This chapter focuses on the use of mindfulness strategies in the treatment of borderline personality disorder (BPD), the rationale for their use with clients with BPD, difference among them and other mindfulness-based treatments, and possible mechanisms of efficacy. Dialectical behavior therapy (DBT) is a comprehensive psychosocial treatment that was first developed for suicidal individuals diagnosed with BPD. A number of randomized controlled trials have documented the efficacy of DBT for BPD. The primary dialectic that faces the DBT therapist is between complete acceptance of the client as he or she is in the current moment and an unwavering dedication to behavioral change and building a life worth living. The change procedures consist of systematic and repeated behavioral analyses of dysfunctional response chains, training in behavioral skills, contingency management in order to weaken or suppress disordered responses and to strengthen skillful responses, and cognitive restructuring. While the data on the overall efficacy of DBT are promising, the degree to which mindfulness is an important mechanism remains an important area of empirical inquiry. However, it is believed that the extant data on the usefulness of mindfulness with other problems, combined with clinical experience, makes a strong case for mindfulness as a crucial element in the successful treatment of BPD.
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