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Why I called the book “When Hope is Not Enough”

In 2007, I wrote the first edition of When Hope is Not Enough. When considering the title, I landed on this one because it rings true to a person who is a supporter and loved one of a person who meets the criteria of Borderline Personality Disorder (BPD). Back when I wrote the book, there were very few books on the subject (only about 2-3) and the most popular of the books – the one recommended by therapist across my country (US) and which had sold hundreds of thousands of copies – had been ineffective in my life. I just found that the skills offered in that book worked at first and then stopped working abruptly.

When I took at Dialectical Behavior Therapy Family Skills Training (DBT-FST – yes, I know there’s way too many acronyms in this area), I found a new set of skills that provided some additional hope – hope which up until then was absent from my life. Yet, that hope, as fresh as it was, was not enough to heal the hurt and navigate the difficult relationships in my life. Instead, I found I had to refine the skills to make them easier to learn. More importantly, I had to master the skills and actually apply them to my life. Skillful means were more important than hope.

I updated the book in 2015 with a second edition to communicate more skills that I’d picked up in the intervening years and to “structure” the skills to make them even easier to master. I am posting this today because it’s been 10 years since I started writing the book and, in those 10 years, the skills contained therein has radically improved my life and my relationships.

I hope that those skills can help you in your relationships as well.

Bon

Dialectical Behaviour Therapy (DBT) and the Buddhist Philosophy

DBT deals with intense and labile emotions. There is a connection between mindfulness and emotion regulation. Mindfulness facilitates adaptive emotion regulation.

Dialectical Behaviour Therapy (DBT) and the Buddhist Philosophy

Posted on March 20th, 2017
Ruwan M Jayatunge M.D.

Dialectical behavior therapy (DBT) is a modified form of cognitive behavioral therapy (CBT) that was developed in late 1970s by Marsha M. Linehan a psychology researcher at the University of Washington (Linehan, 1993). DBT is an empirically supported treatment for suicidal individuals (Linehan et al., 2015). It can be adapted to treat borderline personality disorder patients with comorbid substance-abuse disorder (Koerner & Linehan, 2000) and depressed elderly clients with personality disorders (Lynch et al., 2003). DBT addresses deficits in emotion regulation, distress tolerance and interpersonal relationship.

The patients with borderline personality disorder have faulty schemas and splitting in the patient’s relations to others. They have frantic efforts to avoid real or imagined abandonment. Often they have pattern of unstable and intense interpersonal relationships, impulsivity, emotional instability and recurrent suicidal behavior. In addition they are impacted by chronic feelings of emptiness. Borderline personality disorder is treated with psychotherapy and medication. Dialectical Behavior Therapy and Buddhist Psychotherapy are effective in treating borderline personality disorder.

The basis for DBT is stemming from the mindfulness practice of the Buddhist teachings and the philosophy of dialectics. Mindfulness according to the Buddhism is bare attention a sort of non-judgmental, non-discursive attending to the moment-to-moment flow of consciousness (Sharf, 2015). Mindfulness meditation has three overarching purposes: knowing the mind; training the mind; and freeing the mind (Fronsdal, 2006). As described by Palmer (2002) developing the capacity for being mindful and living in the moment allows a greater potential for feeling appropriately in charge of the self.

DBT combines mindful awareness largely derived from Buddhist meditative practice. Kirmayer (2015) concluded that Mindfulness meditation and other techniques drawn from Buddhism have increasingly been integrated into forms of psycho-therapeutic intervention. Since the 1990s, mindfulness meditation has been applied to multiple mental and physical health conditions, and has received much attention in psychological research (Tang & Posner, 2013). Mindfulness has been described as a practice of learning to focus attention on moment-by moment experience with an attitude of curiosity, openness, and acceptance (Marchand, 2012) Schmidt (2004) states that mindfulness is strongly related to compassion, and it is compassion that serves as a source for all healing intentionality. Both mindfulness and self-compassion involve promoting an attitude of curiosity and non-judgment towards one’s experiences (Raab, 2014). The core mindfulness skills (focus, compassion, curiosity, inner calm, balance, and awareness) lead to serenity.

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Selena Gomez on Instagram Fatigue, Good Mental Health, and Stepping Back From the Limelight

“DBT has completely changed my life,” she says. “I wish more people would talk about therapy. We girls, we’re taught to be almost too resilient, to be strong and sexy and cool and laid-back, the girl who’s down. We also need to feel allowed to fall apart.”

Selena Gomez on Instagram Fatigue, Good Mental Health, and Stepping Back From the Limelight
MARCH 16, 2017 7:01 AM

by ROB HASKELL

On an unusually wet and windy evening in Los Angeles, Selena Gomez shows up at my door with a heavy bag of groceries. We’ve decided that tonight’s dinner will be a sort of tribute to the after-church Sunday barbecues she remembers from her Texan childhood. I already have chicken simmering in green salsa, poblano peppers blackening on the flames of the stove, and red cabbage wilting in a puddle of lime juice. All we need are Gomez’s famous cheesy potatoes—so bad they’re good, she promises. She sets down her Givenchy purse and brings up, in gaudy succession, a frozen package of Giant Eagle Potatoes O’Brien, a can of Campbell’s Cream of Chicken soup, a bag of shredded “Mexican cheese,” and a squat plastic canister of French’s Crispy Fried Onions.

“I bet you didn’t think we were going to get this real,” she says, and when I tell her that real isn’t the first word that springs to mind when faced with these ingredients, she responds with the booming battle-ax laugh that offers a foretaste of Gomez’s many enchanting incongruities.

But real is precisely what I was expecting from the 24-year-old Selena, just as her 110 million Instagram followers (Selenators, as they’re known) have come to expect it. Of course, celebrity’s old codes are long gone, MGM’s untouchable eggshell glamour having given way to the “They’re Just Like Us!” era of documented trips to the gas station and cellulite captured by telephoto lenses. But Gomez and her ilk have gone further still, using their smartphones to generate a stardom that seems to say not merely “I’m just like you” but “I am you.”

“People so badly wanted me to be authentic,” she says, laying a tortilla in sizzling oil, “and when that happened, finally, it was a huge release. I’m not different from what I put out there. I’ve been very vulnerable with my fans, and sometimes I say things I shouldn’t. But I have to be honest with them. I feel that’s a huge part of why I’m where I am.” Gomez traces her shift toward the unfiltered back to a song she released in 2014 called “The Heart Wants What It Wants,” a ballad about loving a guy she knows is bad news.

She sees her shrink five days a week and has become a passionate advocate of Dialectical Behavior Therapy, a technique developed to treat borderline personality disorder that is now used more broadly, with its emphasis on improving communication, regulating emotions, and incorporating mindfulness practices. “DBT has completely changed my life,” she says. “I wish more people would talk about therapy. We girls, we’re taught to be almost too resilient, to be strong and sexy and cool and laid-back, the girl who’s down. We also need to feel allowed to fall apart.”

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Alan Fruzzetti speaks at McLean on Family Skills and Family Interactions with BPD

Professor who developed therapy for uncurable mental illnesses wins 2017 Grawemeyer Award in Psychology

The institute’s mission is to transfer the principles of dialectical behavior therapy to more practitioners and to aid current practitioners with the burnout that can come with working with heard-to-treat patients.

Professor who developed therapy for ‘uncurable’ mental illnesses wins 2017 Grawemeyer Award in Psychology
By MELISSA CHIPMAN | December 3, 2016 6:00 am

Marsha Linehan, director of University of Washington’s Behavioral Research and Therapy Clinics, Center for Behavioral Technology, has been selected as the 2017 Grawemeyer Award winner in Psychology.

Disorders like borderline personality and suicidal ideation have long been considered nearly impossible to treat, but Linehan has developed dialectical behavior therapy, which has shown positive effects during studies. The treatment is a type of cognitive behavioral therapy that teaches four skills to clients: mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation.

“In addition to being considered the state-of-the-art treatment for chronically suicidal individuals, dialectical behavior therapy has been found to be effective for other behavioral disorders, including eating disorders, addiction, anxiety related disorders, post-traumatic stress disorder and depression,” said Professor Woody Petry, award director, in a news release.

Linehan is a Zen master and is credited for bringing Zen-informed practices, like “being fully present in the moment,” into mainstream psychotherapy.

“At a young age, I vowed to get myself out of hell and then to go back and get others out,” said Linehan, who acknowledged publicly in 2011 her own longtime struggle with suicidal ideation and behaviors similar to those found in borderline personality disorder.

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CBT most effective treatment for repeat self-harm

CBT seems to be effective in patients after self-harm. Dialectical behavior therapy did not reduce the proportion of patients repeating self-harm but did reduce the frequency of self-harm.

CBT most effective treatment for repeat self-harm
Hawton K, et al. Lancet Psychiatry. 2016;doi:10.1016/S2215-0366(16)30070-0.

Recent findings showed cognitive behavioral therapy after self-harm was effective while dialectical behavior therapy did not reduce repeat self-harm but reduced frequency of self-harm.

“Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly in young adults aged 15 to 35 years, often repeated, and strongly associated with suicide. Effective aftercare of individuals who self-harm is therefore important,” Keith Hawton, FMedSci, of the University of Oxford, and colleagues wrote.

To assess efficacy of psychosocial interventions for self-harm in adults, researchers conducted a Cochrane systematic review and meta-analysis of 29 randomized controlled trials with three independent trials of the same intervention for adults with recent self-harm.

http://www.healio.com/psychiatry/suicide/news/online/%7Ba5986951-5515-4dee-802a-a0ecbf453f3a%7D/cbt-most-effective-treatment-for-repeat-self-harm