Evidence-based treatments for BPD include Dialectical Behavior Therapy (DBT), Mentalization-based treatment (MBT), schema-focused therapy (SFT), and transference-focused psychotherapy (TFP).

DBT has a strong research backing for being effective with BPD, including at least 56 randomized controlled trials (RCTs) demonstrating DBT's efficacy.  RCTs are the gold standard to prove the efficacy of a treatment and DBT has more RCTs than a lot of other evidence-based treatments, even outside the realm of treating BPD.  Comprehensive DBT has four modes of treatment:

1. Individual therapy where the client meets one-on-one with the therapist.  The client will usually fill out a daily diary card where they're tracking their emotions, behaviors, and urges.  The therapist and client use a personalized target hierarchy to help the client overcome the barriers to their goals.
2. The DBT skills training group is usually 2-2.5 hours and meets weekly for approximately six months.  That's where you learn the core skills.  We have data that shows that the DBT skills are a huge part of what makes DBT effective.  In DBT skills training, clients learn the four DBT skills modules:
   • Mindfulness, where people learn how to take more control of their minds and be more present.  For anyone in the world, not just people with BPD, we're often either thinking of the past or focused on the future, and we're not actually here now.  Mindfulness helps us to be more aware and present because we can handle just this one moment. When we're thinking about all the stuff that can happen in the future, that causes more suffering.  We can handle right now and when we have a good grasp on mindfulness, we can actually use the skills better.
   • The distress tolerance module is all about how to tolerate the moment.  If you can't solve a problem right then, you need to find a way to get through it, so you learn quick skills that will get you through the situation without making things worse.
   • The emotion regulation module helps you learn more about your emotions: how to change your emotions, how to stop your emotions before they start, and what makes you more vulnerable to your emotions.
   • Interpersonal effectiveness teaches you how to be effective with other people, including learning how to figure out and prioritize your goals in interpersonal situations, how to ask for something effectively or say no, how to maintain good relationships, and how to maintain your self-respect.
3. 24/7 DBT phone coaching is a unique aspect of DBT that you don't see in other treatments.  The idea is, we're asking you to stop self-harm and we're going to give you skills, but it's going to take some time.  It would be silly to ask someone to stop problematic behaviors without giving them something in return.  We truly believe that people need to learn how to use skills in all contexts of their lives.  Therapists give clients the opportunity to call at any time for help using skills and that can really help move the therapy forward; it's a critical part.
4. The DBT therapist consultation team is another unique aspect of DBT.  Several DBT therapists get together every week to support each other in providing the treatment and help each other stay adherent to the treatment model.  We really consider ourselves to be a community of therapists treating a community of clients, so a DBT client who is in adherent, comprehensive DBT is not only working with one clinician, they actually have a team of clinicians putting their experience together to help them.