Cultural Diversity and Ethnic Minority Psychology, 16(2), 215–225. doi:10.1037/a0016072.

    Google Scholar 

  • Johnston, J. M., Foxx, R. M., Jacobson, J. W., Green, G., & Mulick, J. A. (2006). Positive behavior support and applied behavior analysis. The Behavior Analyst, 29, 51–74.

    CAS  PubMed Central  PubMed  Google Scholar 

  • Karterud, S., Pedersen, G., Bjordal, E., Brabrand, J., Friss, S., Haaseth, O., et al. (2003). Day treatment of clients with personality disorders: Experiences from a Norwegian treatment research network. Journal of Personality Disorders, 17, 243–262.

    Article  PubMed  Google Scholar 

  • Koons, C. R., Robins, C. J., Lindsey Tweed, J., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior therapy, 32(2), 371–390.

    Article  Google Scholar 

  • Linehan, M. M. (1993). Cognitive– behavioral treatment of Borderline Personality Disorder. New York: Guilford Press.

    Google Scholar 

  • Linehan, M., Armstrong, H. E., Suarez, A., Allmon, D., et al. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline clients. Archives of General Psychiatry, 48(12), 1060–1064.

    Article  CAS  PubMed  Google Scholar 

  • Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Shaw-Welch, S., Heagerty, P., et al. (2002). Dialectical behavior therapy versus comprehensive validation plus 12-step for the modified treatment of opiod dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.

    Article  PubMed  Google Scholar 

  • Linehan, M., Schmidt, H., Dimeff, L. A., Craft, J., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for clients with Borderline Personality Disord and drug-dependence. The American Journal of Addictions, 8(4), 279–292.

    Article  CAS  Google Scholar 

  • Livesley, W. (2012). Moving beyond specialized therapies for borderline personality disorder: The importance of integrated domain-focused treatment. Psychodynamic Psychiatry, 40(1), 47–74. doi:10.1521/pdps.2012.40.1.47.

    Article  PubMed  Google Scholar 

  • Lundgren, T., Dahl, J., Yardi, N., & Melin, L. (2008). Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: A randomized controlled trial. Epilepsy & Behavior, 13(1), 102–108.

    Article  Google Scholar 

  • Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2012). Slow and steady wins the race: A randomized clinical trial of Acceptance and Commitment Therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80(1), 43–53.

    Article  PubMed  Google Scholar 

  • Makela, E. H., Moeller, K. E., Fullen, J. E., & Erdogan, G. (2006). Medication utilization patterns and methods of suicidality in BPD. Annals of Pharmacotherapy, 40, 49–52.

    Article  PubMed  Google Scholar 

  • Marini, M. M., Semenzin, M. M., Vignaga, F. F., Gardiolo, M. M., Drago, A. A., Caon, F. F., et al. (2005). Dropout in institutional emotional crisis counseling and brief focused intervention. Brief Treatment and Crisis Intervention, 5(4), 356–367. doi:10.1093/brief-treatment/mhi027.

    Article  Google Scholar 

  • Martínez-Raga, J., Marshall, E. J., Keaney, F., Ball, D., & Strang, J. (2002). Unplanned versus planned discharges from in-patient alcohol detoxification: Retrospective analysis of 470 first-episode admissions. Alcohol and Alcoholism, 37(3), 277–281.

    Article  PubMed  Google Scholar 

  • McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., et al. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. The American Journal of Psychiatry, 166(12), 1365–1374. doi:10.1176/appi.ajp.2009.09010039.

    Article  PubMed  Google Scholar 

  • Mercer, D. (2007). Medications in the treatment of borderline personality disorder. Current Psychiatry Reports, 9, 53–62.

    Article  PubMed  Google Scholar 

  • Miller, W., & Rollnick, S. (2002). Motivational Interviewing: Preparing People to Change. NY: Guilford Press.

    Google Scholar 

  • Mooney, K. A., & Padesky, C. A. (2000). Applying cllent creativity to recurrent problems: Constructing possibilities and tolerating doubt. Journal of Cognitive Psychotherapy, 14(2), 149–161.

    Google Scholar 

  • Morton, J., Snowdown, S., Gopold, M., & Guymer, E. (2012). Acceptance and commitment therapy group treatment for symptoms of Borderline Personality Disorder. A public sector pilot study. Cognitive and Behavioral Practice,. doi:10.1016/j.cbpra.2012.03.005.

    Google Scholar 

  • Padesky, C. A., & Mooney, K. A. (2012). Strengths-based cognitive–behavioural therapy: A four-step model to build resilience. Clinical Psychology & Psychotherapy, 19(4), 283–290. doi:10.1002/cpp.1795.

    Article  Google Scholar 

  • Rusch, N., Schiel, S., Corrigna, P. W., Leihener, F., Jacob, G. A., Olschewski, M., et al. (2008). Predictors of dropout from inclient dialectical behavior therapy among women with BPD. Journal of Behavior Therapy and Experimental Psychiatry, 39(4), 497–503.

    Article  PubMed  Google Scholar 

  • Sansone, R. A., & Sansone, L. A. (2011). Personality disorders: A nation-based perspective on prevalence. Innovations in Clinical Neuroscience, 8(4), 13–18.

    PubMed Central  PubMed  Google Scholar 

  • Soloff, P. H., & Fabio, A. (2008). Prospective predictors of suicide attempts in BPDat one, two, and two-to-five year follow-up. Journal of Personality Disorders, 22(2), 123–134.

    Article  PubMed  Google Scholar 

  • Soloff, P. H., Lynch, K. G., Kelly, T. M., et al. (2000). Characteristics of suicide attempts of clients with major depressive episode and BPD: A comparative study. American Journal of Psychiatry, 157, 601–608.

    Article  CAS  PubMed  Google Scholar 

  • Stone, M. H. (1993). The fate of borderline patients. New York: Guilford Press.

    Google Scholar 

  • Verheul, R., Van Den Bosch, L. M., Koeter, M. W., de Ridder, M. A., Stijnen, T., & Van Den Brink, W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182(2), 135–140.

    Article  PubMed  Google Scholar 

  • Welch, S., Linehan, M. M., Sylvers, P., Chittams, J., & Rizvi, S. L. (2008). Emotional responses to self-injury imagery among adults with Borderline Personality Disorder. Journal of Consulting and Clinical Psychology, 76(1), 45–51.

    Article  PubMed  Google Scholar 

  • Westra, H. A., & Dozois, D. J. A. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30, 481–498.

    Article  Google Scholar 

  • White, R. G., Gumley, A. I., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., et al. (2011). A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behaviour Research and Therapy, 49(12), 901–907.

    Article  PubMed  Google Scholar 

  • Wilson, K. G., & DuFrene, T. (2009). Mindfulness for two: An Acceptance and Commitment Therapy approach to mindfulness in psychotherapy. Oakland: New Harbinger.

    Google Scholar 

  • Woodall, W. G., Delaney, H. D., Kunitz, S. J., Westerberg, V. S., & Zhao, H. (2007). A randomized trial of a DWI intervention program for first offenders: Intervention outcomes and interactions with antisocial personality disorder among a primarily American-Indian sample. Alcoholism, Clinical and Experimental Research, 31, 974–987.

    Article  PubMed  Google Scholar 

  • Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006). A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichitillomania. Behaviour Research and Therapy, 44, 639–656.

    Article  PubMed  Google Scholar 

  • Zanarini, M. C., Horwood, J., Wolke, D., Waylen, A., Fitzmaurice, G., & Grant, B. F. (2011). Prevalence of DSM-IV BPD in two community samples: 6,300 English 11-year-olds and 34,653 American adults. Journal of Personality Disorders, 25(5), 607–619. doi:10.1521/pedi.2011.25.5.607.

    Article  PubMed  Google Scholar 

  • Zanarini, M. C., Williams, A. A., Lewis, R. E., et al. (1997). Reported pathological childhood experiences associated with the development of BPD. American Journal of Psychiatry, 154, 1101–1106.

    CAS  PubMed  Google Scholar 

  • Zlomke, L. (2003). Token Economies. The Behavior Analyst Today, 4(2), 177–184.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amy Y. Cameron.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cameron, A.Y., Palm Reed, K. & Gaudiano, B.A. Addressing Treatment Motivation in Borderline Personality Disorder: Rationale for Incorporating Values-Based Exercises into Dialectical Behavior Therapy. J Contemp Psychother 44, 109–116 (2014). https://doi.org/10.1007/s10879-013-9253-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-013-9253-9

Keywords

Navigation