Addressing treatment motivation in borderline personality disorder: Rationale for incorporating values-based exercises into dialectical behavior therapy

Dialectical behavior therapy (DBT) is one empirically supported treatment for individuals diagnosed with borderline personality disorder (BPD), and has demonstrated efficacy in reducing distress and behaviors that are often utilized by those with BPD to manage that distress. Treatment dropout rates of those with BPD receiving DBT are high, with serious deleterious effects. Increasing motivation for treatment, including treatment adherence, homework completion and skill use, in those with BPD is a critical factor in improving daily functioning and overall quality of life for these individuals. As described in ACT, values work in the service of increasing values-consistent behavior, or valued or committed action, may be one way to improve treatment motivation both in-session and out of session. This paper outlines the theoretical rationale for adding values components to existing DBT skills, including suggestions for where and how values work might be done in this population and potential difficulties. © 2013 Springer Science+Business Media