Tag Archives: Borderline Personality Disorder

Six Major Problem Areas Addressed by the DBT-CBT Recovery Program

DBT-CBT Addresses Six Major Problem Areas

These six areas are listed below.  Examples of the types of problems
we might have in each area are also noted.

This workbook is designed to meet the needs of people who suffer
from problems in SOME or ALL of the six areas.


1. RELATIONSHIP PROBLEMS

Conflict-Filled or Stormy Relationships   •   Abusive Relationships
Relationship Disappointments or Frequent Ups and Downs
Unfulfilling Relationships   •   Short-Term Relations
Love – Hate Relationships   •   Few or No Close Relations
Fear of Rejection  /  Actual Rejection  /  People Have Pulled Away
Co-Dependency  /  Dependency   •   Attention-Seeking Behavior
Fear of Abandonment  /  Actual Abandonment   •   Mistrust
Mad at Everyone   •   Loneliness  /  Can’t Tolerate Being Alone
Shyness  /  Fear  /   Major Discomfort in Social Situations

2. MOOD SWINGS – DEPRESSION – ANXIETY – ANGER

Moodiness  /  Major Mood Swings   •   Easily Angered   •   Rage
Guilt / Shame   •   Being a “High Drama” Person
Unbearable  /  Intense Emotions   •   Anxiety  /  Panic
Depression  /  Helplessness  /  Hopelessness  /  Worthlessness
Believe Things Won’t Get Better  /  Want to Give Up
Feel Out-of-Control  /  Overwhelmed  /  Suicidal

3. UNHEALTHY THINKING

Worrying  /  Overthinking  /  “Stewing” over Things
Dwelling on the Past   •   Preoccupied with Revenge
Pessimistic Thinking  /  Negative Expectations   •   Irrational Beliefs
Catastrophizing  /  Blowing Things Out of Proportion
Black and White  /  All-or-None Thinking
Putting Ourselves Down  /  Focusing on Our Worst Qualities

4. UNHEALTHY COPING BEHAVIORS

Please see the “List of Common Self-Destructive Coping Behaviors” above.

5. OTHER IMPULSIVE BEHAVIORS – BAD CHOICES

Doing Things on a Whim  /  Making “Snap Judgments”
Not Thinking Things Through and Having Negative Consequences as a Result

6. QUALITY OF LIFE PROBLEMS

Burnt-Out  /  Life Is a Chore   •   Nothing to Live For
Emptiness  /  Meaninglessness  /  Boredom
More Problems Than I Can Bear   •   Must Start Over
Financial Problems  /  Bankruptcy
Job Loss  /  Can’t Keep a Job Loss of Career or Professional License
Demotion  /  Probation at Work
Loss of Relationships   •    Family Pulled Away   •   Can’t See Children
Loss of Trust From Others   •   Reputation Damaged
Loss of Self-Respect and Integrity   •   Loss of Self-Confidence
Problems Getting an Education  /  Not Completing Semesters
Underachievement • Loss of Housing   •   Loss of Transportation
Loss of Possessions • Loss of Pets   •   Loss of Freedom
Legal Problems  /  Probation or Imprisonment
Health Problems  /  New Medical Diagnosis

This list is an excerpt from the DBT-CBT Therapy Workbook – “Out-of-Control:  A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior”  by Melanie Gordon Sheets, Ph.D.  – 2009 – Recovery Works Publications

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The Best Crash Diets are Crash n’ Burn Diets – An Excerpt from the DBT CBT Therapy Workbook

Crash n’ Burn Dieting

Why do you think a “crash diet” 1 is an Emotional Mind behavior?
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We’ve all heard of these diets and most of us have done them! We see many advertised on magazine covers, “Lose 10 pounds in 10 days with the Grapefruit Diet!” Some have strict menu plans. Many limit food choices. We may be able to eat as much as we want…but ONLY lean meat and vegetables…or boiled chicken and rice all day! Consider how limited a high protein – low carbohydrate diet is. One reason these diets fail is they don’t allow us to eat our favorite foods…and WE’RE NOT GOING TO STAY ON A DIET LIKE THAT…FOR VERY LONG!

Crash diets are driven by Emotional Mind because we’re WILLING to do something DESPERATE to lose weight QUICK. We’re IMPATIENT. We want IMMEDIATE RESULTS. We DON’T WANT TO WAIT to lose weight in a REASONABLE and HEALTHY way…even though WE KNOW it’s the only way to lose weight and keep it off! We’re being IRRATIONAL! We’ve deluded 2 ourselves! We’re believing a LIE. SOMEHOW WE BELIEVE THIS CRAZY DIET WILL WORK…that we’ll suddenly develop skills to control our eating…that we’ll give up most or all of our favorite foods…and just eat certain foods. REALLY, IF WE HAD ALL THIS WILLPOWER, why would we need a crazy diet? Why wouldn’t we just do a “normal diet” and eat like a slender person? They eat all kinds of things…just smaller portions!

Just like other Destructive Coping Behaviors, we want IMMEDIATE RELIEF…for our long-term weight problem. So, we do something desperate to lose weight FAST!

The problem with a crash diet is it’s SO UNREASONABLE and STRICT we WON’T STAY ON IT the rest of our life! When we GET OFF the diet, we return to our old eating habits. We GAIN the weight back…AND THEN SOME! That’s because we’ve been starving our body and depriving it of what it needs to function. Our brain sends out “I’M STARVING TO DEATH” signals that tell our body to PROTECT ITSELF FROM DYING. So, our metabolism 3 slows, we BURN FEWER CALORIES, and fat stores up for future famines. 4 At the same time, our BRAIN POUNDS on us to EAT MORE to replenish 5 our body. Finally, we GIVE IN TO TEMPTATION and the demands of our brain and body and we do a ROYAL PIG-OUT! Then we FEEL HORRIBLE physically and emotionally. We’re bloated, sick, disappointed, and ashamed. WE FEEL LIKE A FAILURE. Weight loss seems hopeless, so, we GIVE UP on the diet. WE GAIN ALL OUR WEIGHT BACK…AND THEN SOME!

We’re willing TO TRY to defy 6 the laws of nature to lose a ton of weight fast! A friend once said, “I’ve given up on dieting. Every time I go on a diet, I end up gaining 10 pounds!” After we starve ourselves, our brain pushes us to gain extra weight so our body is prepared for the next famine!

What kind of diet would Rational Mind suggest? ________________
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Rational Mind would encourage us to EAT THINGS WE LIKE, BUT LESS! Then our stomach will shrink and we’ll REDUCE CALORIES. We’ll get in the HABIT of eating “SKINNY PERSON PORTIONS” 7 and we’ll lose weight. Because we’re still getting our favorite foods, we’re less likely to get tired of this “eating plan!” It’ll become A WAY OF LIFE…that we can LIVE WITH for the rest of our life. We’ll STAY ON IT, LOSE WEIGHT, and KEEP IT OFF!

We’ve all heard THE BEST WAY to lose weight is to do it SLOWLY! If we’re not in a major weight gain cycle 8 and we cut our food intake by one-fourth, we may lose 2-3 pounds a month. That’s 24-36 pounds a year and 48-72 in two years! If we cut our intake in half, we may lose 4-5 pounds a month or 48-60 a year and 96-120 in two years! That’s a lot…and we can KEEP IT OFF if we KEEP IT UP! A “three-fourths” or “halves” diet will serve us MUCH BETTER over time than a “crash n’ burn” diet!

I’d rather lose 25 pounds a year by eating reasonably than gaining 10 pounds with a crash diet!

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Notes:
1. A crash diet is very strict and is designed for FAST weight loss.
2. Deluded – (duh-lew-did) – talked ourselves or others into believing something that’s not true.
3. Metabolism – (met-tab-oh-liz-em) – the process of breaking down the food we eat.
4. Famines – (fah-men’s) – times when there’s little or no food in a country or region.
5. Replenish – (ree-plin-ish) – to restore and fill back up!
6. Defy – (dee-fi) – to go against or to challenge.
7. Ever notice how skinny people eat? They eat many of the same foods as an overweight person…just smaller portions. We had a store and I’d go there after my hospital job. I was always shocked to find half a bag of chips or half a candy bar left on the desk. I could never understand why the employee didn’t eat it ALL! Obviously, their eating habits were very different from mine! They’d eat half when I’d eat two!
8. If we‘re on a major weight gain cycle, we’ll have to cut down even more to get our daily calories in the range for losing weight. These numbers are estimates based on someone who’s maintaining their weight or is only gaining a few pounds a year.

On Losing 145 Pounds and Using Dialectical Behavior Therapy (DBT) and Cognitive-Behavioral Therapy (CBT) to Regain Control Over My Over-Eating Eating Disorder!

Well, here’s another day of my recent fight to regain control of my eating and to continue to lose weight…and to prevent a full relapse into my over-eating Eating Disorder!

Felt great to weigh in at 127. One less than yesterday and a common weight for me over the past few months…and going in the right direction!

Started my day with Mindfulness of recovery being my #1 priority today. I thought about how I wanted to eat this day and I took note of what was coming at me today that could challenge my recovery. I thought about the Service Awards Celebration that would be held today at work. They’d serve cake, cookies, and other goodies. I wasn’t sure I wouldn’t eat anything there, so I was aware I needed to plan my food day to allow for that!

Started my work day by buying some time and drinking coffee first thing rather than settling into my 1-1/2 sandwiches of fat-free turkey and double fiber bread (230 cals!). Had that at about 11:30. That held me just fine until the Awards Celebration…I got a 20-year with the state of Texas award. Cool. I did good until the end when folks were chatting by the food tables…and I did it! I had a small piece of cake and would have had a chocolate chip cookie, but no chocolate cookies left of any sort and I wouldn’t waste calories on non-chocolate! Got out of there with only about 50 cals worth of cake! Oh yea! Awesome!

Well, just like I am…I get back to my work area…and there’s candy bars on the counter for sale for Relay For Life…and seeing them brings on the sweet munchies that were brought on by not getting the chocolate chip cookie! Mentioned to my friend that I had the sweet munchies now and she told me about all the treats she had stored in her desk! Oh boy! So had a Reese’s candy bar (270 cals), about a dozen M&M’s….and a good handful of cashews. Can’t imagine that to be more than about 130 calories. Delighted because 400 more calories satiated my sweet craving. Did so well that I skipped my afternoon black bean soup.

Worked late, came home at about 7 and enjoyed three yogurts (240 cals) and started on sunflower seeds. Betcha I won’t need to have the Snicker’s chocolate protein bar tonight after sweets earlier today. Really not craving anything except I’m enjoying the seeds! Think I’ll play Zuma for a while and then package up the books which have sold today. I feel so much better that my eating is better under control. Just need to continue what I’m doing and work through this “near disaster” in my recovery!

I kept track of calories all day…grand total of 1030. That’s a bit low (Rational Mind)…though I really like the number! (Emotional Mind) However, I want to re-experience peace and stability in my eating…and not the roller coaster of late. (Rational Mind) Too few calories for one to two days leads me into out-of-control eating while my body tries to replenish itself! (Rational Mind) I’m just not in the mood for more diet drama. Had my fill of that! (Rational Mind) May snack on something to bring it closer to about 1250 (Wise Mind)…but I really like the 1030 number! (Emotional Mind)

Oh boy, hubby just got home bearing Walmart grocery bags…and I get to put them up! My recovery supportive husband brought home three bags of chips…one of which I happen to really like…but, also a bag of apples. So, I was mindful of my recovery and my recovery goals and realized that if I cracked the bag of chips it would be 200 calories in seconds flat! (Rational Mind) Made a decision to put them up and out of my sight. (Wise Mind) Then, I found the bag of apples…ahhhhhh…had two. So, total calories now about 1160…and now he’s grilling hamburgers outside. Hopefully, I’ll just tear one in half and have that! (Wise Mind) That puts me right at that 1250 number! Boy, sure I love the food he cooks out there on the propane grill. Oh…man!

Willfulness and Willingness…Fighting for Recovery…From My Overeating Disorder!

“You get skinnier every time I see you.” That’s what my friend said to me today…and I thought, “Fat chance of that!”

Weighed this morning – 128. Not horrible, better than 129 the other day…but lots worse than my monthly average the last few months (125 range) with lows at 122-123.

Getting dressed, I put on my size 10’s…my larger pants since I’m not in the 125 range. Oh my God, they were tight. I am not doing tight first thing in the morning, else by mid-afternoon seams will be a-bursting! Went up a half size bigger…ahhhhhh…and to think I was going to put those in storage just in case I started to get fat again. I shouldn’t need to wear those. I wore those at 135. But…if the pants fit, wear them!

I was feeling despondent, helpless, out-of-control…desperate…hopeless. Then, anxiety hit. I realized this could easily be a relapse point. Eating out-of-control…felt discouraged…was bloated…and having to wear “fat pants”…everything was just right for an Emotional Mind recovery sabotage.

My first panic thought was to strictly reduce my calories to 1100…to punish myself. (Emotional Mind thinking).

Rational Mind said, “That’s too low…and punishing yourself will backfire..it’s not a good thing for you.”

Wise Mind said, “Chill out Mel…work to maintain calories in the 1200 range…that’s very do-able for you…you can tighten up a bit.”

Thank God I’m into this DBT-CBT thing…and I live, eat, and breathe it. And thank God I caught myself in the middle of this serious Emotional Mind game. I thought, “You know, I’m not going there.” Then I thought, “I think I’ve just entered a fight for my recovery. It’s at that point now.”

I then recognized I felt a bit angry about this eating thing…frustrated, just tired of it. Then another thought flew through my mind, “I don’t get mad, I get even.” This is usually a negative, revenge type of Emotion-Driven thought, a self-destructive thought. However, for me…today…it was more like, “It’s time to kick this in the ass…I’m tired of it.” “It” being…”I’m tired of my crap”…it’s like “Shit or get off the pot”…or…”If you’re serious about this diet thing, then make it happen already…Get control or lose control. Game’s over. It’s time to get serious.”

I thought about DBT and “Willfulness vs. Willingness.” Well, one is usually bad – the stubborn, willfulness one…and willingness is usually good – the “I’ll do whatever I need to do to be okay”…it’s the “I surrender,” “I accept,”…the, ”I’m ready and willing” one.

Well, for me today, Willfulness was a positive thing. It was the stubborn and determined part of me…that fight from deep inside…being willful in a survivalist type of way…the, “I’ll be damned if this kicks my ass” type of fire from within!

Willingness was there, too. They stood side by side. I was willing to do what I needed to do to get this eating thing going on. I surrender my will to eat whatever I want to eat. I surrender to setting limits for my eating.

Well, I’ve done very well today with just a minimum of distress. Ended the food day at 6:30pm with 1185 cals. For breakfast I had 1-1/2 fat free turkey sandwiches (double fiber whole wheat bread) and drank coffee with about 25 calories of flavored coffee creamer. I had a can of green beans for lunch. That held me over until my mid-afternoon can of black bean soup which kept me from leaving work starving to death and ready to eat everything in sight when I got home from work. Upon arriving home, I had 3 black cherry yogurts (80 cals each and quite a treat) and a Snickers 290 calorie chocolate protein bar (quite a treat…like a candy bar!) I picked at leftovers and had a couple bites of chicken with green peppers. SUCCESS. Had to forego fruit and sunflower seeds today, but I’m fine. Started the sunflower seeds in the evening when I quit cigarettes a few months ago…and also added a lot of fruit then to deal with the nicotine withdrawal CONSTIPATION! Did just fine though without them tonight.

Now…today I went back to some of the dieting basics like I resolved to do a few days ago…yesterday…whenever it was. I kept a running tally of my calories through the day…and emailed them to my home! I was mindful of what I would eat (for the most part), planned my food day (for the most part) and I did the “think through before you do” thing. Now, tomorrow is a new day and I sure hope I experience that fire from within…and fight for my recovery all over again! I hope my battles help you in your fight.

Why Do Borderlines Do Such Crazy Things?

This question was asked…and I couldn’t help to respond. One person responded to the question with an excellent description of the pain and trauma a borderline has experienced…a “well if you went through this…you’d be that way, too” type of response. It helps to make the non-understandable…understandable. It certainly helped to get a sense of the pain someone with bpd goes through…and has gone through.

To his response, I added the following information.

The term borderline originated because in the days of old, folks considered this to be borderline psychosis…because of the seemingly insane, crazy type of behavior…the OUT-OF-CONTROL behavior…behavior that oftentimes makes little sense to the observers and the targets of the behavior. Many times, borderline people don’t understand themselves because of their out-of-control emotions and behavior…imagine how hard it is for someone else to understand their behavior…especially someone who has little or no experience with this kind of stuff. At least the individual asking the question is asking…in a quest to understand the seemingly un-understandable!

From a DBT-CBT perspective, when we’re “Big Time in Emotional Mind,” we have little to no Rational Mind going on…we’re like 95% Emotional Mind and 5% Rational Mind. We’re not thinking straight…we’re not rational…we’re just BIG TIME IN EMOTIONAL MIND. Our emotions are intense…they are driving our perceptions…they are driving our behavior…they are driving our thoughts…we’re not dealing with reality or the way things really are…we are reacting to things based on our emotions, our fears and traumatic experiences, and our emotion-driven beliefs. Our emotions have “done gone crazy”…and we say and do irrational things in such an intense emotional state. But the truth, it’s not about being crazy…or stupid…or anything like that…it’s about being overwhelmed with emotions, memories, fears, trauma…it’s about being desperate…desperate for relief, desperate for comfort, desperate for a continuing relationship, desperate for assurance of safety…and it’s about desperately seeking to reduce our emotional intensity to a level that is more tolerable.

Everyone gets “Big Time in Emotional Mind” now and then…and when we are…we all do crazy, irrational things…we all lose control now and then…and we say and do all kinds of things…that afterwards we say, “What was I thinking?” Well, we weren’t thinking…rationally. We were just reacting emotionally. Emotional Mind was controlling our thoughts and our behavior…and we did some really desperate things to meet our perceived needs in the heat-of-the-moment.

With borderlines (and like the rest of us now and then), the past slams into the present…and it’s really hard to deal with the here-and-now as it is in the here-and-now. They react to today’s situations with the anxiety, intensity, fears, unmet needs, rage, and the memories of all the pain and trauma from the past. I’d venture to say that all borderlines have full-blown PTSD (Post-Traumatic Stress Disorder)…or many features thereof…and they react to the present…and live the present as if it was the past. It’s like they expect the present situations to be a repetition of the past…because the past repeated itself so many times before.

How do I recover from Borderline Personality Disorder: A DBT-CBT perspective

Recovery from Borderline Personality Disorder (BPD) will be one of the hardest things you’ll ever do. It will require a lot of perseverance and focus…and Mindfulness every waking hour. It will require great effort to gain control of out-of-control emotions, behaviors, and thought processes. Then it will require great control to MAINTAIN control over time. You’ll have to want recovery more than anything else in life. Just like the alcoholic…to recover they have to want recovery more than anything else in life. You’re attitude will have to be “Recovery is my #1 priority” and then you’ll have to act in ways to make it so.

The question of how to recover from BPD was posed to me and I wrote a couple paragraphs to give the person an idea of what it would involve. I did not spell out a comprehensive treatment program, just an overview of some things it would involve. BPD is a severe personality disorder that requires a comprehensive treatment plan and years of therapy…and years of practicing new behaviors and skills to undo and change years of dysfunctional responses. So consider the following information to be an overview of the process and know there’s more to it!

Some aspects of recovery include:

    Therapy
    A support system
    Mindfulness
    Practicing life-enhancing coping skills to replace self-destructive ones…and using these in the heat-of-the-moment…and on a day-to-day basis to keep negative emotional levels as low as possible.
    Challenging self-destructive Emotion-Driven Thoughts with Rational Mind thoughts. Rational Mind thoughts relate to the unchanging TRUTH and facts about a situation, our life, other people, etc. Our Emotional Mind thoughts are based on our “in-the-moment perceptions”…or the way we think about things when we’re in an emotional state. For instance, when we’re upset, we may think and say, “Nobody cares about me.” This will be a habit…so we’ll have to catch ourselves (Mindfulness) and turn on Rational Mind and say, “Many people love me and care about me. I’m just thinking that because I’m upset right now. That’s just stinkin’ thinkin’” If we think, “Cutting would help me to feel better.”…we must catch ourselves and say, “Cutting helps in-the-moment, but it ends up causing me more pain and problems. Calling a support person and working through the moment will help me NOW and in the future. Cutting is relapse for me and will only bring me down and land me back into the Cycle of Suffering. I want recovery and I’ve got to use life-enhancing coping skills.” Wise Mind is already kicking in and will be offering some suggestions for getting through the moment.

Borderline Personality Disorder also involves dysfunctional relationship dynamics and patterns. Part of the recovery process is awareness of our sensitivities and our typical responses in relationships. Mindfulness is essential here. When we catch ourselves responding in old dysfunctional ways, we’ll have to use Rational Mind and Wise Mind to alter our responses. Like when someone hurts our feelings, we might think, “She is such a b—-. She was never my friend. I’m never going to talk to her again. I don’t get mad, I get even.” That’s Emotional Mind thinking…it’s Emotion-Driven Thinking…thoughts that are driven by or are caused by whatever emotions we are experiencing. We’re thinking that way just because we’re Big-Time in Emotional Mind. So, we’ll have to catch ourselves and challenge that thought with Rational Mind. For instance, we might remind ourselves of the truth about her and other people, like “She’s usually nice to me. Maybe something’s going on with her and she’s not in such a nice mood right now. She’s been friendly and she’s been my friend. Everyone has their moods…and I guess she’s in one right now.” Wise Mind would kick on and make some problem-solving suggestions, such as, “I’ll pull myself together and go on with my day and TRY not to worry about this. I’ll check back in with her later and see if she’s okay. If something is troubling her, I’ll offer to talk with her about it. If it seems like she’s upset with me, I’ll let her know I appreciate her friendship and I’m sorry if I did something to upset her…and I’ll encourage her to talk with me about it…and I’ll work real hard not to be defensive! I’ll try to smooth things over with her so I can maintain this relationship.”

There’s a lot to working through and changing a lifetime of experiences, habits, thought processes, reactions, etc. Therapy, support groups, a support system, mindfulness, following through with life-enhancing coping behaviors and problem-solving, and an attitude of “Recovery is my #1 priority” are some key elements to recovery. READ self-help books too…and learn as much as you can about recovery. Know that it took a lifetime to get us to this place and time…and it will take a while to recover. It’s step by step, minute-by-minute, hour-by-hour, day-by-day…month after month..and year after year. I think it is reasonable to expect that even though we get to a point of being “pretty well recovered” things will still come up…things that will bring up old feelings, insecurities, and issues…that we’ll have to deal with. But, by then, we’ll be real practiced at it and it won’t take long to set ourselves straight. Honestly, I am “pretty well recovered” but I still have to deal with myself on a daily basis. I consider myself to be “a work in progress.”

Another thing to think about is that it is normal to be “abnormal.” Most people have issues and concerns that bother them. Some struggle to get better n’ better…and others remain in denial and blame others, avoid their issues…and remain in a Cycle of Suffering.