(upbeat bright electronic music)
- Hey, everybody, today, we're gonna talk
about borderline personality disorder or BPD
and whether or not it's treatable.
I often hear from those of you with BPD
that you're constantly being referred out
and struggling to get the help that you need,
all the while doing your best to manage your symptoms.
And it's tough and exhausting at times,
which is why I wanna talk about BPD in a real way
and how it can be successfully treated.
Now first, it's important to understand BPD
and how it can feel to those who have it.
The main symptom is fear of abandonment,
which means that we constantly worry about people leaving us
and not being able to cope with the upset
that comes along with it.
Because of this worry, we can engage in splitting behaviors,
which is when we believe that people
are either all good or all bad.
So if someone does something that hurts our feelings,
it could even be considered a small thing,
then we think that that's indicative
of them wanting to leave, and so we push them away,
possibly shout at them,
and even cut ourselves off from them completely.
In a way, we can think that we're saving ourselves
from future pain and upset,
but this behavior is obviously hurtful to us
and the people we are in relationships with.
We can also struggle with emotional instability,
meaning that we can swing from feeling really sad and low
to intense feelings of anxiety
or anger within just a few hours,
which is what makes this differ from bipolar disorder,
as those symptoms do not shift as rapidly
as they do in those of us with BPD.
Another important component of BPD
that we need to understand when talking about its treatment
is the impulsivity that can come along with it.
This means that we can overeat, overspend, drive recklessly,
and engage in other risky behaviors,
maybe like having sex or doing drugs
with someone that we barely know.
While there are a lot of other signs and symptoms of BPD,
the last one that I wanna address here
is our recurrent suicidal thoughts, gestures, or threats
and self-injurious behavior.
One of the best ways I've heard BPD described
is that we are like emotional burn victims.
And if you just take a minute to think about that,
you can imagine how painful that would be,
how hard being in a relationship could feel,
and how sensitive we would be
to everything happening around us.
Many of my patients have told me that they feel
out of control and upset all the time.
So it's no wonder that we can struggle
with suicidal thoughts and urges to self injure.
But it can be successfully managed and treated.
So hang on and let's jump into
what that looks like and why it works.
The gold standard of treatment for those of us with BPD
is dialectical behavior therapy, or DBT.
Now DBT is based on four main modules,
mindfulness, distress tolerance,
emotion regulation, and interpersonal effectiveness.
Mindfulness is seen as the foundation of DBT,
which is why it is the first part that we tackle
before moving on to anything else,
which makes sense because if we don't understand something
or are even able to identify it, how can we change it?
We can't.
Now there are two parts to the mindfulness module,
what and how skills.
Now skills are observe, describe, and participate.
Now to observe is to take in what's happening
around us right now.
(breathes deeply)
Use all five of your senses
and merely take notes of what's going on.
Don't try to change it, interpret it, or push it away.
Just notice.
Then describe it using factual, not judgemental, language.
For example, we would wanna say something like,
"I feel the wind on my face.
I smell the ocean breeze,
and I see two people walk in together,"
instead of something like,
"Ugh, I hate it when the wind hits me like this.
It's so cold, and I don't deserve
to take time or be by the ocean.
I should be working right right now.
Ugh, and those people, they look like total dorks."
Now, I know that's a complete exaggeration,
but the whole point of the what skill describe
is to do it without any judgment,
which moves us along to participate.
And this means that we participate in the activity
without worrying about what others think.
So if people at work are chatting in the break room,
we chat, too, add in what's going on with us,
and enjoy their company instead of judging ourselves
and thinking that they really don't like us.
We participate 100% in the conversation.
And you could even apply this to activities
like folding laundry where we are active
and present while we do it instead of just thinking
about how much we hate doing laundry
and wish that our partner would've done it.
Now the how skills are focused on how we do the what skills,
and we're supposed to do them non-judgmentally,
one mindfully, and effectively,
which we already addressed in those previous examples.
So let's move on to the distress tolerance portion of DBT,
and the goal of this module is to get us
to be able to calmly recognize a negative scenario
and the impact it's having without reacting to it
by either shutting down or lashing out.
And we can do this by using different tools and techniques,
one of which is distract ourselves
from the unpleasant emotions with an acronym called ACCEPTS,
which stands for activities,
so we can like do a fun activity that we enjoy.
The C is for contribute.
Help others around you or your community.
The other C is comparisons.
Compare yourself to past you when you
were having a tougher time
or to someone else less fortunate.
E is for emotions.
Use your activities to trigger a different emotion
like happiness, excitement, or even joy.
The P is for push away,
and this is like the burner technique
where we force something else to the front of our mind
and put the distressing emotion off to the side for a bit,
which rolls nicely into the next one on, thoughts,
which is when we force ourselves
to think about something else.
And finally, the S stands for sensations.
When we do something like taking a cold shower
or eating something spicy,
these things have intense sensations
that come along with them,
and that can distract us from the initial upset.
Now there are many other distress tolerance skills,
like improve the moment, which offers more ways
to calm our nervous system down.
And it includes things like finding purpose,
relaxing our muscles, and even praying.
And there's the TIPP skill,
which stands for tipping the temperature
of your face with very cold water,
intense exercise for 20 minutes,
paced breathing, and paired muscle relaxation.
And there are tons of tools for this,
but the last one that I use on the regular
is called radical acceptance.
And that's when we choose,
'cause we do have a choice, right?
So we choose to accept what's happening for what it is
and stop trying to change it, ignore it,
or fight back against it.
Just radically accept it as it is.
Okay, let's move on to emotion regulation and how it works.
And if we look back at the symptoms of BPD,
that we discussed earlier on,
one of those was emotional instability,
which is what these tools
and techniques directly assist with,
and there are three main goals within emotion regulation.
And they are: number one,
for us to get better at identifying our emotions,
which is why I'm always asking you to download
and print out those feelings charts; number two,
learning how to lower our vulnerability to our emotions;
and three, to decrease our emotional suffering.
One of the DBT tools will work here
is called the story of an emotion,
which is when we track back to better understand
why we feel the way we feel.
It has us figure out what the prompting event was,
what our interpretation of it was,
maybe what we felt in our body,
what urges came up with it, what action we took,
and what emotions we felt.
It really helps slow down our reactivity
and stop us from getting caught in thinking
that our feelings aren't right or warranted.
And another tool that helps lower our vulnerability,
and I've talked about this one before, is ABCs PLEASE.
And that acronym really taps into our basic needs
with things like accumulating positive emotions,
building mastery, which is when we do something
that we're good at and we get better at it,
and then coping ahead of time.
I've talked about this, preparing ahead
so that if something bad happens, we're ready.
And then we treat any physical illnesses we may have had
'cause if we're sick, we're not our best selves.
We can be really vulnerable to our emotions.
Then we have to eat regular balanced meals,
avoid alcohol and drugs, get enough sleep, and exercise.
And again, there are many more emotion regulation skills
that can help, but the last one I
wanna explain here is opposite action.
And we can use this in conjunction with the story
of emotion tool that I talked about before
so that once we're able to see that our emotional response
is maybe not warranted by what happened
or it's an overreaction, we can then use an opposite action,
make the choice to go against our urge,
and maybe that urge was to self-injure
or lash out at someone that we care about,
and we do the opposite thing, like do some self-care
or reach out for connection and support.
And I know it sounds difficult and it is,
but remember, we don't just jump into these skills.
We have worked our way through the other modules
and issues first.
And finally, the last module, interpersonal effectiveness,
and the goal here is to improve our ability
to communicate our needs, to set and uphold boundaries,
and to deal with any conflict that
may arise in our relationships because those
of us with BPD are actually good with people.
But whenever something upsetting happens,
we can struggle to see a situation clearly
and get caught up in our emotion and our more reactive mind,
which is why this final module is filled with techniques
like DEAR MAN, which helps us assert our needs
and express ourselves more clearly, and it's an acronym
for D is describe your situation using specific facts,
not feelings; E, express the emotions you experienced
when the situation happened; A is assert yourself
by asking clearly and specifically
for what change you're wanting.
The R stands for reinforce by maybe offering a small reward
or like a kickback for getting your way.
Then the M is to be mindful of the situation
by focusing on what you want and ignoring any distractions
through validation and empathy.
A is appearing confident and assertive,
goes a long way, even if you don't feel that way,
and finally, N is for negotiate
and come to a comfortable compromise, right?
Because we can't always get our way,
and we can't always be letting others get their way.
It's a give and take.
And overall, DBT can effectively help those of us
with BPD better manage our disruptive symptoms.
Does it take work? Of course.
Is it hard to change our automatic thoughts and behaviors?
Definitely. But change is always difficult.
And trust me when I tell you that you are worth it.
BPD isn't something that has to affect us all the time.
We can be more mindful, tolerate upsets with more ease,
learn to regulate our emotions,
and go on to have happy and healthy relationships.
And if you were someone that thinks that they may have BPD,
please find a therapist in your area who practices DBT
and possibly comes along with a group, too,
and know that it can and will get better.
Thank you so much for watching and I will see you next time.
(upbeat bright electronic music)