Anything to Stop the Pain - BPD and Non-BPs

I have discovered some resources on the web that may help those with BPD (and those nons who are in a relationship with someone with BPD). These resources are:

Mass General Hospital Mood Charting (thanks to Tides…)

DBT Skills Help:

Emotional Regulation Skills… from dbtselfhelp.com … from Borderline Personality From the Inside Out

Mindfulness Skills… from dbtselfhelp.com

Distress Tolerance Skills… from dbtselfhelp.com

Interpersonal Effectiveness Skills… from dbtselfhelp.com

DBT Family Skills Training… from middle-path.org

You can gain access to more DBT resources, to other pertinent files, and to advice from me and other group members by joining the ATSTP (Anything to Stop the Pain) Google Email List.

Bon Dobbs :: Sep.17.2008 :: Resources, DBT-FST, Mindfulness, DBT, Borderline Personality Disorder :: No Comments »

I have created a new version of my book, which fixes some typos and clarifies some points. I also was able to drop the price! It’s now $19.95, instead of $20.95. Since it got 3 pages shorter, I will be able to make a decent profit at the lower price. That price anticipates the cost it will have to be when I get it on Amazon (shortly).

Anyway, I suggest you check out the preview, and pick up a copy (shameless self-promotion). You can see the preview or buy the printed or downloadable version of When Love is Not Enough at Lulu.com.

If you are one of my readers with BPD, I would suggest getting a copy for anyone with whom you’d like to have an on-going relationship. Why? Because this book teaches a “Non-BP” the attitudes and tools to be more effective and more validating toward someone with BPD. The purpose is to rebuild the lines of communication. Like I said in a previous post (or comment), if I can quote myself here:

The BP/Non-BP relationship seems to me to be one of misunderstanding and miscommunication. I hope that I can help each learn the language of the other. And I agree most public awareness is important - BUT it has to be the right kind of awareness - not the “stay away from these people” or “these people are evil” kind.

Enjoy!

Bon Dobbs :: May.13.2008 :: Pain, Treatment, Boundaries, DBT-FST, Resources, Impulsiveness, Suicide, Shame, Mindfulness, Validation, Lying, Manipulation, Self-Injury, Emotions, Substance Abuse, Parenting, DBT :: No Comments »

At long last (about six months of work and 2 1/2 years of research, experimentation and practice), my first book When Love is Not Enough (WLINE) has been published!

This book is a quick-start, how-to guide for Non-BPs. It spells out step-by-step WHAT to do in your relationship with someone with Borderline Personality Disorder (or BPD traits) and HOW to do it. Unlike other books on this subject (you guys probably know which ones I’m talking about), WLINE tells EXACTLY what to do. Through the use of attitudes and tools, WLINE can help you build mastery over your relationship, regain control of your life and develop a deeper understanding of your BP loved one. I highly recommend it (if I do say so myself).

Although WLINE is fairly short (about 185 pages), it is packed full insights, advice and practical skills to help you understand your BP and to reestablish the lines of communication. If you are a Non-BP, WLINE is an essential resource. If you have BPD, I would recommend that you recommend WLINE to your family members, partners and friends (that is, if they are aware of your disorder). WLINE helps to build the bridge of understanding, serenity and effective communication between Nons and BPs.

It could be the most effective $20.95 you’ve ever spent.

If you’d like to buy a printed or eBook copy of WLINE, I am selling the book through Lulu:

Buy the Book!

A note on the title… I kicked around a number of titles before settling on this one. It is my feeling that most Nons don’t understand that, in addition to love, they have to develop ATTITUDES and SKILLS to be effective in their relationship with a BP. WLINE actually innumerates these attitudes and skills and provides detailed examples of how to apply them. With a commitment to the relationship, application of the concepts in the book and PRACTICE, a Non can learn what IS enough in their relationship with a BP.

Bon Dobbs :: May.09.2008 :: Pain, Treatment, Boundaries, Shame, DBT-FST, Blame, Best of, Impulsiveness, Suicide, Resources, Mindfulness, Biology, Validation, Lying, Manipulation, DBT, Self-Injury, Anger, Substance Abuse, Parenting, Emotions, Borderline Personality Disorder :: No Comments »

Some time ago on when I was on the Welcome to Oz (WTO) Internet group, I started posting about the benefits of DBT (Dialectical Behavior Therapy) for treatment of Borderline Personality Disorder (BPD). I have since left that group and started my own (the ATSTP Google Group). However, at WTO the discussion turned to DBT and its effectiveness (or lack thereof). There is one member of WTO who came down against all behavioral therapies. He posted the following message as a follow up to a message about DBT:

DBT is a behavioral therapy.

The idea is to learn a new behavior by repeated conditioning.

“Fake it until you make it”

It can be effective…Pavlov showed that a lower species can
learn through behavior therapy.

The question is then…is there a better way?

My thought…learn what you need before seeking a product….then buyer beware.

My reaction to this message was complete disbelief. I can only suppose that this guy (who is a Christian BTW) doesn’t believe that humans are in the category of “lower species” (probably because they have a soul and are made in the image of God, as opposed to animals). Of course, his alternative (or “better way”) was his personal belief in Transactional Analysis (popularized by “I’m OK, You’re OK” in the 70s) and the “inner child vs. inner adult” dynamic. That is garbage and hasn’t been shown to be effective with BPD at all.

So, how does DBT work?

DBT is a behavioral therapy. It teaches skills to modify a person’s behavior. Basically, the client begins to behave in a fashion that is different that the behavior that they previously exhibited. The purpose is behavioral modification. The new behavior becomes reconditioned over the old behavior. There person become “retrained.” One of the main problem with BPD is poor/ineffective behavior. If the behavior can be modified, the results of the behavior will not exist. In other words, if you choose NOT to cut yourself, you will not have to go to the hospital and get stitches. Interestingly, I find that this “theory” follows the Buddhist idea of “dependent arising” - which governs “conditioned existence.” That idea is formulated as follows:

When this is, that is.
From the arising of this comes the arising of that.
When this isn’t, that isn’t.
From the cessation of this comes the cessation of that.

See this Wikipedia entry for more information.

DBT functions in four general areas:

1. Core Mindfulness
2. Distress Tolerance
3. Emotional Regulation
4. Interpersonal Effectiveness

One of the differences between DBT and CBT is that DBT emphasizes acceptance of certain things versus complete change. Why? Here is one explanation from Marsha Linehan in the interview with David Van Nuys on “Wise Counsel”:

Dr. Marsha: All right. DBT or Dialectical Behavior Therapy is an integration of two major approaches. The first approach is the approach of cognitive-behavioral therapy.

Dr. David: OK.

Dr. Marsha: So, it contains within that sort of standard cognitive-behavioral therapy or behavior therapy. As behavior therapy changes and improves, DBT changes right along with behavior therapy, cognitive-behavioral therapy and improve.

Dr. David: OK.

Dr. Marsha: Then it balances a technology of change with the corresponding technology of acceptance. The acceptance is a derivative primarily from contemplative spiritual practices of Zen, primarily, but also other contemplative practices. Mindfulness, mindfulness-based practices and also validation of clients.

The acceptance end of the treatment is two-part. It’s a radical acceptance of a client as the client is at this moment by the therapist and teaching the client the same corresponding ability to radically accept. The reason it’s called “dialectical” is because it’s a synthesis of acceptance and change. Back and forth, a constant transaction interplay all the time.

Dr. David: Yes, when I first heard the term “dialectical, ” of course, I immediately thought of Hegel and Karl Marx and so I wasn’t quite sure of what the relationship was but they did talk about synthesis and antitheses and then the… Have I got that right?

Dr. Marsha: Yeah, it’s the theses…

Dr. David: Theses and antitheses.

Dr. Marsha: The antitheses and then the synthesis. The notion is, “everything contains within it its opposite, ” which really means that nothing exists really without an opposite of it. Even if you take something as mundane as a box, there couldn’t be a box if there wasn’t a non-box, a no-box, a not-box, because a box is very defined as it’s this so there’s obviously something that’s not a box.

Everything that exists has its opposite and Dialectics looks at the tension between; what exists and its opposite, or the theses and the antitheses or the opposite, and looks at the transaction between them, and that tension and that transaction which always brings about change.

Dr. David: In terms then of your therapeutic work and your therapy model, what are those two poles of tension?

Dr. Marsha: Oh, there are many. There are many, many, many poles. One of the most fundamental poles is that within every unwise act, there is some inherent wisdom. Taking heroin, which is long term, a dysfunctional, destructive behavior in our culture. Within there, is the wisdom of, “You feel better immediately.” So there is dysfunction and function always coexisting together.

The tension is finding the synthesis of; “Are there other ways for example?” or “How to radically accept that if one’s in great pain, getting out of pain is reasonable” while at the same time accepting that if one is in great pain, getting out of great pain by doing something that will continue to pain in the future is not reasonable. You’re always looking for a synthesis, where is a point that without rejecting the other side.

Here is another explanation of why acceptance was inserted into DBT by Marsha Linehan:

Dialectical Behavior Therapy represents an integration of two traditions: the behavior and cognitive-behavioral therapy tradition which is focused on developing technologies of change, and the mindfulness tradition that comes out of various spiritual practices including Zen Buddhism and contemplative Christian practices. At the start of her career, Dr. Linehan set out to develop a treatment for chronically suicidal patients and found that many of them were so overwhelmed by significant problems that it was not possible to address them all. Instead of focusing solely on how patients could change, what was required was also to help patients to better tolerate their circumstances. She was familiar with Christian contemplative spiritual practices that emphasized surrender to God, but sought out alternative teachers (e.g., a Zen Buddhist and a Benedictine Monk) who could teach her a “technology of acceptance” that would be more free of particular religious overtones. After taking several months to immerse herself in acceptance practices, she began the task of translating them into a language that behaviorists could accept and DBT was born. Though at first she thought the therapy was for suicidal people, in 1980 when the diagnosis of Borderline Personality Disorder was added to the DSM, she realized that it was really a therapy made for treating BPD and similar sorts of issues.

So, through applying behavioral change (from CBT) and acceptance (from Buddhist practice) DBT effectively treats BPD (and similar sorts of issues).

Bon Dobbs :: Apr.29.2008 :: Resources, Treatment, Validation, DBT, Borderline Personality Disorder :: 2 Comments »

Ruminating is the name I have given to the propensity of BPs to have “worry thoughts” about events and to turn them over-and-over in their mind. These events are usually in the past, although sometimes they can be about the possibly of future events linked with past events. Ruminating is an extended form of worry and anxiety in which the sufferer will examine events with an eye to find malignant intentions of others or judgments of themselves. Ruminating can lead to paranoia regarding the intentions of others.

When emotionally dysregulated a person with BPD is experiencing strong emotions in the moment, but the meaning of those emotions is almost always linked to something in the past that they are angry about or something in the future that they fear. This is an aspect of “ruminating.” It is a thought pattern that turns things over-and-over in their mind, looking for danger or embarrassment in situations. It is very “not in the moment.”

Often, the ruminating will extend over long periods of time, from hours to days, and will cause the person with BPD to look for hostile meanings to interactions with others. During this “search for meaning” the person with BPD may ask others about what they meant by certain actions or words while clearly implying that the BP believes that the other person is judging them or angry at them. Ruminating is a form of personalization and fear of judgment. The person with BPD will likely feel that situations which are not “about them” are, in fact, not only “about them” but are exclusively about how they feel about the situation.

Ruminating can lead to emotional reasoning – the situation in which a person’s feelings equal actual facts. If they feel that there is a malicious intent or a negative judgment in a given situation, there MUST be one and ruminating is a method of finding this negative and/or judgmental meaning. Ruminating most often occurs when a person with BPD either has time on their hands or is bored. It also can occur as the person with BPD tries and fails to fall asleep.
Ruminating can be combated with distraction with something the BP enjoys and engages their mind. Physical activities are a good salve for ruminating. Mindfulness, which is a component of DBT, also helps stop ruminating because the point of mindfulness is to be “in the moment” and not consider past or future events.

Bon Dobbs :: Mar.10.2008 :: Mindfulness, DBT, Borderline Personality Disorder :: 1 Comment »

Here is a link to a podcast interview with Dr. Marsha Linehan, the inventor of DBT. It is amazing. It has many technical, therapist-focused things in it, but it is definately worth listening to: Marsha Linehan Interview

You can read the transcript here. 

Bon Dobbs :: Feb.14.2008 :: Treatment, Mindfulness, DBT, Borderline Personality Disorder :: No Comments »

PUVAS is an acronym that comes from “Stop Walking on Eggshells” it means:

Pay attention
Understand fully
Validate emotions
Assert yourself
Shift responsibility where it belongs

Paying attention to what is being helps us avoid making assumptions.

Understanding what someone is trying to communicate may require seeking clarification so we don’t make assumptions.

Validating the emotional statements of the other person will pave the way for further smooth communications.

Asserting yourself is a form of setting boundaries and is a very important piece of the healthy communication process.

Basically, it is similiar to a combination of DEAR MAN and the GIVE skills from DBT. DEAR MAN is extremely helpful for have a conversation with someone who is emotional and to prevent from engaging your emotions yourself. DEAR MAN is:

DEAR (what to do):

Describe - describe the situation WITHOUT being judgmental. Just say what happened without making value judgments of the meaning of what happened or the intentions of the other person.

Express - express how you feel about it with an emotional word (such as sad, glad, mad or scared). Do not judge with this statement either.

Assert - assert what you’d like to happen in the future in this situation - what will not trigger the emotion you expressed.

Reinforce - reinforce means to back up the other person’s statement that moves toward what you wish. If the person says, “I’m sorry. I will try and not do that in the future.” You say, “I would really appreciate that. I don’t like feeling [whatever]. That would make me much happier.”

MAN (how to do it):

Mindfully - this is the “pay attention” part. You should be totally in the conversation and listen to the responses. However, you should ignore statements that are not addressing the issue at hand. You can also repeat your points agina until the other person fully understands what you are saying.

Appear Confident - even if you don’t feel confident discussing the point, you should appear confident. This prevents the other person from attacking or playing on your vulnerabilities.

Negiotiate - in cases where a “middle ground” makes sense, being willing to negiotiate is helpful because no one comes out the total “winner” or “loser”.

The GIVE skills are this:

Be Gentle - don’t attack.

Act Interested - listen carefully to what the other person says and the needs expressed.

Validate - use emotionally validation skills to “soften the blow”.

Easy Manner - use an easy manner and do not dominate the conversation.

Bon Dobbs :: Dec.03.2007 :: Resources, DBT-FST, DBT :: 1 Comment »

Below is a response I gave to a member with a girlfriend with maldapative BPD responses:

The purpose is really about HER and not you though. She thinks that
she is not lovable and is a bad person and is shameful inside. So when
you tell her or show her that she is not unlovable she feels a little
better. The big problem in this dynamic is the middle steps and the
assumption that she can only get validation from the outside. She
needs to learn a new way to solicit what she needs without using FOG.
She just knows no other way. A good way to do this is to have her use
DEAR MAN. Here is a link to the DEAR MAN skill:

http://www.dbtselfhelp.com/html/ie_handout_8.html

You will notice that it says: “Describe the situation when necessary -
sometimes it isn’t stick to the facts and no judgmental statements”

Clearly your girlfriend is NOT doing that. You might want to look into
the GIVE and FAST skills yourself:

http://www.dbtselfhelp.com/html/ie_handout_9.html
Look at “Be GENTLE” it says:

“People tend to respond to gentleness more than they do to harshness.
Avoid attacks, threats, and judgmental statements.
No attacks. This one is pretty clear. People won’t like you if you
threaten them, attack them or express much anger directly.
No threats. Don’t make statements like “I’ll kill myself if you….”
Tolerate a no to requests. Stay in the discussion even if it gets
painful, then exit gracefully.
No judging statements. No name calling, shoulds or implied put downs
in voice or manner. No guilt trips. ”

Clearly your girlfriend is not doing this either.

Here are the FAST skills:

http://www.dbtselfhelp.com/html/ie_handout_10.html

Read them, because I think your “giving in” feelings can be lessened
by using these. You usually use the GIVE and FAST skills together.

The assumption part is that YOU are required to make HER feel better.
In the long run, this is never lasting because you could always go
away, make another decision and go against her. That is the dynamic of
fear of abdonment IMO - it is that you will ultimately figure out that
she is a bad person (like she feels about herself) and leave her to
her on devices. All of the things that your girlfriend does boils down
to this pattern. She feels bad about herself, she feels ultimately
unlovable, she feels that the world is hostile and she feels that one
day she will be exposed for the bad person she is. That is why she
does the sex stuff, rages at you, uses FOG, etc. Her tactics are
extremely disordered but, up until now, they are effective for her (at
least for a short time). She is not getting to the root of her issues
though. SHE is the only one who can make herself feel better, not you
or anything else. Unfortunately, untreated she will continue along her
pattern, because she hasn’t addressed the core shame issues.

In the case of DBT, they work on behavior (healthy tactics) that,
after repetition, become conditioned. It could be said they don’t work
on the “root” either - they can’t “fix” her. What they can do is
replace “unskillful” tactics (FOG, cutting, threating suicide, etc.)
with “skillful” tactics (also know as “skillful means” from Buddhism).
The tactics they supply are: Mindfulness, Emotional Regulation,
Distress Tolerance and Interpersonal Effectiveness (of which DEAR MAN
is a skill). Anytime you reinforce an unskillful tactic, you make it
stronger. If you ignore it, it will subside and it is best and
quickest to subside if there is another skillful tactic (that you
reinforce) waiting in the wings.
 

Bon Dobbs :: Sep.11.2007 :: Best of, DBT :: No Comments »

From Marsha Linehan article on everything2:

Dr. Linehan’s education was based in the established field of cognitive-behavioral psychology, which the video refers to as `a technology of change’, focused on changing behavior through learning and experience. However, while treating borderlines in the early 1980s, Dr. Linehan decided that the cognitive-behavioral model that she was working with was insufficient, and that she needed to incorporate an element she calls `radical acceptance’. Dr. Linehan makes clear in her videotaped presentation that `acceptance’ was a real buzzword in psychology around the time that she started to promote DBT, but she maintains that her idea of `radical acceptance’ is different. When most psychologists talk about `acceptance’, she states, they mean `acceptance as change’, accepting the client in order to create a change, accepting the client’s unfulfilled potential instead of the client’s actual being. Dr. Linehan believed that for her borderline clients to get well, therapy needed to involved a level of acceptance that would go above and beyond `acceptance as change’. For inspiration, she turned to Eastern psychology as translated into Zen Buddhist meditation practice. However, fearing that her colleagues due to their cultural biases would not take her work seriously if she were to call it `Zen Behavior Therapy’, Dr. Linehan also researched Western philosophical traditions. There she discovered dialectics, the approach in which thesis paired with antithesis brings synthesis. Dialectics seemed appropriately seasoned for the Western palates of the practitioners who would be reading her work, and thus, DBT was born.

http://www.everything2.com/index.pl?node_id=1688345

bon :: Jun.09.2007 :: DBT :: No Comments »

This is a portion of a message that I posted on WTO many months ago. I will probably cut some more out of it and post it here, because I think it is important. I have removed some of the details and responses to other messages that would not make sense here:

I think people often make mistakes in “self-diagnosis”. For all I know, half the people (or more) viewing these messages are not dealing with BPD at all, but instead something else. That is one of the reasons that a couple of months ago, I specifically asked a mother on this board whether her daughter was diagnosed with BPD and how old the daughter was – because the behavior that she described could be attributed to many “disorders” (including the disorder of being a teenager).

There is a movement within the psychiatric community to change the name of BPD. Some also want BPD to be classified as an Axis I disorder. So, it could be that “borderline personality disorder” will not exist anymore and BPD will not be a “personality” disorder anymore. The point of saying this is that I think the traits of which you speak are shared among many different disorders, personality or otherwise.

In the CBT community, one of the things they talk about is “cognitive distortions” - basically thinking in a way that doesn’t match the “objective” facts. Here is a snip from “The Feeling Good Handbook” about cognitive distortions:

All-or-nothing thinking: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.

Overgeneralization: You see a single negative event as a never–ending pattern of defeat.

Mental filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

Disqualifying the positive: You reject positive experiences by insisting they “don’t count” for some reason or other. You maintain a negative belief that is contradicted by your everyday experiences.

Jumping to conclusions: You make a negative interpretation even
though there are no definite facts that convincingly support your
conclusion.

Mind reading: You arbitrarily conclude that someone is reacting negatively to you and don’t bother to check it out.

The Fortune Teller Error: You anticipate that things will turn out badly and feel convinced that your prediction is an already-established fact.

Magnification (catastrophizing) or minimization: You exaggerate the
importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow’s imperfections). This is also called the “binocular trick.”

Emotional reasoning: You assume that your negative emotions necessarily reflect the way things really are: “I feel it, therefore it must be true.”

Should statements: You try to motivate yourself with shoulds and
shouldn’ts, as if you had to be whipped and punished before you
could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct should
statements toward others, you feel anger, frustration, and resentment.

Labeling and mislabeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him, “He’s a damn louse.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.

Personalization: You see yourself as the cause of some negative external event for which, in fact, you were not primarily responsible.

Now, at times everyone, disordered or not, does some of these
things. In the case of BPD, many of these distortion can into play.
But these distortions are shared with other disorders and with “normal” thinking.

bon :: Jun.07.2007 :: DBT :: 1 Comment »