Improve Borderline Personality Disorder with Dialectical Behavior Therapy Mindfulness

Improve Borderline Personality Disorder with Dialectical Behavior Therapy Mindfulness

 

By John M. de Castro, Ph.D.

 

“People with borderline personality disorder can be challenging to treat, because of the nature of the disorder. They are difficult to keep in therapy, frequently fail to respond to our therapeutic efforts and make considerable demands on the emotional resources of the therapist, particular when suicidal behaviors are prominent. Dialectical Behavior Therapy is an innovative method of treatment that has been developed specifically to treat this difficult group of patients in a way which is optimistic and which preserves the morale of the therapist.” – Psych Central

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. Although the effectiveness of DBT for BPR is well established the most effective and cost effective means of delivering DBT has not been established.

 

In today’s Research News article “Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder: a pragmatic randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040072/ ), Sinnaeve and colleagues examine the effectiveness of DBT provided either as a Step-down DBT program or delivered on an out-patient basis. The Step-down DBT program consisted of 3 months of therapy as an inpatient and then 6 months as an outpatient. Outpatient DBT was delivered for 12 months completely on an outpatient basis. They recruited adult (18–45 years of age) patients with severe Borderline Personality Disorder (BPD) and randomly assigned them to either the step-down or outpatient program of Dialectical Behavior Therapy (DBT). They were measured at baseline and at 3, 6, 9, and 12 months of treatment for psychiatric symptoms, borderline personality disorder, suicidal thoughts, quality of life, and costs of therapy delivery.

 

They found that both programs were effective and produced significant decreases in the severity of Borderline Personality Disorder (BPD). But, the step-down program was far more effective in retaining participants with 95% of the participants who started the program completing it as opposed to only 45% of the out-patient participants completing the program. In addition, the step-down program patients had significant reductions in suicidal intentions and improvements in quality of life while the out-patient participants did not. Hence the step-down delivery of DBT was found to be significantly more effective than the outpatient DBT,

 

On the other hand, the step-down program was far more expensive to deliver; €19,899 per patient versus €12,472. To further investigate this the costs per Quality Adjusted Life Year (QALY) for both programs were calculated. QALY measures how much benefit (increase in quality of life) is produced per unit of cost. This analysis suggested that the step-down program was not as cost effective as the outpatient program. So, it would appear that although a step-down program is more effective it may not be as cost effective as a more traditional outpatient program. Regardless, Dialectical Behavior Therapy (DBT) was an effective treatment for severe Borderline Personality Disorder (BPD) regardless of delivery method.

 

So, improve borderline personality disorder with dialectical behavior therapy produced mindfulness.

 

“DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials, the most rigorous type of clinical research.“ – Kristalyn Salters

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sinnaeve, R., van den Bosch, L. M. C., Hakkaart-van Roijen, L., & Vansteelandt, K. (2018). Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder: a pragmatic randomized controlled trial. Borderline Personality Disorder and Emotion Dysregulation, 5, 12. http://doi.org/10.1186/s40479-018-0089-5

 

Abstract

Background

Step-down dialectical behaviour therapy (DBT) is a treatment consisting of 3 months of residential DBT plus 6 months of outpatient DBT. The program was specifically developed for people suffering from severe borderline personality disorder (BPD). The present study examines the effectiveness and cost-effectiveness of step-down DBT compared to 12 months of regular, outpatient DBT.

Methods

Eighty-four participants reporting high levels of BPD-symptoms (mean age 26 years, 95% female) were randomly assigned to step-down versus standard DBT. Measurements were conducted at baseline and after 3, 6, 9 and 12 months. The Lifetime Parasuicide Count and BPD Severity Index (BPDSI) were used to assess suicidal behaviour, non-suicidal self-injury (NSSI) and borderline severity. Costs per Quality Adjusted Life Year (QALY) were calculated using data from the EQ-5D-3L and the Treatment Inventory Cost in Psychiatric Patients (TIC-P).

Results

In step-down DBT, 95% of patients started the program, compared to 45% of patients in outpatient DBT. The probability of suicidal behaviour did not change significantly over 12 months. The probability of NSSI decreased significantly in step-down DBT, but not in outpatient DBT. BPDSI decreased significantly in both groups, with the improvement leveling off at the end of treatment. While step-down DBT was more effective in increasing quality of life, it also cost significantly more. The extra costs per gained QALY exceeded the €80,000 threshold that is considered acceptable for severely ill patients in the Netherlands.

Conclusions

A pragmatic randomized controlled trial in the Netherlands showed that 9 months of step-down DBT is an effective treatment for people suffering from severe levels of BPD. However, step-down DBT is not more effective than 12 months of outpatient DBT, nor is it more cost-effective. These findings should be considered tentative because of high noncompliance with the treatment assignment in outpatient DBT. Furthermore, the long-term effectiveness of step-down DBT, and moderators of treatment response, remain to be evaluated.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040072/

 

Improve Borderline Personality Disorder and Reduce Suicidal Thoughts with Mindfulness

Improve Borderline Personality Disorder and Reduce Suicidal Thoughts with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation encourages recognition of the wide palate of human emotions, but also keenly encourages one not to fixate on these temporary feelings. Work in mindfulness meditation includes labeling these emotions in a non-judgmental manner and allowing them to pass just as freely as they came. The misery and the suffering those with BPD experience in life often come from our denial of some of these emotions.” – Blaise Aguirre

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. BPD is dangerous as it can propel the sufferer, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives.

 

BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DBT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder (BPD). Mindfulness training has been found to be helpful intreating substance abuse and decreasing suicidal thoughts. Hence, there appears to be a relationship between mindfulness and Borderline Personality Disorder (BPD), substance abuse and suicidal thoughts.

 

In today’s Research News article “The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834542/, Shorey and colleagues recruited adult women with Borderline Personality Disorder (BPD) who were also undergoing treatment for substance abuse. The women completed measures of mindfulness, BPD features, including affective, identity problems, negative relationships, and self-harm, suicidal thoughts, alcohol abuse, drug use, and impression management. They then conducted regression analyses to investigate the relationship between mindfulness and BPD, suicidality, and drug use.

 

They found that in these patients the higher the levels of mindfulness the lower the levels of BPD features, including affective, identity problems, negative relationships, and self-harm, the lower the levels of suicidal thoughts, and the higher the levels of impression management. Hence, mindfulness was significantly negatively associated with BPD symptoms and suicidality. These relationships, with the exception of self-harm, remained significant even after statistically accounting for alcohol use, drug use, age, and impression management.

 

These results suggest that mindfulness may be an antidote to Borderline Personality Disorder (BPD) symptoms and suicidal thoughts. It is possible that this results from the ability of mindfulness to improve emotion regulation. Mindful people to experience their emotions deeply but are able to respond to them rationally and adaptively. Characteristically, patients with BPD avoid experiencing negative emotions. So, mindfulness, by promoting the experience of these emotions may counteract one of the core features of BPD.

 

It should be recognized that these results are correlational. So, causality cannot be determined. But, since Dialectical Behavior Therapy (DBT) which contains mindfulness training is the only known therapy that has been shown to be effective for BPD. It would seem reasonable to suggest that mindfulness causes changes in BPD symptoms. A randomized clinical trial of mindfulness training for BPD symptoms and suicidality should be conducted in the future to test these ideas. The potential for mindfulness training to improve the symptoms of this devastating and dangerous mental illness mandates that such a trial be conducted.

 

So, improve borderline personality disorder and reduce suicidal thoughts with mindfulness.

 

“Mindfulness meditation training can help people with BPD to feel less “stuck” in their emotions, and less judgmental of the emotions and themselves. Mindfulness meditation training may also help individuals with BPD be more effective in applying healthy coping skills in the midst of emotional pain, because mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.” – Line Goguen-Hughes

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Shorey, R. C., Elmquist, J., Wolford-Clevenger, C., Gawrysiak, M. J., Anderson, S., & Stuart, G. L. (2016). The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment. Psychiatry Research, 238, 122–128. http://doi.org/10.1016/j.psychres.2016.02.040

 

Highlights

  • Theory suggests mindfulness is inversely related to BPD/suicidal ideation
  • We investigated this in a sample of women in treatment for substance use
  • Dispositional mindfulness was negatively associated with BPD
  • Dispositional mindfulness was negatively associated with suicidal ideation

Abstract

Borderline personality disorder (BPD), which is characterized by unstable moods, behavior, and relationships, is also associated with heightened suicidal ideation. Prior research has demonstrated that BPD and suicidal ideation are prevalent among women in substance use treatment. Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation among women in treatment for substance use to support their associations, which was the purpose of the present study. Pre-existing medical records were reviewed from a residential substance use treatment center. A total of 81 female patients were included in the current study. Patients completed self-report measures of mindfulness, BPD, suicidal ideation, substance use, and impression management at treatment intake. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. Future research should examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834542/

Fluctuations in Mindfulness Occur with Fluctuations in Borderline Personality Disorder Symptoms.

Fluctuations in Mindfulness Occur with Fluctuations in Borderline Personality Disorder Symptoms.

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation encourages recognition of the wide palate of human emotions, but also keenly encourages one not to fixate on these temporary feelings. Work in mindfulness meditation includes labeling these emotions in a non-judgmental manner and allowing them to pass just as freely as they came. The misery and the suffering we (and especially those with BPD) experience in life often come from our denial of some of these emotions.” – Shannon Fitzgerald

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. In addition, 30 to 90 % of BPD cases are associated with high rates of early traumatic experiences including sexual, physical and emotional abuse. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. BPD is dangerous as it can propel the sufferer, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives.  Needless to say, it is widespread, debilitating, and markedly reduces health and health related quality of life.

 

BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DBT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder and impulsivity. A characterizing feature of Borderline Personality Disorder (BPD) is instability, with huge swings in moods and thoughts, leading to impulsive behaviors. It is not known what produces this instability. But since mindfulness is known to affect BPD symptoms it is possible that fluctuations in mindfulness leads to fluctuations in BPD symptoms.

 

In today’s Research News article “Weekly fluctuations in nonjudging predict borderline personality disorder feature expression in women.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876819/

Eisenlohr-Moul and colleagues recruited female undergraduate students and measured them for Borderline Personality Disorder (BPD) features and mindfulness. To insure a wide range of BPD symptom severities, they recruited four groups based upon BPD symptom severity (low, low average, high average, and high). To investigate symptom fluctuations over time, the participants were measured weekly for four weeks for mindfulness, BPD symptom severity, and BPD symptoms, including affective instability, identity problems, negative relationships, and self-harm.

 

They found that high levels of three mindfulness facets, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience, predicted lower levels of BPD features, affective instability, identity problems, negative relationships. Hence, overall, mindfulness is associated with lower emotional and behavioral symptoms of BPD. They then looked at weekly fluctuations of mindfulness and their associations with BPD symptoms and found that high levels of nonjudging predicted lower weekly BPD symptom expression, including weekly self-harm scores. Hence, weekly fluctuations in BPD symptoms were associated negatively with weekly fluctuations in the nonjudging facet of mindfulness.

 

These are interesting results that for the first time look at the potential source of the instability in mood and behavior so characteristic of Borderline Personality Disorder (BPD). They suggest that changes in mindfulness, especially nonjudging may be at least in part responsible. This is compatible with other findings that mindfulness in general is associated with emotion regulation, lower impulsivity, and positive relationships.

 

These findings suggest a speculation that when the individual judges their experience to a greater extent than usual it may precipitate self-recriminations producing shifts in mood and behavior. It should be noted, however, that this study is correlational, so no conclusions about causation can be made. It is equally likely that fluctuations in BPD symptoms shift mindfulness. Regardless, the study is a step forward in identifying why there is so much variability in the emotions and behaviors of individuals with Borderline Personality Disorder (BPD).

 

“Mindfulness meditation training can help people with BPD to feel less “stuck” in their emotions, and less judgmental of the emotions and themselves. Mindfulness meditation training may also help individuals with BPD be more effective in applying healthy coping skills in the midst of emotional pain, because mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.” – Line Goguen-Hughes

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Eisenlohr-Moul, T., Peters, J. R., Chamberlain, K. D., & Rodriguez, M. (2016). Weekly fluctuations in nonjudging predict borderline personality disorder feature expression in women. Journal of Psychopathology and Behavioral Assessment, 38(1), 149–157. http://doi.org/10.1007/s10862-015-9505-y

 

Abstract

Objectives

Borderline personality disorder (BPD) features have been linked to deficits in mindfulness, or nonjudgmental attention to present-moment stimuli. However, no previous work has examined the role of fluctuations in mindfulness over time in predicting BPD features. The present study examines the impact of both between-person differences and within-person changes in mindfulness.

Design

40 women recruited to achieve a flat distribution of BPD features completed 4 weekly assessments of mindfulness (Five Facet Mindfulness Questionnaire; FFMQ) and BPD features. Multilevel models predicted each outcome from both 1) a person’s average levels of each facet and 2) weekly deviations from a person’s average for each facet.

Results

Average acting with awareness, nonjudging, and nonreactivity predicted lower BPD features at the between-person level, and weekly deviations above one’s average (i.e., higher-than-usual) nonjudging predicted lower BPD feature expression at the within-person level.

Conclusions

Within-person fluctuations in the nonjudging facet of mindfulness may be relevant to the daily expression of BPD features over and above dispositional mindfulness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876819/

 

Improve Borderline Personality Disorder Therapy with Virtual Reality

Image may contain: one or more people, phone, indoor and closeup

 

By John M. de Castro, Ph.D.

 

“Through virtual reality, the brain can succumb to compelling evidence that you are actually somewhere else. . . not only putting users in a relaxing location, but also completing the exercises, can shift your mood and teach you to live a more mindful life — overcoming the stresses encountered in everyday life.” – Naomi Cornman

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DPT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.

 

Technology is recently becoming applied to training in mindfulness. Indeed, mindfulness training carried out completely on-line has been shown to be effective for as number of conditions. But, now virtual reality (VR) devices are improving and becoming readily available. Previously it has been shown the virtual reality (VR) can be helpful in treating phobias. It is not known, however, if VR can be used in mindfulness training and in the treatment of Borderline Personality Disorder (BPD).

 

In today’s Research News article “The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1429942637029658/?type=3&theater

or see summary below or view the full text of the study at:

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.01573/full?utm_source=newsletter&utm_medium=email&utm_campaign=Psychology-w45-2016

Nararro-Haro and colleagues performed a single subject case study of the use of VR to potentiate the effects of the mindfulness training used in Borderline Personality Disorder (BPD). The participant was a 32-year old woman who was diagnosed with BPD. She was being treated with Dialectical Behavior Therapy (DBT) but was having difficulty with the mindfulness component of DBT. In addition to the standard DBT virtual reality (VR) of floating down a gentle river was used along with the DBT mindfulness audio tracks. The participant was measured during and after training for mindfulness, mood, urges and dysfunctional behaviors.

 

After treatment, the participant had marked reductions in urges to commit suicide, harm herself, quit therapy, and substance abuse. In addition, she had markedly reduced negative emotions. These results are encouraging but there was only a single subject, there was no control condition, and there was no follow-up. So, no firm conclusions about effectiveness can be reached. But the results demonstrate that virtual reality can be employed to help potentiate the effectiveness of therapy of Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (BPD).

 

So, improve borderline personality disorder therapy with virtual reality

 

“Traditional exposure therapy is easier to do when the phobia is of something common and easily accessible. A person afraid of dogs can visit a neighbor’s dog. An agoraphobic can slowly venture outside for short periods of time. But treating phobias like fear of flying or fear of sharks with traditional exposure therapy may be expensive or impractical in real life. That’s where VR has a major advantage. Treating PTSD with VR works similarly, exposing patients to a simulation of a feared situation (a battle in Iraq, for example), and appears to be just as effective.” –  Emily Matchar

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Nararro-Haro MV, Hoffman HG, Garcia-Palacios A, Sampaio M, Alhalabi W, Hall K and Linehan M (2016) The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study. Front. Psychol. 7:1573. doi: 10.3389/fpsyg.2016.01573

 

Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resources. Most patients with BPD never receive DBT®. Incorporating computer technology into the DBT® could help increase dissemination. Immersive Virtual Reality technology (VR) is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly “floating down” a 3D computer-generated river while listening to DBT® mindfulness training audios. Urges to commit suicide, urges to self harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session and VR mindfulness was well accepted/liked by the patient. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT® skills treatment modules would reduce cost and increase dissemination.

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.01573/full?utm_source=newsletter&utm_medium=email&utm_campaign=Psychology-w45-2016

 

Improve Quality of Life in Borderline Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“One problem that clients with borderline personality disorder face is that their behaviors are often ruled by emotions. This frequently leads to destructive behaviors such as drug use, risky sexual encounters, and self-injury. The goal of mindfulness as used in DBT is to get patients to recognize these patterns so they can act more thoughtfully.”Christina Olenchek

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. In addition, 30 to 90 % of BPD cases are associated with high rates of early traumatic experiences including sexual, physical and emotional abuse. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. BPD is dangerous as it can propel the sufferer, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives.  Needless to say it is widespread, debilitating, and markedly reduces health and health related quality of life.

 

BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DBT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder and impulsivity. The effectiveness of DBT has been only demonstrated in adults. But Borderline Personality Disorder (BPD) also can occur in adolescents. But, it is not known if DBT may be effective for adolescents with BPD and can improve their health and quality of life.

 

In today’s Research News article “Health related quality of life for young people receiving dialectical behaviour therapy (DBT): a routine outcome-monitoring pilot.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1370544862969436/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954798/

Swales and colleagues received and summarized data from 4 different programs that administered Dialectical Behavior Therapy (DBT) to adolescents with Borderline Personality Disorder (BPD). They obtained health status data including mobility, self-care, usual activities, pain or discomfort and anxiety and depression. They found that DBT produced a significant improvement in health status and health related quality of life with a clinically significant large effect size. Comparison of these results to those obtained in other studies with adults indicated that the results for the adolescents were comparable or better.

 

These are interesting findings but they suffer from the lack of a control comparison condition. It should be kept in mind, however, that Borderline Personality Disorder (BPD) rarely improves even with other forms of treatment. So, it is unlikely that these youths spontaneously got better or responded to a placebo effect. The results are important in that they demonstrate for the first time that DBT is effective for BPD in adolescents, improving their health and health related quality of life. Hence, mindfulness training appears to be an important of successful treatment of Borderline Personality Disorder (BPD) in adolescents.

 

So, improve quality of life in borderline patients with mindfulness.

 

“Many people with BPD have comorbid conditions, which often include mood disorders, anxiety disorders, or substance-use disorders. Studies show that mindfulness helps for many of these.” – Blaise Aguirre

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Swales, M., Hibbs, R. A. B., Bryning, L., & Hastings, R. P. (2016). Health related quality of life for young people receiving dialectical behaviour therapy (DBT): a routine outcome-monitoring pilot. SpringerPlus, 5(1), 1137. http://doi.org/10.1186/s40064-016-2826-9

 

Abstract

Purpose: Adults presenting with borderline personality disorder (BPD) score poorly on measures of health related quality of life (HRQoL). Little is known about HRQoL in adolescents with BPD type presentations and how treatment impacts quality of life. Our primary aim was to use routinely collected quality-of-life outcome measures pre and post-treatment in dialectical behaviour therapy (DBT) for adolescents to address this gap. Secondary aims were to benchmark these data against EuroQol 5 dimensions (EQ-5D™) outcomes for clients treated in clinical trials and to assess the potential of the EQ-5D™ as a benchmarking tool.

Method: Four adolescent DBT teams, routinely collecting outcome data using a pseudonymised secure web-based system, supplied data from consecutive discharges.

Results: Young people in the DBT programmes (n = 43) had severely impaired HRQoL scores that were lower at programme admission than those reported in published studies using the EQ-5D™ in adults with a BPD diagnosis and in one study of adolescents treated for depression. 40 % of adolescents treated achieved Reliable Clinical Change. HRQoL improved between admission and discharge with a large effect size. These results were not statistically significant when clustering in programme outcomes was accounted for.

Conclusion: Young people treated in NHS DBT programmes for BPD type presentations had poorer HRQoL than adults with a BPD diagnosis and adolescents with depression treated in published clinical trials. The EQ-5D™ detected reliable change in this group of adolescents. Programme outcome clustering suggests that both the measure and the web-based monitoring system provide a mechanism for benchmarking clinical programmes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954798/

 

Blink Less with Long-Term Meditation

Meditation Eye Blink2 Kruis

 

By John M. de Castro, Ph.D.

 

“The emotional effects of sitting quieting and going within are profound. The deep state of rest produced by meditation triggers the brain to release neurotransmitters, including dopamine, serotonin, oxytocin, and endorphins. Each of these naturally occurring brain chemicals has been linked to different aspects of happiness” – Chopra Center

 

Contemplative practices produce improvements to the practitioners’ ability to think (cognition), their ability to regulate emotions, and to their mental health. They also produce marked changes to the nervous system including the size, activity, and connectivity of structures in the brain. All of these brain structures rely on neurotransmitters for communications between their cells (neurons). These are special molecules that transmit the signals between neurons. Without them, the brain would cease to function.

 

Dopamine is a neurotransmitter that is distributed throughout the brain and appears to be involved in a wide variety of brain functions. It is classified as a neuromodulator. That is, it alters the overall activity levels of widespread areas of the nervous system. As a result, it is involved in a wide variety of functions including pleasure, motor function, thinking, memory, motivation, arousal, and activation. In other words, its involved in most everything. Dysfunction in the dopamine system has been associated with a number of physical and mental diseases, including Parkinson’s Disease, Schizophrenia, and ADHD.

 

Dopamine, like most neurotransmitters is difficult to measure as it is released in miniscule quantities and is broken down very quickly. In living humans its activity can be indirectly measured by measuring the rate and pattern of eye blinks. It has been shown that dopamine is particularly involved in the control of the eyelid and blinking, with high blink rates associated with high levels of dopamine and low rates with low levels. In today’s Research News article “Effects of meditation practice on spontaneous eyeblink rate”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1186584258032165/?type=3&theater

Kruis and colleagues take advantage of this association of dopamine with eye blink rates to indirectly measure the effects of meditation on brain dopamine levels. They compared long-term meditators (at least 3-years of experience with meditation naïve participants. The naïve participants were then randomly assigned to an 8-week Mindfulness Based Stress Reduction (MBSR) training, and 8-week health education program, or a no-treatment control group.

 

They found that long-term meditators had significantly slower blink rates than meditation naïve participants and also they had a different pattern of blinks, with longer periods without eye blinks, interrupted by short periods of frequent blinks. It didn’t matter what type of meditation that they engaged in. The slower rate and different pattern of eye blinks are indicative of lower levels of dopamine in the brains of long-term-meditators. Eight-weeks of MBSR or health education did not change eye blink rates or pattern. This suggests that short-term meditation practice is insufficient to significantly alter dopamine levels.

 

The results are interesting and suggest that in addition to the known effects of meditation on brain structures it also appears to affect neurochemistry. In particular, the results suggest that meditation can change the overall levels of an important neuromodulator, dopamine. It can be speculated that this effects of long term meditation on a transmitter with widespread activity and function may, at least in part, be responsible for meditations widespread effects on physical and mental health of practitioners. It should be pointed out, however, that 8-weeks of Mindfulness Based Stress Reduction (MBSR) training is sufficient to produce many of the effects of meditation on physical and mental health. Since, Dopamine levels were not affected by 8-weeks of MBSR training the change in dopamine levels are probably not responsible for these effects. It remains for future research to further explore this tantalizing speculation.

 

So, blink less with long-term meditation.

 

“if you learn how to properly meditate, and commit to a daily practice, you will alter concentrations of various neurotransmitters, including dopamine.  There is evidence in particular that mindfulness meditation is capable of increasing signaling in areas of the brain involved in emotional regulation and control of attention.” – Mental Health Daily

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Be Less Impulsive with Mindfulness

“The antithetical nature of mindfulness and automatic or impulsive behaviors provides theoretical promise for the efficacy of mindfulness skills in the treatment of impulse control disorders.” – Kelcey J. Stratton

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. In addition, 30 to 90 % of BPD cases are associated with high rates of early traumatic experiences including sexual, physical and emotional abuse. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say it is widespread and debilitating.

 

Many of these symptoms occur in other mental illnesses. Impulsivity, however, distinguishes BPD from other disorders. In addition, it is the reason that the disorder is dangerous to the individuals as it can propel them, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives. BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DPT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder and impulsivity. Indeed, BPD sufferers who are high in mindfulness tend to be low in impulsivity. It would make sense, then, that the mindfulness training occurring in Dialectical Behavior Therapy (DPT) may be an effective treatment for the dangerous symptom of impulsivity.

 

In today’s Research News article “Effects of mindfulness training on different components of impulsivity in borderline personality disorder: results from a pilot randomized study”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709962/

Soler and colleagues randomly assigned Borderline Personality Disorder (BPD) patients to receive 10-weeks of Dialectical Behavior Therapy (DPT) which was modified to include only Mindfulness Training (MT) or Interpersonal Effectiveness Training (IE). IE is designed to teach patients how to act more effectively in interpersonal interactions. They found that only the Mindfulness Training group showed a significant improvement in three self-reported aspects of impulsivity, motor impulsiveness (acting without forethought); attentional impulsiveness (the tendency to make quick, non-reflexive decisions), and non-planning impulsiveness (failure to prepare for future events). They also measured impulsivity with a series of laboratory tests designed to measure various aspects of impulsivity. They found that the Mindfulness Training group showed improvements in delaying gratification and in time perception.

 

These results are interesting. They suggest that the Mindfulness Training component of Dialectical Behavior Therapy (DPT) may be effective in treating the impulsivity characteristic of Borderline Personality Disorder (BPD) by improving the patients’ ability to delay gratification. Improved time perception may be responsible for better ability to delay gratification. It is important to note that impulsivity usually involves an inability to wait to get what is wanted. So, improved ability to delay gratification would be antithetical to impulsiveness. This may be the underlying mechanism by which mindfulness reduces impulsivity.

 

As mentioned BPD is a difficult disorder to treat and potentially dangerous to the self and others. It appears that the distinctive feature of BPD, impulsivity, is improved by DBT and that it is the mindfulness training that is responsible. This is particularly important as impulsivity is primarily responsible for the dangerous behaviors of BPD sufferers. It also appears that the mindfulness training acts to reduce impulsivity by improving time perception and the ability to delay gratification.

 

Impulsivity produces actions reflexively without awareness. Mindfulness training by improving the individual’s awareness of the immediate situation would tend to counteract impulsive action. So, mindfulness training may be essential to DBT’s ability to reduce impulsiveness by making the individual more aware of what they are doing. One cannot be mindful and impulsive at the same time.

 

So, be less impulsive with mindfulness.

 

“Decreased impulsivity has significant and wide implications for those suffering from it. This includes less general psychiatric morbidity, improved substance use outcomes, and general improvement in decision making skills, affecting every area of a person’s life in meaningful ways.” – Gisli Kristofersson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Trauma May Reduce Mindfulness

 

“People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” ― Marsha M. Linehan

 

Borderline personality disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say it is widespread and debilitating.

 

BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (BPT). It is interesting that DBT emphasizes mindfulness. This suggests that there may be a relationship between the etiology of Borderline Personality Disorder and mindfulness. In addition 30 to 90 % of BPD cases are associated with high rates of early traumatic experiences including sexual, physical and emotional abuse. Also, mindfulness has been shown to reduce the impact of trauma on the individual http://contemplative-studies.org/wp/index.php/2015/07/17/dont-be-afraid-2-dealing-with-trauma/. All of this suggests that childhood trauma may affect BPD by lowering mindfulness.

 

In today’s Research News article “Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships.”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1091537470870178/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518520/

Elices and colleagues measure childhood trauma, personality and mindfulness in a sample of individuals with relatively severe Borderline Personality Disorder (BPD). They found, although did not report, that the degree of mindfulness measured was very low in the BPD sample than occurs in the general population. They also reported high levels of childhood trauma in the BPD sample.

 

One of the most interesting findings was that the mindfulness characteristics of acting with awareness and non-judging were negatively associated with childhood trauma, but only with sexual abuse. That is for individual with BPD who experienced sexual abuse in childhood there were lower levels of acting with awareness and non-judging than with BPD sufferers who didn’t experience this form of trauma. Given the mindfulness scores were low to begin with and that sexual abuse is negatively associated with mindfulness, suggests that trauma may make a bad situation worse.

 

These are very preliminary results and do not clearly make a case for childhood trauma affecting Borderline Personality Disorder by lowering mindfulness, the results are compatible with this idea. It obviously needs to be explored further.

 

So, improve mindfulness to combat the effects of trauma.

 

“Thirty seconds of pure awareness is a long time, especially after a lifetime of escaping yourself at all costs.” ― Kiera Van Gelder

 

CMCS – Center for Mindfulness and Contemplative Studies