Enhancing Self-Esteem in Patients with Borderline Personality Disorder Through Dialectical Behavior Therapy-informed Music Therapy - Findings from a Mixed-Methods Study

Background: Low and unstable self-esteem, as well as identity disturbance, are central features of borderline personality disorder (BPD). Although self-esteem and identity are also considered important aspects of music therapy, their significance in the context of music therapy within the framework of Dialectical Behavior Therapy (DBT) has hardly been investigated to date. Aims: This study investigates whether elements of the German-language DBT skills training module on self-esteem are reflected in music therapy and whether music therapy can contribute to enhancing self-esteem in patients with BPD. Method: Using an exploratory mixed-methods design based on the Convergent Design, patients, DBT co-therapists, and music therapists were interviewed. The qualitative data were analyzed using content-structuring qualitative content analysis. For the quantitative data, parametric tests were used and, in cases of statistical significance, verified with non-parametric tests. Results: The results show overlaps between the DBT self-esteem skills training module and music therapy. In particular, the experience of one's own person, increased self-esteem, and self-expression were described as relevant aspects of DBT-informed music therapy. Patients reported increased self-assurance, self-confidence, and positive self-evaluations. 78.3% of respondents (N=23) perceived music therapy as contributing to self-esteem. The presence of self-esteem-related content was significantly associated with a higher rating of how helpful music therapy was perceived to be (U=2.0; Z=-3.255; p<.001). Conclusion: The study suggests that self-esteem-related content constitutes an important component of DBT-informed music therapy. Music therapy offers, in particular, opportunities to promote self-perception, self-efficacy, and self-disclosure, thereby contributing to the enhancement of self-esteem in patients with BPD. Further research is needed to investigate these relationships and the effectiveness of corresponding music therapy interventions.