1. Yangsan Hospital Mingeol Kim, M.D., ACT.
Dialectical Behavior Therapy for Individuals with Borderline Personality Disorder and Substance Dependence
Yangsan Hospital
Mingeol Kim, M.D., ACT.

2. Modification of CBT for BPD

3. Comparing DBT to CBT Acceptance and Validation – Eastern Zen Practice
Treating Therapy interfering behaviors both client and therapist – Psychodynamic concept of Tr., CTr.
Therapeutic Relationship – Attachment Theory
Dialectic Process – Dialectic Philosophy

4. Difficulties to Treat
Rate of suicide and suicide attempts already high among the individuals with…
Borderline Personality Disorder (BPD)
Substance Use Disorder (SUD)
BPD + SUD

5. Comorbidity Prevalence
Substance Use Disorders(SUDs) commonly co-occurred with….
SUD & Mood Disorder - ICBT
SUD & Borderline Personality Disorder(BPD)
- DBT Modifications for SUD
Mood Disorder & Antisocial Personality Disorder
– most high comorbidity prevalence
- Anger Management Porgram

6. Borderline PD
A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness
Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

7. Anti-Social PD
A) There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following: failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
impulsiveness or failure to plan ahead;
irritability and aggressiveness, as indicated by repeated physical fights or assaults;
reckless disregard for safety of self or others;
consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another;
B) The individual is at least age 18 years.
C) There is evidence of conduct disorder with onset before age 15 years.
D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.

8. Structure of DBT DBT Skill Training Group DBT Individual Therapy
DBT Team Meeting (Therapist Consultation Team)
Telephone Coaching ( 24 hours – Office hour)
Homework – Diary Card

9. DBT Skill Training Group - 3 Modules
1. Interpersonal Effectiveness
2. Emotion Regulation
3. Distress Tolerance
4. Clean Mind (for BPD + SUD)

10. DBT Skill Training Group - Hierachy
Mindfulness
Life Threatening Behavior
Therapy Interfering Behavior
Quality of Life Behavior
New Agenda
Skill Class

11. Diary Card I

12. Diary Card II

13. Dialectical Abstinence
Synthesis of
Unrelenting insistence on total Abstinence before any illicit drug use.
Radical acceptance, nonjudgmental problem solving, and effective relapse prevention after use.
Balanced position

14. Path to Clear Mind Decrease substance abuse
Decrease physical discomfort
Decrease urges, cravings, and temptations to use drugs
Decrease options to use drugs
Decrease contact with cues for drug use
Increase reinforcement of “Clear Mind” behaviors