Category Archives: Adult Mental Health

DBT and Borderline Personality Disorder

Posted March 12, 2020

DBT and Borderline Personality Disorder

What Is Borderline Personality Disorder (BPD)?

Borderline Personality Disorder (BPD) is a mental health diagnosis that involves difficulty regulating emotions. When someone with BPD experiences intense stress over an extended period, it can be tough for that person to de-escalate to a “normal” level of functioning. This feeling may express itself as self-harm, unhealthy relationships, and impulsivity. Individuals diagnosed with BPD are 75% female, though professionals suspect that men are often misdiagnosed.

What Are the Symptoms of Borderline Personality Disorder?

Characteristics of borderline personality disorder vary by the individual, but some are more usual than others, according to the Diagnostic and Statistical Manual (DSM). Here are some of the most common symptoms of BPD:

  • Extreme mood swings
  • Feelings of instability and insecurity
  • Desperation to avoid abandonment, either real or imagined
  • Unstable relationships that alternate between intense feelings of love and hatred
  • Distorted and unstable self-image
  • Impulsive and dangerous behaviors

What Are the Causes of Borderline Personality Disorder?

The definitive causes of BPD are not thoroughly understood, but experts agree that it’s probably multifactorial. Genetics likely play a role, as those with a close relative with BPD are more likely to be diagnosed themselves. Environmental factors, especially childhood trauma and being raised in an invalidating environment, seem to contribute to the development of BPD. Individuals with BPD may have neurological differences in the parts of the brain that control emotional regulation.

Because of the multiple factors that contribute to BPD, there is no single test to diagnose it or one single indicative symptom. Mental health professionals use a comprehensive assessment that includes a complete history of symptoms and functioning across areas.

How Can Dialectical Behavioral Therapy Help BPD?

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral treatment initially designed to treat those diagnosed with borderline personality disorder (BPD). It focuses on thoughts, beliefs, behaviors, and actions to reduce symptoms and enhance life functioning. DBT was the first form of psychotherapy that has demonstrated effectiveness in treating BPD through controlled clinical trials. It is now the preferred first-line treatment for this disorder with a broad base of evidence and documented success rates in reducing adverse outcomes such as these:

  • Psychiatric hospitalizations
  • Hospital stays
  • Substance abuse
  • Self-injury
  • Suicidal behavior
  • Severity of symptoms

While DBT cannot cure BPD, it is proven effective for reducing symptoms and helping with the management of them. Research finds that up to 77% of people no longer met the criteria for BPD after one year of treatment with DBT.

What Can I Expect from DBT?

DBT usually involves a combination of group and individual sessions, classroom training, and phone coaching. Patients track symptoms and the use of their new skills daily while receiving services.

The skills training portion of DBT includes four types of skills.

  • Mindfulness skills focus on keeping a person fully present in the moment. Observation, description, and participation in daily experiences are all part of this learning. Patients learn to process thoughts, emotions, external responses to the environment, and sensations without deeming them either good or bad. These skills are needed to implement more advanced DBT skills successfully.
  • Interpersonal effectiveness skills are those that help an individual assert his or her needs and manage relationship conflicts.
  • Distress tolerance skills teach individuals to cope with stress without exacerbating it through negative means such as self-injury, impulsivity, and risky behaviors.
  • Emotion regulation involves helping a person learn to identify and manage feelings and reactions to them.

Where Can I Learn More About DBT as a Treatment for BPD?

DBT can help clients with BPD reach positive long-term functioning. The best results involve a combination of psychotherapy, family and peer support, and medications. Reach out to Mental Health Systems (MHS) to schedule an evaluation to see if DBT can help you or someone you love.

Image Credit: Shutterstock /pathdoc

Super-users in Health Care. MHS’ Dr. Mark Carlson Leads Training on Clients with Chronic Conditions

Posted March 3, 2020
Did you know that 5% of the general population accounts for about 50% of health care costs?  Coined super-users, these clients struggle to engage, burn out providers, and often have poor outcomes.  For many of these clients, traditional therapy techniques are either ineffective, or make the situation worse.  “Therapists and health care providers often haven’t seen the research and don’t know the strategies that work with these clients”, says Dr. Mark Carlson, who has spoken nationally on super-users.  “Fortunately, there are clear strategies that work across approaches that help engage clients, improve outcomes, and lead to therapists and care providers feeling better about their work with high need clients”, Dr. Carlson continued.
Held on March 6th, click here for more information and to register for this event.

Parasympathetic Nervous System and Trauma

Posted March 2, 2020

What Is the Parasympathetic Nervous System?

The parasympathetic nervous system (PSNS), sometimes called the feed-and-breed or rest-and-digest system, is part of the autonomic nervous system, along with the sympathetic nervous system. Located between the brain and spinal cord, the PSNS is tasked with saving the body’s energy by slowing the heart rate and increasing the activity of the intestines and glands during periods of rest. It also relaxes the sphincter muscles in the gastrointestinal system.

Here are some of the body functions stimulated through the parasympathetic nervous system. The PSNS uses acetylcholine as its primary neurotransmitter, but other peptides may act on the PSNS as well.

  • Sexual arousal
  • Lacrimation (crying or shedding tears)
  • Digestion: The PSNS dilates the blood vessels of the GI system to allow for greater blood flow.
  • Salivation: The PSNS stimulates the salivary glands and speeds up peristalsis.
  • Urination and defecation

The PSNS also constricts air passageways when the body needs less oxygen, such as during rest periods. It also constricts the pupils when closer vision is required. These functions complement those of the sympathetic nervous system, which is best known for stimulating the fight or flight response when the body perceives a threat.

 

When Is the Parasympathetic Nervous System Activated?

During times of stress, your body’s sympathetic nervous system activates your fight or flight response. It happens quickly so that the body is almost instantly ready to run or defend itself. In contrast, the parasympathetic nervous system’s job is to relax the body and use hormones to slow down those frantic responses once the threat is gone. The PSNS gives the body a calm and relaxed feeling over a period of time. The changes don’t happen as quickly as those of the sympathetic nervous system.

 

How Does Trauma Affect the Nervous System?

In periods of stress, the body’s fight or flight response activates. A normally regulated nervous system experiences the stress but returns to normal when the threat has passed. This period during which you have the ability to self regulate is called the window of tolerance, and most people move through several of these cycles daily. One example is rushing to get somewhere and running late but relaxing once you reach your destination on time. However, the system works very differently when the body experiences trauma.

Traumatic events push the nervous system outside its ability to regulate itself. For some, the system gets stuck in the “on” position, and the person is overstimulated and unable to calm. Anxiety, anger, restlessness, panic, and hyperactivity can all result when you stay in this ready-to-react mode. This physical state of hyperarousal is stressful for every system in the body. In other people, the nervous system is stuck in the “off” position, resulting in depression, disconnection, fatigue, and lethargy. People can alternate between these highs and lows.

In cases of extreme and chronic stress, such as ongoing trauma, complex PTSD may result. One example is children who are raised in abusive homes. Another is a soldier returning from combat. The nervous system becomes conditioned to exist in a state of fear. That state can continue into adulthood, triggered by things that would seem utterly unrelated to the childhood trauma. For example, the soldier may react to the backfiring of a car as if the sound is gunfire because he or she is in a constant state of fear, ready to react to the firing of a bullet.

 

How Do You Calm Down the Parasympathetic Nervous System?

A competent and trained therapist can help clients learn to activate the PSNS to control feelings of stress and anxiety, improve mood, boost the immune system, and reduce blood pressure. Many activities can help trigger this calming response in the body:

  • Meditation and progressive relaxation
  • Identifying and focusing on a word that you find peaceful or calming
  • Exercise, yoga, tai chi, and similar activities
  • Spending time in a serene natural place
  • Deep breathing
  • Playing with small children and pets

Other ways to activate the PSNS include getting a massage, repeating a calming chant or prayer, and participating in hobbies. Anything that you find calming, reassuring, and relaxing can be a way to wake up your parasympathetic nervous system.

Some of the techniques to activate the PSNS may come as a surprise. They focus on connecting your brain to the physical activity you are involved in, removing it from the “stuck” stage. Here are some examples:

  • Gently touching your lips with two fingers can activate the PSNS because the lips are rich with parasympathetic fibers.
  • Focusing on one thing at a time and avoiding the temptation to multitask can maximize the benefits of activating the PSNS.
  • Visualization and imagery and picturing yourself in a peaceful place that you love can activate the calming actions of the PSNS.

 

Self Care and PTSD

Practicing self-care can help those who have PTSD learn to release stress and pull the nervous system back into regulation. These tips can help.

  • Choose relationships that are safe. People who calm you and make you feel secure can help you activate your PSNS. People are social by nature and find comfort in connection with others. Isolation and superficial relationships can even aggravate mental health challenges.
  • Take mindful breaths to connect your breathing to your conscious thoughts rather than to automatic panic responses.
  • Connect with a trauma-focused therapist who understands these concepts and can help you recognize the signs of a dysregulated nervous system. A trained professional can help you identify what’s calming for you, and this may be different from person to person. For example, one person may find it soothing to sit still while others need the motion to feel at peace.

 

Does DBT Work for PTSD?

Dialectical Behavior Therapy (DBT) is a form of Cognitive Behavioral Therapy (CBT) intended to treat patients with the symptoms of Borderline Personality Disorder (BPD). However, since many of these patients also have Post-Traumatic Stress Disorder (PTSD) and vice versa, DBT can be useful in helping with both diagnoses. BPD and PTSD are both characterized by difficulty in controlling emotions, impulsive behaviors, and problems managing interpersonal relationships.

DBT was developed in the 1980s by Dr. Marsha Linehan. Like CBT, DBT emphasizes controlling thoughts and behaviors in a way that reduces symptoms. However, DBT also focuses on the acceptance of emotions and thoughts through the use of mindfulness skills. Researchers in a German study found that treating people with PTSD using DBT reduced the symptoms, such as depression and anxiety, and led to improvement that continued weeks after the therapy ended. Research continues into this promising use of DBT.

 

Contact MHS for Help Today

MHS offers DBT for adults and adolescents as young as 12, including those with co-occurring disorders, to help them reduce symptoms and improve quality of life. The Adherent DBT program at the Woodbury, Edina, Plymouth, and Roseville locations is closely modeled after the curriculum developed by Dr. Marsha Linehan. It is nationally accredited and certified by the Minnesota Mental Health Division Department of Human Services.

At MHS, DBT combines different techniques such as mindfulness, emotional regulations, interpersonal skills, and distress tolerance to effect lasting change. Clients identify personal goals, and MHS provides support to help them reach those targets. Therapists help clients get motivated and practice what they learn in therapy.

To learn more about how this intensive outpatient approach can help you, contact us today.

Image Credit: Shutterstock / GBALLGIGGSPHOTO

Help A Loved One; Look Out For These Signs of Suicidal Behavior

Posted April 12, 2019

Suicide is a traumatic experience for an entire community. As there is a diverse range of signs, symptoms, and causes, understanding the many signs can help you reach out to a loved one. If you are concerned that someone you know may be having suicidal thoughts, learn to spot common warning signs and how adult DBT can help them deal with their thoughts, feelings, and actions.

Changes in Mood

While no single sign can completely predict attempted suicide, many individuals who are considering show mood changes:

  • Anxiety
  • Shame/humiliation
  • Depression
  • Irritability
  • Anger/agitation
  • Sudden calmness

Continue reading

Why is My Child Acting Out?

Posted April 10, 2019

Challenging behavior is a frequently experienced part of raising a child, and it’s not unusual for a child to act out as a response to everyday stressors, changes in their routine, and other typical factors. However, if you’re concerned that your child is struggling to overcome significant behavioral issues and/or emotional difficulties, it may be time to seek out professional help and resources.

What is Causing this Behavior?

It’s not unusual for parents to be confused by a child’s challenging behavior, especially when it’s difficult to pinpoint the reasons behind it. It can be difficult not to feel like you are at fault, or to experience feelings of guilt for wondering if you simply have a “bad” child. However, a child’s negative behavior can often be attributed to one key factor: on some level, their basic needs are not being met. For some children, that may be something as simple as an inconsistent sleep schedule, the stress of dealing with a new school, or complex feelings about the birth of a new sibling. Continue reading

IT Security in Our Homes (Click Link)

Posted June 15, 2018

Randall Webb: So we’ll go ahead and get started. My name is Randall Webb. I work for TARCSYS Corporation. We are a Southern-based IT company. I come from the great metropolis of Nashville, Tennessee. We focus on IT security. What the point of this is, is I really want to change your paradigm and change your mindset about what IT security is. Okay? All of us either are parents or we work with IT in our lives, and we know people that we may want to implement some of these things for, and so that’s what the goal is. The title of this is Household Incorporated, and we will explain what that is and why. It’s a roadmap for IT security in our homes. Continue reading

8 TIPS to Help Clients Do Homework

Posted June 6, 2018

Dr. Lane P.: Hi, I’m Dr. Lane Pederson. One of the most common questions I get from participants in my seminars is, How do I get clients to do homework? In this short video, I’m going to share with you eight tips that I find to be very effective. Continue reading

Relaxation Script for Pain

Posted December 13, 2017

Studies indicate that up to 50% of individuals diagnosed with chronic pain will also meet the DSM-IV-TR diagnostic criteria for anxiety. This is because many individuals who experience chronic pain describe anxiety and pain distress as a circular fashion: pain contributing to stress, which leads to muscle tension, which leads to more pain. It is important to practice relaxation strategies to cope with anxiety which will release tension in the body. You will find one example of a relaxation script below. In addition, use your mindfulness skills to pay attention to your body’s needs and shift the relaxation script as needed.

Breathing and Body Relaxation Script:

  • Begin by resting your body in a comfortable position. You may close your eyes, or if you are more comfortable keeping them open, stare at a fixed focal point in the room. Start grounding your awareness into your body. Feel your feet firmly meeting the floor, your back supporting you in your chair.
  • Once you have physically grounded yourself, slowly bring your attention to your breath. Notice the patterns of your breathing- the inhalation, pause, and exhalation.
  • Observe the rise and fall of your belly as you are breathing. If you notice that you are breathing from the chest, work to slow your breathing down, with slower and deeper breaths from your diaphragm. Allow for a few more rotations of this breath, going deeper and deeper into your core.
  • The goal of this breathing exercise is target a slower breath, a soothing breath. Perhaps counting allows you to pace your breathing. Try this experience, perhaps starting with intervals of 4 seconds.
    • Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4. Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4.
  • Repeat for a few more rotations.
  • It is natural for distractions to pop up in your mind. If you observe a distraction, identify it as just a thought and redirect your attention to your breathing.
    • Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4.
  • Continue this breathing until you have found a natural rhythm of inhalations and exhalations that work for your body today.
  • Continuing to move with this rhythm, consider the idea of releasing tension with your exhalation as we expand into meditation with the breath. Feel yourself working to inhale calming energy, and exhaling muscle tension.
    • Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Imagine your body slowly releasing all of the built up tension.
  • As you work through your muscle groups, observe the experience of feeling lighter in your muscles are you work to cleanse your body of the tension.
    • Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4.
  • Continue this process for as long as you find meaningful for you. When you are ready, you may begin the process of orienting yourself back to your surroundings. Feel your back against the chair, your legs against the chair, your feet resting on the ground. When you are ready, you may start to shift your body and prepare to move on to the next part of your day. Remember that you can return to this place, to ground yourself and release tension in your body, at any time you choose.