Why is Mindfulness Helpful?
Mindfulness+and+DBT

Mindfulness is one of the core skills of dialectical behavior therapy (DBT). DBT has been shown to be an effective treatment for borderline personality disorder (BPD), self-harm, suicidal thoughts and attempts, depression, and other issues of intense emotion. In DBT, clients spend the first two weeks of every module of skills classes focused on the practice of mindfulness.

How does mindfulness contribute to the great effectiveness of DBT? How does practicing mindfulness lead to symptom reduction? One recent study considered what facets of mindfulness contribute to symptom reduction in persons with borderline personality disorder (BPD).

The researchers used a tool called the Five Facet Mindfulness Questionnaire. This measure breaks down mindfulness into five different attributes. These attributes are:

  • observing

  • describing

  • acting with awareness

  • nonjudging of inner experience

  • nonreactivity to inner experience

In DBT skills classes, participants practice mindfulness in an attempt to develop these skills. The learn to observe their surroundings, and their internal emotional and cognitive world. They learn to describe what is going on around and within themselves, in a non-judgmental way, without a strong reaction. In turns they learn to act with awareness, making more intentional, purposeful decisions.

These mindfulness subskills all go together but are some of them more related to the reduction in BPD symptoms that comes from learning DBT skills?  It turns out,

Acting with awareness and nonjudging of inner experience seems to be especially important. By acting with increased awareness, persons with BPD take more control and are able to make more effective, less emotion-driven decisions. By judging one’s inner experiences less, including one’s thoughts and emotions, persons with BPD are able to experience negative thoughts and emotions without it resulting in a cascade of self-judgement and further negative emotion. Participants improving in these mindfulness skills also showed lover levels of depression and overall distress.

Tanner Oliver
Fall and Winter 2019 DBT Course Dates

Our fall session starts August 26th!

We will cover the DBT skill of Emotion Regulation. During the upcoming winter session, we will discuss Interpersonal Effectiveness.

Fall Session: Emotion Regulation

  • 8/26-10/14 (9 weeks)

Winter Session: Interpersonal Effectiveness

  • 10/28-12/16 (7 weeks, no group the week of Thanksgiving)

Contact us at FRTC to learn how DBT can help you build a life worth living.

Tanner Oliver
Why do people cut themselves?
Cutting

Non-suicidal self-injury (NSSI), also called self-harm, is someone hurts themselves on purpose. When most people think of NSSI, they think of cutting, as when people use knives or razors to cut themselves. Other ways people commit self-harm include burning, hitting, consuming chemicals, scratching, hair-pulling, and overdosing (on OTC, prescription, or illegal drugs). Self-harm is more common in people with histories of depression, suicidality, or a diagnosis of borderline personality disorder.

Why do people commit self-harm? According to one theory, self-harm is motivated by emotional dysregulation. Emotional dysregulation is a key characteristic of borderline personality disorder, and is a problem for many people suffering from emotional disorders. People with emotion regulation difficulties tend to feel their emotions more strongly, stay upset longer, and have difficulty calming down. These people will often turn to unhealthy ways of coping with strong, negative emotions. One such method: self-harm.

A recent study examined the relationship between emotional dysregulation and self-harm. The result? A significant relationship between levels of emotional dysregulation and self-harm behavior. According to the authors:

Emotion dysregulation subscales most strongly associated with NSSI included limited access to regulation strategies, non-acceptance of emotional responses, impulse control difficulties, and difficulties engaging goal-directed behavior.

Dialectical Behavior Therapy is designed to address issues of emotional dysregulation, through skills such as distress tolerance (accepting strong negative emotions) and emotional regulation (ways to reduce strong emotions).

Tanner Oliver
DBT skills groups begin this week!
Summer DBT. Better than a beach pineapple.

Summer DBT. Better than a beach pineapple.

Dialectical Behavior Therapy (DBT) skills groups begin this week! There's still time to sign up. This summer, we'll be learning about Distress Tolerance: how to weather those difficult moments and strong emotions.

Our DBT groups meet once a week for an hour and a half. In a classroom like setting, clients learn and practice a variety of DBT skills to improve their quality of life.

Skills learned in DBT group therapy sessions are then discussed in individual therapy, where the client practices applying those skills to the issues they are facing in their life.

Here are the available class times this summer:

  • Tuesday evenings, from 4:00-5:30 pm

  • Wednesday mornings, from 10:00-11:30 am

  • Thursday afternoons, from 11:30-1:00 pm

Contact us for more info, or to sign up!

Tanner Oliver
Borderline Personality Disorder and Physical Health
BPD and Health

There has long been a noted link between borderline personality disorder (BPD) and poor physical health consequences. BPD certainly does not impact physical health for everyone, but for many, BPD drives behaviors that are known to be detrimental, or even dangerous.

Since BPD is a characterized by a deficit of emotion regulation skills, people with BPD sometimes engage in disparate attempts to feel better which can have long term negative consequences. A recent study examined some of these behaviors. They include:

  • alcohol and drug abuse

  • self-harm

  • chronic use of opioid, benzodiazepine, and anti-psychotic medications

  • smoking

  • poor diet

  • poor sexual health

  • poor adherence to medical treatments

There is also a relationship between BPD and binge-eating and sleep issues.

DBT is a treatment for BPD, and it used to target specific, problematic behaviors. While the focus is on emotional health, DBT could also target behaviors that have a negative effect on physical health.

Tanner Oliver
May is Borderline Personality Disorder Awareness Month
BPD Awareness Month

May is Borderline Personality Disorder Awareness Month.

In 2007, the House of Representatives passed a resolution supporting efforts to educate the public about BPD, and in support of BPS Awareness Month. The text of that resolution, recognizing the severity of BPD and the importance of raising awareness about, is included below.

Also, learn more about BPD: its causes, symptoms, and treatment.

Whereas borderline personality disorder (BPD) affects the regulation of emotion and afflicts approximately 2 percent of the general population;

Whereas BPD is a leading cause of suicide, as an estimated 10 percent of individuals with this disorder take their own lives;

Whereas BPD usually manifests itself in adolescence and early adulthood;

Whereas symptoms of BPD include self-injury; rage; substance abuse; destructive impulsiveness; a pattern of unstable emotions, self-image, and relationships; and may result in suicide;

Whereas BPD is inheritable and is exacerbated by environmental factors;

Whereas official recognition of BPD is relatively new, and diagnosing it is often impeded by lack of awareness and frequent co-occurrence with other conditions, such as depression, bipolar disorder, substance abuse, anxiety, and eating disorders;

Whereas despite its prevalence, enormous public health costs, and the devastating toll it takes on individuals, families, and communities, BPD only recently has begun to command the attention it requires;

Whereas it is essential to increase awareness of BPD among people suffering from this disorder, their families, mental health professionals, and the general public by promoting education, research, funding, early detection, and effective treatments; and

Whereas the National Education Alliance for Borderline Personality Disorder and the National Alliance on Mental Illness have requested that Congress designate May as Borderline Personality Disorder Awareness Month as a means of educating our Nation about this disorder, the needs of those suffering from it, and its consequences: Now, therefore, be it

Resolved, That the House of Representatives supports the goals and ideals of Borderline Personality Disorder Awareness Month.

Tanner Oliver
Parental Validation: Tips for Dealing with Your Teen
Teen DBT Validation

When someone else is upset, it isn’t always easy to be sympathetic. This is especially true when it seems like they are upset for little or no reason, or they are overreacting. For parents, this can be a constant struggle. All children do this, though it usually settles down with time. Some people, though, struggle with strong emotions all their life. It can be especially difficult living with a high-emotion teenager.

The truth is, some people get upset easier than others, and have a hard time calming down. We call the ability to calm oneself down an emotion regulation skill. Some people, because of their biology, have a hard time with emotional regulation. (Though it can be learned- teaching these skills is a key component of DBT).

For the parent of a teen with poor emotion regulation skills, life can be difficult, and your relationship with your child can suffer. During times of high emotion, it is only natural to think, or to say:

“Get over it”

“You are overreacting”

“Act your age”

We call these responses invalidating. The problem? These responses are usually not effective. By effective, we mean helping you get what you want. When your teen is upset, the thing you probably want most from your interaction with them is for them to feel better and calm down. These types of responses tends to not calm people down, but instead lead to more negative emotion. Only now the negative emotion is about both the original issue and your response to it.

These responses are probably not effective even if they are true. Someone may be “overreacting,” in the sense that they are over estimating the significance of an event. Teens often overestimate the importance of events, because they lack the perspective of experience. For example, the end of a romantic relationship tends to be much more painful during adolescence, because of unrealistic expectations about the relationship.

When people are upset, they usually can’t be argued or berated into feeling better. Often, people cannot be convinced to feel better, even with a rational argument. Emotions often have to be felt, and take time to run their course.

Even more crucially, invalidating responses can result in confusion and greater negative emotion. Over years, these responses can be damaging. If children constantly receive the message that their emotions are “wrong,” their emotion regulation skills tend to suffer: they never become skilled at recognizing, labeling, or controlling their emotions.

So, if your teen is really upset, and you don’t agree with their reaction or beliefs driving the reaction, how do you respond? 

Effective responses tend to begin with validation. Validation requires recognizing the emotions the other person is experiencing.

“You seem to be feeling X”

“I’m sorry you feel so sad/angry/upset”

“That is very sad when X happens”

It can be very difficult to be validating sometimes. It can be helpful to remember that validation does not require you to agree with the reasons behind emotion, or the intensity of the emotion, or the poor coping skills being used. It is simple a recognition of the reality of what the other person is feeling. 

When dealing with someone who is highly emotional, practice working from how things are, rather than how you wish them to be. Maybe you don’t think someone should be upset, but if they are, that is what you have to work with. Here are some tips on how to be validating:

  • Give the person your full attention

  • Observe and reflect what the other person is feeling (“ You seem very upset”)

  • Demonstrate acceptance and understanding (“It can be very hard when x happens”)

  • Avoid being judgmental (“You’re overreacting”), insincere (saying things you don’t really mean),

Give these tips a try, and you may find it helps when dealing with your high-emotion teen, calming them down faster, and strengthening your relationship.

Tanner Oliver
Announcing our Summer Intensive DBT Program for Teens
Teen DBT Program

Summer 2019 we will be offering an intensive teen DBT program, for high schoolers and college freshman.

The schedule is condensed and accelerated, designed to fit an entire year’s worth of topics over summer break. Participants will meet twice a week for 90 minutes for DBT skills group, where they will cover all the same material taught in our regular courses. The course lasts 8 weeks.

They also have the option of meeting for 50 minutes weekly with an individual therapist. If your teen already has a therapist, they may be able to join us for just DBT skills group, and we will work with their therapist to ensure they are making progress.

Learn more about our DBT program to see what participants learn.

Components

Our Teen Summer Intensive DBT program has several components:

  • Twice weekly, 90 minute DBT Skills Groups (for 8 weeks).

  • Two, 2-hour Parent Groups. In Parent Group, we provide an overview of everything your teen is learning about. This will help you understand their new skills, and support them in applying them. This isn’t group therapy, and no sharing is required. We can accommodate 1 or 2 parents or guardians per teen. Parents groups meet on two Saturdays.

  • A custom program workbook with handouts and worksheets.

  • Optional: Weekly 50 minute individual therapy. Usually, you must have an individual therapist to participate in DBT Skills Group. For those that want or need it, we can offer individual therapy as well. If your teen is local, we can work around their schedule so they can continue to see their therapist after the program ends and the school year begins.

  • Optional: Therapist transition assistance. If your teen is a graduating senior going off to college, or a college freshman home for the summer, we can help them find a therapist to see during the next school year. We will also connect with their new therapist, and help with the transition.

Program Schedule & Cost

Our teen summer intensive DBT program for the summer of 2019 will be on Tuesdays and Thursdays, from 1:30-3:00. The first class meets on June 4th, and the last on July 25th. Parents classes are from 10:00-12:00 on Saturday June 8th, and Saturday July 13th.

Early-Bird Pricing is available until May, at $1500. The regular price is $2000. This includes 28-hours of DBT skills instruction, therapist location and transition assistance (for those leaving for college), and all materials. Your insurance may cover part of the cost, and we can provide you with a statement to seek reimbursement.

Tanner Oliver
Can Your DNA Predict Therapy Success?
Borderline Personality Disorder and BPD

Research has identified several genes that may be important for the development of borderline personality disorder (BPD). Of special interest are epigenetic mechanisms: genes that may turn on or off depending on one’s experience.

What kind of experiences? Intense, early childhood experiences are no doubt important for the development of BPD. This includes different forms of maltreatment, abuse, and neglect. Those experiences contribute to the development of BPD, possibly through the activation or deactivation of certain genes.

A recent study examined three such genes and therapy outcome. The researchers examined 44 patients with BPD undergoing Dialectical Behavior Therapy (DBT). The results? They found a relationship between repression in two of the genes and therapy success. Two of the genes (APBA3 and MCF2) showed higher levels of “DNA methylation” on those persons for whom DBT was successful.

Why does this matter? In the future, it may be possible to predict whether or not DBT will be successful based on a genetic test. Eventually, it may be possible to tailor treatment for BPD (and other disorders) based upon one’s genetic makeup.

Tanner Oliver
Improvement of Mindfulness Skills After Attending Dialectical Behavior Therapy Skills Group
DBT Mindfulness

A recent study examined 35 adults diagnosed with borderline personality disorder (BPD), attending a 20-week dialectical behavior therapy (DBT) skills group. The researchers were interested in improvements in mindfulness skills. They measured improvements in:

  • observing: noticing one’s surroundings and inner experiences

  • describing: labeling one’s sensations, observations, thoughts and feelings

  • acting with awareness: acting with attention

  • nonjudging of inner experience: experiencing thoughts and feelings without judgement

  • nonreactivity to inner experience: experiencing thoughts and feelings without emotionally reacting to them

They discovered increases in some facets of mindfulness. They discovered a relationship between acting with awareness and nonjudging of inner experience and reductions in BPD and depression symptoms.

In DBT skills classes, about every two months participants spend two weeks focusing just on mindfulness skills. Could it be beneficial to focus on acting with awareness and nonjudging of inner experience during those two weeks? Perhaps, if more research shows those factors contribute more to symptom improvement.

Tanner Oliver
The Biological Basis of Borderline Personality Disorder (BPD)

According to the biosocial model of borderline personality disorder, BPD is the result of a complex interaction between biological vulnerabilities and the environment, which results in the development of the disorder. Of special interest are invalidating environments- those in which children’s emotional experiences are ignored, belittled, otherwise invalidated by caretakers. In some cases, this emotional mistreatment occurs along with verbal, physical or sexual abuse.

The biological vulnerabilities of interest are related to hyperreactivity (sensitive to cues, especially to negative stimuli) and hyperarousal (a higher baseline level of emotion, with a slower return to baseline). Research on borderline personality disorder in the biological sciences attempts to identify the genetic source of these vulnerabilities.

One current focus of research are genes governing the stress response, located in the the hypothalamic-pituitary-adrenal (HPA) axis. These region of the brain determines how people respond to stress, from interpersonal conflict to encountering a wild animal.

Future research will continue to identity relevant genes, while also examining epigenetic effects- the switching on or off of genes in response to the environment. That is, events such as child abuse can “activate” certain genes implicated in BPD. Eventually, it may be possible to “deactivate” those genes through medical intervention (gene therapy). It is also possible implicated genes do “turn off” over time in response to corrective environmental experiences (which can include therapy, such as DBT).

Tanner Oliver
Reducing the Negative Consequences of Drinking

A recent study examined the use of "alcohol protective behaviors" used by college students experiencing PTSD symptoms. The authors explored the relationship between the negative consequences of alcohol use and PTSD symptoms. They noted that those symptoms were less in people who use "alcohol protective behaviors." This was especially true for women. What are these helpful behaviors?

First are "manner of drinking" strategies. These are ways to avoid the negative consequences of drinking, related to the method of drinking. For example, someone might choose to avoid drinking games, avoid hard liquor, or avoid taking shots.

Second are limiting strategies. These are ways to help to prevent the negative consequences of drinking by setting a limit on the number of drinks consumed. Before drinking, for example, someone may decide to limit themselves to three beers, or two glasses of wine.

Third are "serious harm reduction strategies," or attempts to directly prevent serious negative consequences. For example, one might intentionally not drive to an event with drinking, so there will be no chance to drive later while under the influence.

Studies have shown persons with certain mental health issues, such as PTSD, tend to use alcohol protective behaviors less often. A helpful intervention, therefore, might be to teach persons in therapy who are also experiencing negative consequences from alcohol use about the benefits of such strategies, and encourage their use. Such persons may or may not also be struggling with alcohol addiction. If they are, they may not be ready to reduce or stop their use. In either situation, alcohol protective behaviors could be a helpful addition to treatment.

alcohol consequences
Tanner Oliver
Involving Significant Others in Borderline Personality Disorder Treatment
Family DBT

Most therapy is independent, conducted one-on-one, with the client and therapist working together. When couples are having relationship trouble they may seek couples counseling. Families may seek out family counseling to reduce interpersonal conflict and improve relationships. But, when there is one patient seeking treatment for a specific mental health issue, romantic partner involvement is usually neglected.

When someone with borderline personality disorder (BPD) seeks treatment, should romantic partners be included in treatment? BPD greatly impacts the ability to have stable, rewarding relationships. In addition, it can be very stressful for those who love someone diagnosed with BPD. It can be difficult to live with a partner who displays unpredicted shifts in mood, high levels of anger and conflict, self-harm, suicide attempts, and other risky behaviors.

There are many ways for those who love someone with BPD to get help. Persons can seek outside support and information. Persons can receive supportive therapy for themselves, ideally from a therapist experienced in treating borderline personality disorder. Or, such persons can be included in their loved one’s treatment. A recent study examined the inclusion of significant others in BPD treatment, and examined whether that lead to better outcomes for the persons with BPD.

The authors examined a number of previous studies that involved significant others in BPD treatment, including dialectical behavior therapy (DBT). One of the most promising techniques involved bringing in the client’s partners for a 2-hour training, on the CBT or DBT techniques the client was learning. This allowed the partners to better support the BPD client. For example, a partner could assist an upset client unable to remember which skill to apply… “Did you try X?”

Partner involvement is no doubt valuable, though there is a lack of systematic ways to accomplish this. Many DBT clinicians who do include significant others likely do so in an informal, case by case basis, and would likely benefit from a manualized approach.

Tanner Oliver
Treating Anxiety and Depression with "Transdiagnostic" Methods
Anxiety and Depression Treatment

At Front Range Treatment Center, we often use the Unified Protocol when treating clients with mixed depression and anxiety. The UP is a transdiagnostic treatment. What does this mean?

There is an ongoing debate amongst mental health researchers whether it is better to focus on developing ever more precise distinctions between disorders and disorder sub-types, or to focus on diagnostic groupings and emphasize common underlying processes that cut across multiple diagnoses and diagnostic categories (Norton & Paulus, 2016). The widespread use of the DSM encourages clinicians to make fine diagnostic distinctions, and thereby encourages the use of highly focused and diagnosis-specific treatments. However, some clinicians and researchers argue in favor of a diagnostic and treatment philosophy grounded in commonalities rather than distinctions. This debate of “splitting” versus “lumping” is especially lively amongst those who treat and research the mood disorders, with a growing number of persons emphasizing the consistent similarities amongst those with anxiety and depressive disorders.

One of the most popular transdiagnostic interventions is the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP). The UP was designed to address vulnerabilities common to persons with anxiety and depressive disorders, such as negative affect, negative attribution bias, and avoidant tendencies (Barlow et al., 2017). The UP has been found effective in reducing the symptoms of PTSD, as well as generalized anxiety disorder, panic disorder, phobias, major depressive disorder, borderline personality disorder, eating disorders, and substance abuse. The UP has been shown to reduce symptoms severity, improve affect, and improve daily functioning (Farchione et al., 2012).

There is also some evidence the UP has a lower attrition rate than single-diagnosis treatments. Barlow (2017) compared the efficacy of the Unified Protocol with diagnosis specific, single-disorder protocols (SDPs). They discovered the UP and SDPs were statistically equivalent in their efficacy. However, the UP group was significantly more likely to complete treatment than the SDP group.

Tanner Oliver
Now Hiring!

At Front Range Treatment Center, we are on the search for a part-time therapist. We are looking for someone interested in Dialectical Behavior Therapy (DBT) and other forms of Cognitive Behavioral Therapy (CBT).

Check out our ad and apply, here.

FRTC
Crying and Borderline Personality Disorder
BPD Crying

A recent article examined crying in persons with borderline personality disorder (BPD). Intense emotions, emotional reactivity, difficulty coping with and controlling emotions: these are all common in persons with BPD. The authors sought to find out, do people with BPD cry more, and for different reasons, than persons who do not have BPD?

The results suggest that, yes, persons with borderline personality disorder do cry more than persons without BPD. However, they found that persons with BPD deal with tears in a similar manner to persons without BPD- that is, they do not try to cry, nor cry excessively once they start. The authors suggest that persons with borderline personality disorder cry more because they actually face more situations which illicit tears. That is, BPD results in situations more likely cause crying, or misperceptions about situations, rather than directly causing more crying. Persons with BPD tended to look at situations in a way more likely to cause crying than others.

Most interestingly, persons with BPD showed a lower awareness of the impact of their tears on others. Persons without BPD were more aware (and perhaps self-conscious) of the effects of their emotional display on others. Persons with borderline personality disorder were less likely to consider the impact of their tears on persons around them.

Tanner Oliver
Researcher and "Father" of Borderline Personality Disorder Dies

Dr. John Gunderson, professor of psychiatry at Harvard and famed researcher on borderline personality disorder, died on January 11th at the age of 76.

Dr. Gunderson, trained as a psychoanalyst, authored 12 books, and almost 250 articles, on borderline personality disorder and related topics. He helped to define the features of BPD, and helped to define BPD as a diagnosis included in the Diagnostic and Statistical Manual (DSM-III) in 1980. He also developed a borderline personality disorder treatment protocol for nonspecialists working with persons who have BPD.

In he 1930’s and 40’s, borderline personality disorder was thought to be a psychotic condition, on the “borderline” between psychosis and neurosis. Dr. Gunderson was part of a group of researchers who helped change the perception of the central feature of BPD from psychosis to a mood dysfunction. He was among the first to conceptualized the treatment resistance of those with BPD as a feature of the disorder.

Being alone is often intolerable to [those with BPD] because it is associated with a profound sense of being bad... a self-image distortion accompanied by such intense feelings of guilt or shame that the question of worthiness to live often follows.
— Dr. John Gunderson
Tanner Oliver
The Stereotype of the Moody and Rebellious Teenager
Moody Teens

A recent article in the WSJ examined the expectations American parents have when their children reach their teenage years. The stereotype of teenagers as moody, rebellious, emotional, and troubled is deeply ingrained in popular culture, and is central to some psychological theories.

In reality, research has shown most teens do not have an especially difficult time. Many do, and the teenage years certainly present challenges, but the moody and rebellious teenager is the exception. In addition, many rebellious, risk taking behaviors have been on the decline amongst teens for years. Rates of drug and alcohol abuse and unprotected sex have been falling for decades, with the exception of marijuana use.

It is important for parents to have realistic expectations for their children’s behavior. There is a danger that, if parents expect emotional instability, they could miss serious psychological warnings signs. Anecdotally, teens suffering from depression, and even suicidality, often report difficultly getting their parents to allow them to seek treatment.

If parents expect rebellious and risky behavior, they tend to excuse it. If they excuse (or even sanction) such behavior , it will probably increase. The teenage years are a time of increased independence and boundary testing, and it is important that parents do not prematurely abandon their role in defining what is appropriate. Parents should not allow or promote risky behavior, such as underage drinking, without expecting that behavior to increase.

Tanner Oliver
DBT Concept: The Well Within
DBT Well Within

The Well Within is a metaphor designed by Marsha Linehan, the creator of Dialectical Behavior Therapy (DBT). In my practice, I find this metaphor helps some clients understand why they have a hard time accessing their wise mind.

Image that you are standing on the edge of a well, and peering down into the water. The water represents your wisdom. Overtime, you begin to associate water with your wisdom. Some people look into the well, and see nothing by dry earth. This often occurs when there are trap doors that block our access to our wisdom. Trap doors may include: traumatic experiences, substance use or judgments that you have about yourself or the world. One of the purposes of DBT therapy is to help us identify trap doors in our lives and figure out how to remove them so we can access our wisdom.

Now, sometimes what happens is we experience intense emotions. These serve as clouds, that rain down. Water may collect on your trap doors. So you look into your well, you see water and you conclude, “Ah Ha! This is wisdom! I’m totally justified in acting this way!” This is not the case. We call this “water on the trap door thinking” and it occurs when extreme emotions mascaraed as our wisdom. Be vigilant to this type of thinking!

Jenell Effinger