What Do You Think of DBT? * Dr. Leland Heller is a family physician who has treated thousands of patients with the Borderline Personality Disorder. BPD is a medical disorder and that this and other Biological Unhappiness disorders are treatable with medication first and then by retraining the brain * Biological Unhappiness * BiologicalUnhappiness.com

WHAT DO YOU THINK OF DBT? What Do You Think of DBT? Ask The Doctor Dr. Leland Heller Biological Unhappiness What Do You Think of DBT? What Do You Think of DBT? WHAT DO YOU THINK OF DBT? What Do You Think of DBT? Question: I am a therapist working for Devereux of Florida. I have been intensively trained in Dialectical Behavioral Therapy, which was designed by Marsha Linehan to work with Borderline Personality Disorders. Have you had any experience with this type of counseling? If so, how do you rate it? My understanding is that the literature of the day speaks volumes to how great it works, but I did not see it mentioned on your website. Dr. Heller’s Answer: I have enormous respect for what Marsha Linehan has accomplished, and I admire her work and her efforts. Although the study was not truly blinded for the absence of psychotropic medications, with DBT she was the first to show significant quantifiable improvement from psychological counseling in treating borderlines, with a 50% reduction in parasuicidal behavior (self-mutilation and suicide attempts). Dialectical Behavioral Therapy (DBT) has shown effectiveness in substance abuse and other psychiatric disorders as well.  Based on a Zen model (Dr. Linehan’s description), DBT principles can be used by any therapist, although the landmark BPD study used multiple therapists working as a team.  I’ve had some patients go through DBT programs and rated it very highly, particularly the reframing skills they learned.  I’ve also have a few who believed it didn’t help them. There are many references to DBT on my website, primarily in the “Ask the Doctor” and “Medline research on the borderline personality disorder” sections. I believe all borderlines need counseling, although a significant percentage can’t afford it.  Most BPD patients have told me that counseling was of minimal or no benefit until their medications were right. Once successfully treated medically, most borderlines have a difficult time finding a good therapist.  They need a non-judgmental, knowledgeable, optimistic, compassionate, dedicated, strong human being who is willing to be truthful and unwilling to be manipulated – whatever their specific school of therapy.  The focus needs to be on now and the future, with minimal emphasis on the past.  I congratulate you on your training, and hope you’re one of those people.  There are many borderlines out there who desperately need good therapists. To the best of my knowledge there have been no head to head studies of one form of psychotherapy versus another for BPD treatment, with or without medications.  Most research that I’ve encountered advocates some form of cognitive/behavioral therapy.  I am not trained as a psychotherapist. Dr. Gunderson from Harvard advocates psychodynamic psychotherapy, but only by an extremely well trained therapist.  He believes this form of psychotherapy “has been a serious disservice” to BPD patients when the therapist isn’t adequately trained or experienced. Psychoanalysis doesn’t work and usually makes borderlines worse, particularly those who experienced childhood abuse.  Many patients have told me this, and there is evidence for this conclusion in the literature.  Rehashing the past usually makes borderlines worse. Since I’m a strong believer in the BPD medical model, my preference is to get the medically treatable symptoms treated first.  I then emphasize recognition and medical treatment of dysphoric episodes, so that raging and self-destructive behaviors can be prevented, reduced or controlled.  Dysphoric episodes cause most of the damage and need to be treated aggressively.  All it takes is one bad episode to destroy a marriage or a life. I’ve worked for over 15 years with therapist Mary Sales.  She focuses on helping borderlines recognize when they need their as needed medications for dysphoria, affirmations, relaxation techniques, and cognitive/behavioral approaches.  I saw significant similarities to Ms. Sales’ approach when reading Marsha Linehan’s descriptions of how she interacts with patients. I’m also a big believer in motivational and “success” techniques that are used in the business and personal growth arena, particularly Zig Ziglar’s work.  Learning how to be a success in every area of life is a critical process for recovery from the BPD.  Borderlines often need training in social and life skills, particularly those who have been abused and/or those with ADHD.  Borderlines have to heal mind, body and spirit.  They need to “retrain the brain.”  There’s an old saying: no executive on his death bed ever said “I wish I’d spent more time at the office.”  The BPD usually deprives them of healthy love relationships.  I believe that eventually being able to have those kind of love relationships is an important goal of treatment. I’ve communicated with therapists, patients, family members and clinicians about DBT.  This communication combined with the medical literature from Medline (National Library of Medicine) and the books I’ve read (such as “Borderline Personal Disorder” – edited by Mary Zanarini, PhD from Harvard) shows that DBT can be helpful for many people, sometimes extraordinarily helpful.  Your statement “the literature of the day speaks volumes to how great it works” overstates what the literature actually shows, however.  Most DBT studies are short term, and the landmark study only showed a 50% reduction in self-mutilation and suicide attempts. I got involved treating borderlines because psychiatrists wouldn’t treat my patients, and I was having success – particularly after reading the medical literature and the conversations I had with NIMH researcher (and former acting director) Dr. Rex Cowdry.  I see 4-6 new BPD patients per week and probably 5-8 follow ups per day as part of my regular practice.  I’ve treated thousands of individuals with the BPD.  With the correct medications, I expect all unprovoked mood swings, chronic anger, chronic irritability, and emptiness to be completely gone.  I don’t consider any self-mutilation episodes to be acceptable.  Mary Sales and I have learned a lot over the years, and I believe a combination of what we’ve learned with many aspects of DBT could be sensational. What Do You Think of DBT? 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Ask the Doctor Home What Do You Think of DBT? MENU: What Do You Think of DBT? 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You can watch and listen to Dr. Heller in the comfort and convenience of your own home.  Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. What Do You Think of DBT? “Biological Unhappiness” “Open this book and it will open your mind.  By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery.  “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World. What Do You Think of DBT?    What Do You Think of DBT? Dr. Leland Heller  Dyslimbia Press, Inc. 1713 US Hwy 441 N, Suite E • Okeechobee, FL  34972 • 863-467-8771 Email: Hours: M-Thu. 8:30AM-5PMFri. 8:30AM-12 Noon*(*During November through April, the office is open until 3PM on Fridays.) All material not explicitly credited otherwise is copyrighted © 1999-2011 Dr. Leland Heller. All Rights Reserved.  May not be duplicated without the permission of Dr. Leland Heller or Dyslimbia Press. Biological Unhappiness™, BiologicalUnhappiness.com™, & Dyslimbia Press™ are trademarks of Dr. Leland HellerDesigned and/or hosted by the webmasters at: US-Webmasters.com (TM) Start here to find it FAST!(TM)