Skip to main content
Top
Published in: Journal of Contemporary Psychotherapy 1/2016

01-03-2016 | Original Paper

DBT and Schema Therapy for Borderline Personality Disorder: Mentalization as a Common Factor

Author: Stephanie Montgomery-Graham

Published in: Journal of Contemporary Psychotherapy | Issue 1/2016

Login to get access

Abstract

This paper adds to the existing body of literature by examining two different therapeutic approaches to the treatment of borderline personality disorder (BPD), namely: (1) dialectical behavior therapy (DBT), and (2) schema therapy. DBT is an evidence-based treatment for BPD while schema therapy is gaining ground as an effective therapy for BPD. Treatment approaches and etiological conceptualizations of each therapeutic modality are compared and contrasted. Theoretical underpinnings of each therapy are cognitive and behavioural but each therapy has developed its own techniques and rationale. Mentalization is discussed as an important mechanism of change in the successful treatment of BPD that is seen to underlie both DBT and schema therapy. To conclude DBT efficacy studies and schema therapy effectiveness studies are briefly reviewed.
Literature
go back to reference Allen, J. G. (2008). Coping with trauma: Hope through understanding. Arlington: American Psychiatric Pub. Allen, J. G. (2008). Coping with trauma: Hope through understanding. Arlington: American Psychiatric Pub.
go back to reference American Psychiatric Association. (2001). Practice guidelines for the treatment of patients with borderline personality disorder: American Psychiatric Association Guidelines. American Journal of Psychiatry, 158, 1–58.CrossRef American Psychiatric Association. (2001). Practice guidelines for the treatment of patients with borderline personality disorder: American Psychiatric Association Guidelines. American Journal of Psychiatry, 158, 1–58.CrossRef
go back to reference Bamelis, L. M., Evers, A. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 305–322.PubMedCrossRef Bamelis, L. M., Evers, A. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 305–322.PubMedCrossRef
go back to reference Björgvinsson, T., & Hart, J. (2006). Cognitive behavioral therapy promotes mentalizing. In J. G. Allen & P. Fonagy (Eds.), Handbook of mentalization-based treatment (pp. 157–170). Sussex: Wiley.CrossRef Björgvinsson, T., & Hart, J. (2006). Cognitive behavioral therapy promotes mentalizing. In J. G. Allen & P. Fonagy (Eds.), Handbook of mentalization-based treatment (pp. 157–170). Sussex: Wiley.CrossRef
go back to reference Bricker, D., & Labin, M. (2012). Teaching mindfulness meditation in a schema therapy framework. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research and practice (pp. 259–270). Maklen, MA: Wiley.CrossRef Bricker, D., & Labin, M. (2012). Teaching mindfulness meditation in a schema therapy framework. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research and practice (pp. 259–270). Maklen, MA: Wiley.CrossRef
go back to reference Carter, G. L., Willcox, C. H., Lewin, T. J., Conrad, A. M., & Bendit, N. (2010). Hunter DBT project: Randomized controlled trial of dialectical behavior therapy in women with borderline personality disorder. Australian and New Zealand Journalof Psychiatry, 44, 162–173.CrossRef Carter, G. L., Willcox, C. H., Lewin, T. J., Conrad, A. M., & Bendit, N. (2010). Hunter DBT project: Randomized controlled trial of dialectical behavior therapy in women with borderline personality disorder. Australian and New Zealand Journalof Psychiatry, 44, 162–173.CrossRef
go back to reference Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18.PubMedCrossRef Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18.PubMedCrossRef
go back to reference Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. The American Journal of Psychiatry, 164, 922–928.PubMedCrossRef Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. The American Journal of Psychiatry, 164, 922–928.PubMedCrossRef
go back to reference Dimeff, L., & Linehan, M. (2001). Dialectical behaviour therapy in a nutshell. The California Psychologist, 34, 10–13. Dimeff, L., & Linehan, M. (2001). Dialectical behaviour therapy in a nutshell. The California Psychologist, 34, 10–13.
go back to reference Edwards, D., & Arntz, A. (2012). Schema therapy in historical perspective. In M. van Vreeswijk, J. Broersen, & J. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research and practice (pp. 3–28). Maklen, MA: Wiley. Edwards, D., & Arntz, A. (2012). Schema therapy in historical perspective. In M. van Vreeswijk, J. Broersen, & J. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research and practice (pp. 3–28). Maklen, MA: Wiley.
go back to reference Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40, 317–328.PubMedCrossRef Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40, 317–328.PubMedCrossRef
go back to reference Fonagy, P., & Bateman, A. W. (2007). Mentalizing and borderline personality disorder. Journal of Mental Health, 16, 83–101.CrossRef Fonagy, P., & Bateman, A. W. (2007). Mentalizing and borderline personality disorder. Journal of Mental Health, 16, 83–101.CrossRef
go back to reference Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy versus transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–659.PubMedCrossRef Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy versus transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–659.PubMedCrossRef
go back to reference Goodman, G. (2013). Is mentalization a common process factor in transference-focused psychotherapy and dialectical behavior therapy sessions? Journal of Psychotherapy Integration, 23, 179–192.CrossRef Goodman, G. (2013). Is mentalization a common process factor in transference-focused psychotherapy and dialectical behavior therapy sessions? Journal of Psychotherapy Integration, 23, 179–192.CrossRef
go back to reference Harned, M. S., Chapman, A. L., Dexter-Mazza, E. T., Murray, A., Comtois, K. A., & Linehan, M. M. (2008). Treating co-occuring axis I disorders in recurrently suicidal women with borderline personality disorder. Journal of Consulting and Clinical Psychology, 76, 1068–1075.PubMedCrossRef Harned, M. S., Chapman, A. L., Dexter-Mazza, E. T., Murray, A., Comtois, K. A., & Linehan, M. M. (2008). Treating co-occuring axis I disorders in recurrently suicidal women with borderline personality disorder. Journal of Consulting and Clinical Psychology, 76, 1068–1075.PubMedCrossRef
go back to reference Kellogg, S. H., & Young, J. E. (2006). Schema therapy for borderline personality disorder. Journal of Clinical Psychology, 62, 445–458.PubMedCrossRef Kellogg, S. H., & Young, J. E. (2006). Schema therapy for borderline personality disorder. Journal of Clinical Psychology, 62, 445–458.PubMedCrossRef
go back to reference Kliem, S., Kroger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modelling. Journal of Consulting and Clinical Psychology, 78, 936–951.PubMedCrossRef Kliem, S., Kroger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modelling. Journal of Consulting and Clinical Psychology, 78, 936–951.PubMedCrossRef
go back to reference Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., & Bastian, L. A. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.CrossRef Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., & Bastian, L. A. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.CrossRef
go back to reference Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
go back to reference Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York: Guilford Press. Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York: Guilford Press.
go back to reference Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.PubMedCrossRef Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.PubMedCrossRef
go back to reference Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.PubMedCrossRef Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.PubMedCrossRef
go back to reference Linehan, M., Dimeff, L., Reynolds, S. K., Comtois, K. A., Shaw-Welch, S., Heagerty, P., & Kivlahan, D. R. (2002). Dialectical behavior therapy versus comprehensive validation plus 12 step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.PubMedCrossRef Linehan, M., Dimeff, L., Reynolds, S. K., Comtois, K. A., Shaw-Welch, S., Heagerty, P., & Kivlahan, D. R. (2002). Dialectical behavior therapy versus comprehensive validation plus 12 step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.PubMedCrossRef
go back to reference Lobbestael, J., Arntz, A., & Sieswerda, S. (2005). Schema modes and childhood abuse in borderline and antisocial personality disorders. Journal of Behavior Therapy and Experimental Psychiatry, 36(3), 240–253.PubMedCrossRef Lobbestael, J., Arntz, A., & Sieswerda, S. (2005). Schema modes and childhood abuse in borderline and antisocial personality disorders. Journal of Behavior Therapy and Experimental Psychiatry, 36(3), 240–253.PubMedCrossRef
go back to reference Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006). Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations. Journal of Clinical Psychology, 62, 459–480.PubMedCrossRef Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006). Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations. Journal of Clinical Psychology, 62, 459–480.PubMedCrossRef
go back to reference Masley, S. A., Gillanders, D. T., Simpson, S. G., & Taylor, M. A. (2012). A systematic review of the evidence base for schema therapy. Cognitive Behavior Therapy, 41, 185–202.CrossRef Masley, S. A., Gillanders, D. T., Simpson, S. G., & Taylor, M. A. (2012). A systematic review of the evidence base for schema therapy. Cognitive Behavior Therapy, 41, 185–202.CrossRef
go back to reference McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. The American Journal of Psychiatry, 166, 1365–1374.PubMedCrossRef McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. The American Journal of Psychiatry, 166, 1365–1374.PubMedCrossRef
go back to reference Morrison, N. (2000). Schema-focused cognitive therapy for complex, long-standing problems: A single case study. Behavioral and Cognitive Psychotherapy, 23, 269–283.CrossRef Morrison, N. (2000). Schema-focused cognitive therapy for complex, long-standing problems: A single case study. Behavioral and Cognitive Psychotherapy, 23, 269–283.CrossRef
go back to reference Nordahl, H. M., & Nysaeter, T. E. (2005). Schema therapy for patients with borderline personality disorder: a single case series. Journal of Behavior Therapy and Experimental Psychiatry, 36, 254–264.PubMedCrossRef Nordahl, H. M., & Nysaeter, T. E. (2005). Schema therapy for patients with borderline personality disorder: a single case series. Journal of Behavior Therapy and Experimental Psychiatry, 36, 254–264.PubMedCrossRef
go back to reference Oldham, J. M. (2005). Guideline watch: Practice guideline for the treatment of patients with borderline personality disorder. Focus, 3(3), 396–400.CrossRef Oldham, J. M. (2005). Guideline watch: Practice guideline for the treatment of patients with borderline personality disorder. Focus, 3(3), 396–400.CrossRef
go back to reference Palmer, R. L. (2002). Dialectical behavior therapy for borderline personality disorder. Advances in Psychiatric Treatment, 8, 10–16.CrossRef Palmer, R. L. (2002). Dialectical behavior therapy for borderline personality disorder. Advances in Psychiatric Treatment, 8, 10–16.CrossRef
go back to reference Perris, P., Fretwell, H., & Shaw, I. (2012). Therapist self‐care in the context of limited reparenting. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice (pp. 473–491). Maklen: Wiley.CrossRef Perris, P., Fretwell, H., & Shaw, I. (2012). Therapist self‐care in the context of limited reparenting. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice (pp. 473–491). Maklen: Wiley.CrossRef
go back to reference Rizvi, S. L., & Ritschel, L. A. (2014). Mastering the art of chain analysis in dialectical behavior therapy. Cognitive and Behavioral Practice, 21(3), 335–349.CrossRef Rizvi, S. L., & Ritschel, L. A. (2014). Mastering the art of chain analysis in dialectical behavior therapy. Cognitive and Behavioral Practice, 21(3), 335–349.CrossRef
go back to reference Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44, 73–80.CrossRef Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44, 73–80.CrossRef
go back to reference Robbins, C. J. (2002). Dialectical behavior therapy for borderline personality disorder. Psychiatric Annals, 32, 608–616.CrossRef Robbins, C. J. (2002). Dialectical behavior therapy for borderline personality disorder. Psychiatric Annals, 32, 608–616.CrossRef
go back to reference Sempértegui, G. A., Karreman, A., Arntz, A., & Bekker, M. H. J. (2013). Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities. Clinical Psychology Review, 33, 426–447.PubMedCrossRef Sempértegui, G. A., Karreman, A., Arntz, A., & Bekker, M. H. J. (2013). Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities. Clinical Psychology Review, 33, 426–447.PubMedCrossRef
go back to reference Spinhoven, P., Geisen-Bloo, J., van Dyck, R., Kooiman, K., & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 75, 667–686.CrossRef Spinhoven, P., Geisen-Bloo, J., van Dyck, R., Kooiman, K., & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 75, 667–686.CrossRef
go back to reference Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11, 337–341.PubMedCrossRef Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11, 337–341.PubMedCrossRef
go back to reference van den Bosch, L. M. C., Koeter, M. W. J., Stijnen, T., Verheul, R., & van den Brink, W. (2005). Sustained efficacy of dialectical behavior therapy for borderline personality disorder. Behaviour Research and Therapy, 43, 1231–1241.PubMedCrossRef van den Bosch, L. M. C., Koeter, M. W. J., Stijnen, T., Verheul, R., & van den Brink, W. (2005). Sustained efficacy of dialectical behavior therapy for borderline personality disorder. Behaviour Research and Therapy, 43, 1231–1241.PubMedCrossRef
go back to reference van den Kieboom, P., & Jonker, D. (2012). Individual schema therapy. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice (pp. 311–322). Maklen: Wiley.CrossRef van den Kieboom, P., & Jonker, D. (2012). Individual schema therapy. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice (pp. 311–322). Maklen: Wiley.CrossRef
go back to reference Verheul, R., van den Bosch, L. M. C., Koeter, M. W. J., de Ridder, M. A. J., Stijnen, T., & van den Brink, W. (2003). Dialectical behavior therapy for women with borderline personality disorder. British Journal of Psychiatry, 182, 135–140.PubMedCrossRef Verheul, R., van den Bosch, L. M. C., Koeter, M. W. J., de Ridder, M. A. J., Stijnen, T., & van den Brink, W. (2003). Dialectical behavior therapy for women with borderline personality disorder. British Journal of Psychiatry, 182, 135–140.PubMedCrossRef
go back to reference Young, J. E., Klosko, J., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press. Young, J. E., Klosko, J., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press.
Metadata
Title
DBT and Schema Therapy for Borderline Personality Disorder: Mentalization as a Common Factor
Author
Stephanie Montgomery-Graham
Publication date
01-03-2016
Publisher
Springer US
Published in
Journal of Contemporary Psychotherapy / Issue 1/2016
Print ISSN: 0022-0116
Electronic ISSN: 1573-3564
DOI
https://doi.org/10.1007/s10879-015-9309-0

Other articles of this Issue 1/2016

Journal of Contemporary Psychotherapy 1/2016 Go to the issue