Improve Borderline Personality Disorder with Mindfulness

Improve Borderline Personality Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

DBT . . . is considered one of the best treatments for [Borderline Personality Disorder] in terms of documented success rates. . . [Borderline Personality Disorder] is effective in reducing psychiatric hospitalization, substance use, and suicidal behavior. . .  self-injurious behaviors, and the severity of borderline symptoms.” – Kristalyn Salters-Pedneault

 

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. About ¾ of BPD patients engage in self-injurious behaviors.

 

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. The research regarding the effectiveness of DBT reduces for BPD patients has been accumulating. So, it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Psychological therapies for people with borderline personality disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199382/ ) Storebø and colleagues review and summarize the published randomized controlled trials on the effectiveness of Dialectical Behavior Therapy (DBT). for the treatment of Borderline Personality Disorder (BPD). They found 25 randomized controlled trials.

 

They report that the published research found that Dialectical Behavior Therapy (DBT) compared to treatment as usual, wait-list controls, and no-treatment produced significantly greater reductions in Borderline Personality Disorder (BPD) severity, self-harm, anger, impulsivity, dissociation, psychotic-like symptoms, and emotional instability and significantly greater increases in psychological functioning. There were no significant differences in adverse events between DBT and controls.

 

The published research clearly demonstrates that Dialectical Behavior Therapy (DBT) is a safe and effective treatment for Borderline Personality Disorder (BPD).

 

“‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it’s possible for you to achieve both these goals together.” – Mind

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews, 5(5), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2

 

Abstract

Background

Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers‐Winterling 2012).

Objectives

To assess the beneficial and harmful effects of psychological therapies for people with BPD.

Search methods

In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication.

Selection criteria

Randomised controlled trials comparing different psychotherapeutic interventions with treatment‐as‐usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self‐harm, suicide‐related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects.

Data collection and analysis

At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane’s ‘Risk of bias’ tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis.

Main results

We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation‐based treatment (MBT). The comparator interventions included treatment‐as‐usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months.

Psychotherapy versus TAU

Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) −0.52, 95% confidence interval (CI) −0.70 to −0.33; 22 trials, 1244 participants; moderate‐quality evidence. This corresponds to a mean difference (MD) of −3.6 (95% CI −4.4 to −2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is −3.0 points).

Psychotherapy may be more effective at reducing self‐harm compared to TAU (SMD −0.32, 95% CI −0.49 to −0.14; 13 trials, 616 participants; low‐quality evidence), corresponding to a MD of −0.82 (95% CI −1.25 to 0.35) on the Deliberate Self‐Harm Inventory Scale (range 0 to 34). The MIREDIF of −1.25 points was not reached.

Suicide‐related outcomes improved compared to TAU (SMD −0.34, 95% CI −0.57 to −0.11; 13 trials, 666 participants; low‐quality evidence), corresponding to a MD of −0.11 (95% CI −0.19 to −0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of −0.17 points was not reached.

Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD −0.45, 95% CI −0.68 to −0.22; 22 trials, 1314 participants; low‐quality evidence), corresponding to a MD of −2.8 (95% CI −4.25 to −1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of −4.0 points was not reached.

Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases.

A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning.

Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD −0.39, 95% CI −0.61 to −0.17; 22 trials, 1568 participants; very low‐quality evidence), corresponding to a MD of −2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of −3.0 points was not reached.

BPD‐specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data.

Psychotherapy versus waiting list or no treatment

Greater improvements in BPD symptom severity (SMD −0.49, 95% CI −0.93 to −0.05; 3 trials, 161 participants), psychosocial functioning (SMD −0.56, 95% CI −1.01 to −0.11; 5 trials, 219 participants), and depression (SMD −1.28, 95% CI −2.21 to −0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low‐quality evidence). No evidence of a difference was found for self‐harm and suicide‐related outcomes.

Individual treatment approaches

DBT and MBT have the highest numbers of primary trials, with DBT as subject of one‐third of all included trials, followed by MBT with seven RCTs.

Compared to TAU, DBT was more effective at reducing BPD severity (SMD −0.60, 95% CI −1.05 to −0.14; 3 trials, 149 participants), self‐harm (SMD −0.28, 95% CI −0.48 to −0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD −0.36, 95% CI −0.69 to −0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self‐harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD −0.58, 95% CI −1.22 to 0.05, 4 trials, 333 participants). All findings are based on low‐quality evidence. For secondary outcomes see review text.

Authors’ conclusions

Our assessments showed beneficial effects on all primary outcomes in favour of BPD‐tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF‐defined cut‐off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) .

The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low‐quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self‐harm and suicide‐related outcomes.

However, compared to TAU, we observed effects in favour of DBT for BPD severity, self‐harm and psychosocial functioning and, for MBT, on self‐harm and suicidality at end of treatment, but these were all based on low‐quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.

Go to:

Plain language summary

Psychological therapies for people with borderline personality disorder

Background

People affected by borderline personality disorder (BPD) often have difficulties with controlling their impulses and emotions. They may have a poor self‐image, experience rapid changes in mood, harm themselves and find it hard to engage in harmonious interpersonal relationships. Different types of psychological treatments (‘talking treatments’) have been developed to help people with BPD. The effects of these treatments must be investigated to decide how well they work and if they can be harmful.

Objective

This review summarises what we currently know about the effect of psychotherapy in people with BPD.

Methods

We compared the effects of psychological treatments on people affected by BPD who did not receive treatment or who continued their usual treatment, were on a waiting list or received active treatment.

Findings

We searched for relevant research articles, and found 75 trials (4507 participants, mostly female, mean age ranging from 14.8 to 45.7 years). The trials examined a wide variety of psychological treatments (over 16 different types). They were mostly conducted in outpatient settings, and lasted between one and 36 months. Dialectical behaviour Therapy (DBT) and Mentalisation‐Based Treatment (MBT) were the therapies most studied.

Psychotherapy compared with usual treatment

Psychotherapy reduced the severity of BPD symptoms and suicidality and may reduce self‐harm and depression whilst also improving psychological functioning compared to usual treatment. DBT may be better than usual treatment at reducing BPD severity, self‐harm and improving psychosocial functioning. Similarly, MBT appears to be more effective than usual treatment at reducing self‐harm, suicidality and depression. However, these findings were all based on low‐quality evidence and therefore we are uncertain whether or not these results would change if we added more trials. Most trials did not report adverse effects, and those that did, found no obvious unwanted reactions following psychological treatment. The majority of trials (64 out of 75) were funded by grants from universities, authorities or research foundations. Four trials reported that no funding was received. For the remaining trials (7), funding was not specified.

Psychotherapy versus waiting list or no treatment

Psychotherapy was more effective than waiting list at improving BPD symptoms, psychosocial functioning, and depression, but there was no clear difference between psychotherapy, and waiting list for outcomes of self‐harm, and suicide‐related outcomes.

Conclusions

In general, psychotherapy may be more effective than usual treatment in reducing BPD symptom severity, self‐harm, suicide‐related outcomes and depression, whilst also improving psychosocial functioning. However, only the decrease in BPD symptom severity was found to be at a clinically important level. DBT appears to be better at reducing BPD severity, self‐harm, and improving psychosocial functioning compared to usual treatment and MBT appears more effective than usual treatment at reducing self‐harm and suicidality. However, we are still uncertain about these findings as the quality of the evidence is low.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199382/

 

Reduce Self-Harm and Suicidality in Adolescents with Mindfulness

Reduce Self-Harm and Suicidality in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

“growing evidence supports DBT-A as a likely viable treatment intervention for adolescents who self-harm.” – Kimberly R. Freeman

 

Around 43,000 people take their own lives each year in the US. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Indeed, suicide is the second leading cause of death in adolescents.

 

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years.

 

One of the few treatments that appears to be Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic 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. DBT has been found to reduce self-injurious behaviors. The data is accumulating so there is a need to review and summarize what has been found.

 

In today’s Research News article “Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188531/ ) Kothgassner and colleagues review, summarize, and perform a meta-analysis of the published research literature on the effectiveness of Dialectical Behavior Therapy (DBT) for the treatment of self-harm and suicidality in adolescents.

 

They identified 21 published research studies encompassing 1673 adolescents. They report that the published research found that Dialectical Behavior Therapy (DBT) resulted in significant reductions in self-harm and suicide ideation in the adolescents. They further found that the longer the duration of DBT treatment the greater the reductions in suicidal ideation.

 

This summary of the published research studies suggests that Dialectical Behavior Therapy (DBT) is a safe and effective treatment for the reduction of self-harm and suicidal thoughts in adolescents. Since, suicide is the second leading cause of death in adolescents and has increased substantially over the last decade, a treatment that can help reduce these rates is needed. The present results suggest that DBT with its associated training in mindfulness may be able to address this need.

 

So, reduce self-harm and suicidality in adolescents with mindfulness.

 

the DBT-A group experienced fewer episodes of self-harm. . . as well as statistically significant reductions in suicidal ideation and depression (both of which are risk factors for suicide).” – Suicide Prevention Resource Center

 

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

 

Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological medicine, 51(7), 1057–1067. https://doi.org/10.1017/S0033291721001355

 

Abstract

Background

Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.

Methods

We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.

Results

Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63).

Conclusions

DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188531/

 

Reduce Self-Harm in Patients with Borderline Personality Disorder with Mindfulness

Reduce Self-Harm in Patients with Borderline Personality Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Dialectical Behavior Therapy group skills training was associated with a reduction in non-suicidal self-injury in patients with Borderline Personality Disorder.” – Gary Rothbard

 

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years. Frequently, untreated depression and other mental health challenges create an environment of despair that leads people to cope with these challenges in unhealthy ways. Nearly 50 percent of those who engage in self-injury have been sexually abused.

 

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. About ¾ of BPD patients engage in self-injurious behaviors.

 

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. DBT reduces self-injurious behaviors in BPD patients.

 

In today’s Research News article “Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952764/ ) Westad and colleagues recruited adults with subthreshold Borderline Personality Disorder (BPD) and provided them with 1 hour individual therapy and 2.5 hours of group skills training per week for 8 weeks of Dialectical Behavior Therapy (DBT). Prior to treatment they were assessed for personality and clinical symptoms. Before and after treatment they were measured for self-harm and suicidal behaviors, depression, hopelessness, personality disorders, quality of life, general health, and psychological, social, and occupational functioning.

 

They found that over the first year following therapy 94% of the patients ceased self-harm behaviors in an average of 16 weeks. Compared to baseline, following treatment the patients had significant increases in quality of life and functioning and significant decreases in depression, hopelessness, and personality disorders. A comparison of patients who reduced self-harm behaviors quickly to those who took longer for the reduction did not reveal any significant differences.

 

In the present study there wasn’t a control condition. So, alternative confounding interpretations are present. But the findings replicate previous controlled work that Dialectical Behavior Therapy (DBT) produces significant improvement in Borderline Personality Disorder and reductions in self-harm behaviors. So, the results of the present study are likely to due to DBT alone. The findings expand knowledge in that they demonstrate the effectiveness of DBT for patients who are subthreshold for BPD.

 

Dialectical Behavior Therapy (DBT) is one of very few treatments that are effective for Borderline Personality Disorder (BPD). But DBT is a complex therapy that includes mindfulness and other significant components. So, it is unclear which components or combination of components are necessary and sufficient for the clinical benefits.

 

So, reduce self-harm in patients with borderline personality disorder with mindfulness.

 

DBT might provide an effective treatment for severe self-harm in institutional settings.” – Gail Skillington

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Yngvill Ane Stokke Westad, Kristen Hagen, Egil Jonsbu, Stian Solem. Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy, Front Psychol. 2021; 12: 578230. Published online 2021 Feb 26. doi: 0.3389/fpsyg.2021.578230

 

Abstract

The first aim of the study was to identify when deliberate self-harm (DSH) behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment (DBT). The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 participants where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early (up to 8 weeks) and late (8+ weeks) responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority (93.5%) ceased their self-harming within the first year, and the average number of weeks was 15.5 (SD = 17.8). Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952764/

 

Change Behavior for the Better with Mindfulness

Change Behavior for the Better with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness practice supports and facilitates behavior change through training attention, emotion, and self-awareness.” – Yi-Yuan Tang

 

We tend to think that illness is produced by physical causes, disease, injury, viruses, bacteria, etc. But many health problems are behavioral problems or have their origins in maladaptive behavior. This is evident in car accident injuries that are frequently due to behaviors, such as texting while driving, driving too fast or aggressively, or driving drunk. Other problematic behaviors are cigarette smoking, alcoholism, drug use, or unprotected sex.

 

Problems can also be produced by lack of appropriate behavior such as sedentary lifestyle, not eating a healthy diet, not getting sufficient sleep or rest, or failing to take medications according to the physician’s orders. Additionally, behavioral issues can be subtle contributors to disease such as denying a problem and failing to see a physician timely or not washing hands. In fact, many modern health issues, costing the individual or society billions of dollars each year, and reducing longevity, are largely preventable.

 

Hence, promoting healthy behaviors and eliminating unhealthy ones has the potential to markedly improve health. Mindfulness training has been shown to promote health and improve illness. It is well established that mindfulness can improve healthy behaviors. The research has been accumulating. So, it is reasonable to stop and summarize what has been learned. In today’s Research News article “Mindfulness and Behavior Change.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647439/ )  Schuman-Olivier and colleagues review and summarize the published research on the ability of mindfulness training to promote healthy behaviors.

 

They report that the published studies found that mindfulness training reduces cravings and produces improvements in alcohol and substance abuse disorders, binge eating disorder, obesity, improves smoking cessation, reduces emotional eating and eating when not hungry and produces weight reduction. Mindfulness training has been shown to improve self-management of chronic diseases, including hypertension, COPD, and diabetes and results in improvements in quality of life and reductions in anxiety and depression. Mindfulness training also reduces impulsive behavior, risky sexual behavior, aggression, and violent behaviors. It also reduces self-injury, suicidal thinking, and suicidal behavior.

 

The authors go on to produce and discuss a model of how mindfulness training may be improving troubling behaviors. They speculate that mindfulness training produces a general improvement in self-regulation which results in improved control of behavior. This self-regulation is produced by improvements in attention and cognitive control, emotion regulation, and self-related processes, as well as motivation and learning ability. Regardless, it is clear that mindfulness training improves behaviors that can lead to or exacerbate illness. It’s actually amazing that such simple practices can have such profound and widespread effects in promoting health and well-being and treating diseases.

 

So, change behavior for the better with mindfulness.

 

On your path to create change invite compassion and embrace and accept where you are. Only from a place of compassion will your efforts move into fruition. What is the next compassionate step you can make towards this change today?” – Carley Hauck

 

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

 

Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020). Mindfulness and Behavior Change. Harvard review of psychiatry, 28(6), 371–394. https://doi.org/10.1097/HRP.0000000000000277

 

Abstract

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

CONCLUSION

A growing evidence base supports the benefits of mindfulness for behavior change. A mindful self-regulation model based on an integration of neuroscientific findings describes the complex and synergistic effects of attention/cognitive control, emotion regulation, and self-related processes, as well as motivation and learning mechanisms that may provide a unique pathway toward sustainable behavior change. While evidence supports the impact of mindfulness on behavior change for key health behaviors related to psychiatric practice, more high-quality research is needed, especially with objective measures, larger samples, replication studies, active controls, and formal monitoring of adverse events.474 The field will also benefit from additional research on the impact of integrating compassion practices and from a focus on trauma-sensitive adaptations for diverse populations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647439/

 

Reduce the Risk of Suicide in Adolescents with Mindfulness

Reduce the Risk of Suicide in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.” — Christina Vogt

 

Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the adolescent can feel overwhelmed and unable to cope with all that is required. This can produce despair leading to suicide. Indeed, suicide is the second leading cause of death in adolescents.

 

Mindfulness training for children and adolescents has been shown to have very positive effects. These include academic, cognitive, psychological, and social domains. Mindfulness training has been shown to improve emotion regulation and to benefit the psychological and emotional health of adolescents. Importantly, mindfulness training with children and adolescents appears to improve the self-conceptimprove attentional ability and reduce stress. This suggests that mindfulness practices may be effective in reducing the risk of suicide in adolescents. Indeed, mindfulness training has been shown to reduce suicidality.

 

Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. 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. Hence it makes sense to review the published research studies examining the effectiveness of DBT for the reduction of the risk of suicide in adolescents.

 

In today’s Research News article “Recent advances in understanding and managing self-harm in adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816451/), Clarke and colleagues review and summarize the published research studies on the use of various therapeutic techniques including Dialectical Behavior Therapy (DBT) for the reduction of the risk of suicide in adolescents. They report that the published research supports the ability of mindfulness-based interventions, especially DBT for the reduction of self-injurious behaviors in adolescents with a high risk of suicide. It appears that the most important components for the effectiveness of DBT are “family involvement, emotion regulation skills, communication skills, and problem-solving skills.” As a result, they deem DBT as “the first and only “well-established” treatment for suicidal and [self-injurious]  adolescents.”

 

So, reduce the risk of suicide in adolescents with mindfulness.

 

One RCT of DBT with adolescents has been conducted in Norway demonstrating greater reductions in self-harm behaviors than enhanced usual care at 19 week and one year follow-up.” Michele Berk

 

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

 

Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent advances in understanding and managing self-harm in adolescents. F1000Research, 8, F1000 Faculty Rev-1794. doi:10.12688/f1000research.19868.1

 

Abstract

Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816451/

 

Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

 

By John M. de Castro, Ph.D.

 

The pain of depression is quite unimaginable to those who have not suffered it,  and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Mindfulness training has been shown to reduce suicidality. Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. 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. It is important to identify the characteristics of adolescents who are most likely to benefit from DBT for the reduction of suicide.

 

In today’s Research News article “Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099), Adrian and colleagues recruited adolescents with previous lifetime suicide attempt, repetitive self‐harm in the past 12 weeks, borderline personality disorder (BPD) characteristics, and clinically significant suicidal ideation. They were randomly assigned to receive 6-months of either Dialectical Behavior Therapy (DBT) or individual/group supportive therapy. They were measured before and after treatment and at the midpoint of treatment for suicide attempts, non-suicidal self-injuries, self-harm, prior self-harm severity, externalizing symptoms, other psychiatric disorders, substance abuse, PTSD symptoms, borderline personality disorder (BPD) symptoms, adolescent-parent conflict, and emotional dysregulation. In addition, their parents were measured for emotional distress and adolescent-parent conflict.

 

They found that non-white adolescents had a greater response to treatment than white adolescents in the reduction in suicide ideation. The adolescent’s pre-treatment history also affected the response to treatment with adolescents with greater levels of family conflict, more extensive self‐harm histories, and more externalizing problems having a greater reduction in self-harm. They also found that Dialectical Behavior Therapy (DBT) was more effective for adolescents who were high in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation.

 

These results are interesting and suggest that certain adolescents are more responsive to treatment than others. Non-white (particularly Latino) youths, adolescents with greater levels of family conflict, more extensive self‐harm histories, more externalizing problems, higher in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation had more positive changes produced by therapy. These factors may be used to triage which youths would be most likely to benefit from different therapies and thus may potentiate therapeutic benefits.

 

Suicide is a major problem for adolescents and self-harm, self-injury, suicide ideation, and suicide attempts are all indicators of potential lethal outcomes. So, treatment is extremely important. Dialectical Behavior Therapy (DBT) appears to be effective but it is particularly effective for certain youths. Knowing this can help target and refine therapy to improve therapeutic effectiveness in reducing suicides in adolescents.

 

So, reduce suicidality in certain adolescents with mindfulness.

 

“Being curious about your suicidal thoughts is another part of mindful observation. If you have the thought, “I should kill myself,” how does it affect the thought’s meaning to then tell yourself, “Hmm, I wonder why I just had the thought that I should kill myself?” – Stacey Freedenthal

 

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

 

Molly Adrian, Elizabeth McCauley, Michele S. Berk, Joan R. Asarnow, Kathryn Korslund, Claudia Avina, Robert Gallop, Marsha M. Linehan. Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry, 30 July 2019, 60(10), 1123-1132, https://doi.org/10.1111/jcpp.13099

 

Key points

  • Adolescent prior self‐harm, externalizing problems, and reported family conflict were significant predictors of change in self‐harm, NSSI, and suicidal ideation, where adolescents with higher family conflict and less severe self‐harm history produced on average more reduction in SH from baseline to post‐treatment.
  • DBT produced better rate of improvement compared to IGST for adolescents who were emotionally dysregulation and whose parents had higher baseline emotion dysregulation and psychopathology.
  • Clinicians could consider either IGST or DBT for adolescents with self‐harm histories whose parents are well regulated and do not have impairing psychopathology. Adolescents with emotional dysregulation and parents with psychopathology and emotion dysregulation may benefit more from DBT than IGST.

Abstract

Background

In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST.

Methods

Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes.

Results

Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals.

Conclusions

These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099

 

Reduce Self-Harming in Adolescents with Mindfulness

Reduce Self-Harming in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

“In order to end self-harm, one needs to change one’s whole relationship with oneself, and how one sees oneself. A good starting point is with one’s thoughts. Mindfulness keeps one fully grounded in the present … in the presence of the action of the present moment. Mindfulness helps one to observe and note thoughts, positive or negative, without feeling the need to act upon them.” – Ian Ellis-Jones

 

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years. Frequently, untreated depression and other mental health challenges create an environment of despair that leads people to cope with these challenges in unhealthy ways. Nearly 50 percent of those who engage in self-injury have been sexually abused. 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. About ¾ of BPD patients engage in self-injurious behaviors.

 

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. DBT reduces self-injurious behaviors in BPD patients.

 

In today’s Research News article “Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928596/ ), Haga and colleagues recruited adolescents who had repeatedly harmed themselves and randomly assigned then to receive 19 once a week 1 hour sessions of either Dialectical Behavior Therapy (DBT) or enhanced usual care. Enhanced usual care consisted of a combination of psychotherapy and cognitive behavioral therapy tailored to treat suicidality and self-harm. They were measured before and after treatment and 1 year later for self-harm episodes and global functioning. The costs of treatment were also estimated.

 

They found that at the end of treatment the adolescents who received Dialectical Behavior Therapy (DBT) had significantly fewer self-harm episodes and lower levels of suicide ideation and depression than those who received enhanced usual care. Importantly, a year later, the group that received DBT still had significantly fewer self-harm episodes. In addition, DBT did not cost more than the enhanced usual care program to implement.

 

These results are important and suggest that Dialectical Behavior Therapy (DBT) is an effective and cost-effective treatment for adolescents who harm themselves. This is particularly important as self-harm is often a predictor of eventual suicide. The reduction in suicidal ideation in these adolescents is an indication of this. Hence, DBT can reduce self-harm behaviors and reduce the suffering of these troubled adolescents.

 

So, reduce self-harming in adolescents with mindfulness.

 

dialectical behavior therapy, or DBT, for treatment of children and adolescents. DBT, regarded as one of the few treatments that has shown success in combating self-injury behaviors, combines Buddhism’s mindfulness with cognitive behavior therapy in a program that teaches coping and communication skills.” – Paradigm Malibu

 

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

 

Haga, E., Aas, E., Grøholt, B., Tørmoen, A. J., & Mehlum, L. (2018). Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm. Child and Adolescent Psychiatry and Mental Health, 12, 22. http://doi.org/10.1186/s13034-018-0227-2

 

Abstract

Background

Studies have shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm in adults and adolescents.

Aims

To evaluate the cost-effectiveness of DBT for adolescents (DBT-A) compared to enhanced usual care (EUC).

Methods

In a randomised study, 77 adolescents with repeated self-harm were allocated to 19 weeks of outpatient treatment, either DBT-A (n = 39) or EUC (n = 38). Cost-effective analyses, including estimation of incremental cost-effectiveness ratios, were conducted with self-harm and global functioning (CGAS) as health outcomes.

Results

Using self-harm as effect outcome measure, the probability of DBT being cost-effective compared to EUC increased with increasing willingness to pay up to a ceiling of 99.5% (threshold of € 1400), while with CGAS as effect outcome measure, this ceiling was 94.9% (threshold of € 1600).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928596/

 

Reduce Self-Injury with Mindfulness

Reduce Self-Injury with Mindfulness

 

By John M. de Castro, Ph.D.

 

“In order to end self-harm, one needs to change one’s whole relationship with oneself, and how one sees oneself. A good starting point is with one’s thoughts. Mindfulness keeps one fully grounded in the present … in the presence of the action of the present moment. Mindfulness helps one to observe and note thoughts, positive or negative, without feeling the need to act upon them.” –  Ian Ellis-Jones

 

Self-injury is “direct and deliberate destruction of one’s own body tissue in the absence of suicidal intent.” The most common self-injury methods are cutting, scratching, hitting a part of the body against a hard surface, and punching, hitting or slapping one’s self. It is a disturbing phenomenon occurring worldwide, especially in developed countries. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years. Frequently, untreated depression and other mental health challenges create an environment of despair that leads people to cope with these challenges in unhealthy ways.

 

Non-suicidal self-injury appears to be an individual’s attempt to cope with overwhelming negative emotions. Mindfulness has been shown to produce better regulation of emotions, where the mindful individual is fully aware of and feels the emotions, but can respond to them rationally and adaptively. Thus, mindfulness may be an antidote for self-injurious behavior. Indeed, one of the characterizing symptoms of Borderline Personality Disorder (BPD) is self-injurious behaviors and a mindfulness based technique, Dialectical Behavior Therapy (DBT) is the only therapy that has been shown to be effective in reducing the symptoms of BPD. So, it would be reasonable to investigate further the relationship between mindfulness, self-injurious behavior.

 

In today’s Research News article “Mindless Suffering: the Relationship Between Mindfulness and Non-Suicidal Self-Injury.” (See summary below). Caltabiano & Martin recruited undergraduate students and had them complete measures of mindfulness, including five subscales, observe, describe, act with awareness, non-judging, and non-reacting, and self-injurious behavior, and severity of self-injury. Surprisingly, over half of the participants indicated that they had engaged in self-injury sometime in their lives. To further investigate this phenomenon, the researchers separated and compared those participants who reported self-injurious behaviors to those who did not.

 

Participants who self-injured reported that they did so for a variety of reasons including emotion regulation, self-punishment, to mark distress, preventing dissociation, toughness, self-care, preventing suicide, boundaries between themselves and others, conformity, revenge, autonomy, sensation seeking, and peer bonding. Those participants who did not self-injure, compared to those who did, were significantly higher in overall mindfulness, and the mindfulness facets of acting with awareness, non-judging, and non-reacting. In addition, the self-injurers that evidenced less severe self-injury had higher mindfulness scores than those who had severe self-injuries. They also found that the higher the levels of mindfulness the lower the levels of using self-injurious behaviors to regulate emotions.

 

These are interesting results. But, it must be taken into consideration that the study was correlational and thus causation cannot be determined. But, the results clearly indicate that there is a strong significant relationship between mindfulness less self-injury. This suggest that a randomized controlled clinical trial should be performed to investigate the effect of mindfulness training on self-injurious behaviors to established whether mindfulness produces less self-injury and whether mindfulness training would be a useful therapeutic technique to treat people who self-injure.

 

It is interesting that the mindfulness facets of acting with awareness, non-judging, and non-reacting were the most strongly associated with low self-injury. This suggests that the reason that mindfulness may be effective is because it lowers the individual’s tendency to judge and react to their feelings.

 

So, reduce self-injury with mindfulness.

 

“mindfulness may be a beneficial element of prevention efforts for suicide, especially among those who have self-injured in the past.” – Alia Warner

 

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

 

Caltabiano, G. & Martin, G. Mindless Suffering: the Relationship Between Mindfulness and Non-Suicidal Self-Injury. Mindfulness (2017) 8: 788. doi:10.1007/s12671-016-0657-y

 

Abstract

Non-suicidal self-injury is a complex behaviour, disturbingly prevalent, difficult to treat and with possible adverse outcomes in the long term. Previous research has shown individuals most commonly self-injure to cope with overwhelming negative emotions. Mindfulness has been shown to be associated with emotion regulation, and mindfulness-based interventions have shown effectiveness in a wide range of psychological disorders. This research explored whether lack of mindfulness or problems in mindfulness are involved in self-injury. A non-clinical sample of 263 participants (17–65 years) completed an online survey measuring self-injurious behaviours and mindfulness. Differences in levels of mindfulness between individuals with and without a history of self-injury were investigated. Analysis of variance indicated mindfulness (overall and in terms of specific facets “act with awareness”, “non-judge” and “non-react”) was significantly lower in individuals with a history of self-injury compared to those without. Pairwise comparisons revealed current self-injurers reported significantly lower mindfulness than past self-injurers and non-self-injurers, with medium effect sizes of d = 0.51 and d = 0.77, respectively. In logistic regression, low mindfulness significantly predicted self-injury (B = 0.04, p < .001). These findings have clinical implications, suggesting that mindfulness-based interventions may assist individuals to give up self-injurious behaviours and may be an important part of prevention strategies.

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/

Reduce Self-harm with Mindfulness-based Dialectical Behavior Therapy

DBT self-harm2 Ruocco

 


By John M. de Castro, Ph.D.

 

“People who self-injure have often found themselves either the victims of abuse or otherwise powerless and helpless in the midst of terrible circumstances. Self-abuse often provides an escape from overwhelming feelings of isolation, fear, humiliation or fury. Some who self-injure explain that it gives a sense of control in a world where they feel helpless. It can also be a physical sign of emotional pain.” – CHRISTY MATTA

 

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years. Frequently, untreated depression and other mental health challenges create an environment of despair that leads people to cope with these challenges in unhealthy ways. Nearly 50 percent of those who engage in self-injury have been sexually abused. 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. About ¾ of BPD patients engage in self-injurious behaviors.

 

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. DBT reduces self-injurious behaviors in BPD patients. But, not all respond. In order to improve treatment for self-injurious behaviors in BPD is important to identify the factors associated with patients who respond to treatment vs. those who don’t.

 

In today’s Research News article “Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1293102947380295/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870399/

Ruocco and colleagues studied the neural responses of Borderline Personality Disorder (BPD) patients who decrease self-injurious behaviors in response to Dialectical Behavior Therapy (DBT) vs. those who don’t respond. Patients had their brains scanned before and after 7-months of DBT. They found that a wide variety of self-harming behaviors were significantly reduced after the DBT. They also found that those patients who responded well and had large reductions in self-harming demonstrated less activation of the Dorsolateral Prefrontal Cortex before treatment than patients who didn’t respond well to treatment. After treatment the patients who responded to therapy showed greater activation of the Dorsolateral Prefrontal Cortex. These relationships were present even after controlling for depression and mania.

 

These are interesting and potentially important results. The Dorsolateral Prefrontal Cortex is known to be involved in behavioral regulations. It appears that patients low in this activation, in other words, low in behavioral regulation, benefit the most from treatment which increases this activity and increases self-control. Hence, these results suggest that BPD patients who respond best to treatment are those whose self-injurious behaviors are exacerbated by lack of ability to regulate behaviors. DBT appears to reduce self-harm by improving the patient’s ability to regulate their self-injurious behaviors. These findings also suggest that the best candidates for DBT are those who lack behavioral regulation ability.

 

So, reduce self-harm with mindfulness-based dialectical behavior therapy.

 

“Mindfulness teaches these teens to experience emotion without acting on it, thus building in a delay to self-harming behavior.” – Pat Harvey

 

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

Ruocco, A. C., Rodrigo, A. H., McMain, S. F., Page-Gould, E., Ayaz, H., & Links, P. S. (2016). Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study. Frontiers in Human Neuroscience, 10, 220. http://doi.org/10.3389/fnhum.2016.00220

 

Abstract

Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870399/