Dynamic Deconstructive Psychotherapy (DDP) is a 12-month treatment for borderline personality disorder and other complex behavior problems, such as alcohol or drug dependence, self-harm, eating disorders, and recurrent suicide attempts. DDP combines elements of translational neuroscience, object relations theory, and deconstruction philosophy in an effort to help clients heal from a negative self-image and maladaptive processing of emotionally charged experiences. Neuroscience research suggests that individuals having complex behavior problems deactivate the regions of the brain responsible for verbalizing emotional experiences, attaining a sense of self, and differentiating self from other, and instead activate the regions of the brain contributing to hyperarousal and impulsivity.
There are two underpinning mechanisms of BPD that are central to the DDP approach:
- Embedded sense of badness
- Aberrant processing of emotional experiences
DDP helps clients connect with their experiences and develop authentic and fulfilling connections with others. During weekly, 1-hour individually adapted sessions, clients discuss recent interpersonal experiences and label their emotions, reflect upon their experiences in increasingly integrative, accepting, and realistic ways, and learn how to develop close relationships with others while maintaining their own sense of self.
In research studies, DDP has been shown to improve symptoms of borderline personality disorder, dissociation, and depression, to lessen complex behavioral problems, such as suicide attempts, self-harm, and substance misuse, to decrease institutional care, and to improve functioning. DDP has been shown to be more effective for the treatment of borderline personality disorder than other common approaches. Approximately 90% of clients who undergo a full year of treatment will achieve clinically meaningful improvement, and recovery usually progresses after treatment ends. Because of these findings, the U.S. federal agency SAMHSA has included DDP on its National Registry of Evidence-Based Programs and Practices.
The Neurobiology of BPD (taken from Gregory, 2014)
The aetiology of BPD is controversial, and the following explanation offered by professor Robert Gregory is only one of a number of views. We offer this perspective because of it’s foundation in neuroscience.
- The Emotion Processing Hypothesis postulates that BPD is a disorder of emotion processing, rather than emotion regulation.
- Due to interpersonal stress, BPD does not have the normal processing of emotion that is lateral to medial movement of information through the prefrontal cortex (PFC) and integration with cortical and subcortical networks.
- BPD demonstrates less activation of PFC and greater limbic system activation (ventral striatum, amygdala) and less integration of cortical and subcortical networks.
- BPD may process emotional experiences through subcortical limbic systems rather than then usual verbal/symbolic processing through lateral to medial flow of information through the temporal lobe and PFC.
- Emotional processing regions such as the amygdala, hippocampus, anterior cingulate gyrus and medial prefrontal cortex have shown to be in deficit in BPD.
- BPD display greater activation of limbic structures (amygdala, hippocampus, ventral striatum) when responding to emotional stimuli.
- Deactivation of anterior cingulate gyrus and the medial prefrontal cortex when exposed to strong emotional stimuli, as well as decoupling of limbic and cortical networks – resulting in a difficulty to encode emotional experience into language and identifying, labelling and acknowledging emotions.
- BPD have reportedly low levels of endogenous opioids and are less able to turn off the PANIC system, described by Panksepp, when hyperaroused by emotional stimuli. To alleviate the PANIC system BPD may use self-destructive or hostile actions, or self-soothing coping mechanisms to activate their ventral stratal region (the PLEASURE system according to Panksepp) which dampens amygdala activity.
- In summary, people with BPD utilise limbic solutions to interpersonal problems.
- More severe cases of BPD may not only have emotion processing network deficits but diminished baseline tonic activity in certain brain regions.
Gregory, R. J. (2014). Remediation for treatment-resistant borderline personality disorder: Manual of dynamic deconstructive psychotherapy. Syracuse, NY: SUNY Upstate Medical University. Downloaded from http://www.upstate.edu/psych/pdf/education/psychotherapy/ddp_manual.pdf