Emotional Regulation, Trauma, Somatics. C1, U 2, S 13 (26)...again! Notes and research.
Updated: Aug 15, 2020
Very happy to get back into this unit for the second time and more in depth in DBT terms.
The grounding practice was very useful and every bit of meditation practice helps sharpen those skills a bit more.
Straight to the point this week:
First of we got speaking about trauma and the hows and whys and the different affects it has on people and society and how it manifests very differently in person to person even if they have very similar or shared traumatic experiences. I need to look up research and research ancestral trauma further once I get the time. One thing at a time. There is so much to take in and learn with DBT and my other courses I have going on.
I have lots of books I need to buy and read for a start. I have completed three great books about BPD and mindfulness recently but the they keep coming at me. I'm also going back over some Eckhart Tolle and Marsha Linehan stuff.
Debbie Corso ancestral trauma ⬆⬆🔴 Self reminder! I need to but the Corso stuff.
This is something I need to look at closer and examine in depth as I believe it is deeply related to my messy old brain and ongoing troubles in my life and in fact I feel it may explain a lot, shed light on why my parents, certainly one of them, neglected me and allowed abuse to enter my life. It's all about the chain of events and breaking that negative self perpetuating chain of behaviours. It's a heavy complicated subject that isn't for this blog in any great depth but some research on this subject is below, nicked from another site as per:
Have you ever thought about traumatic experiences as having their roots in the lives of your parents or grandparents? Trauma can be defined as the loss of an essential part of ourselves—a sense of safety, trust, or security.
Trauma ultimately has the ability to define our behaviours, actions, and sense of self. Research is also showing the destructive effects of trauma being passed down from generation to generation in our DNA and cultural nurturing.
Trauma occurring before the age of 18 is particularly harmful. Child maltreatment is a significant public health problem. It is estimated that one out of every 10 children in the United States experiences one or more forms of physical, sexual, or emotional abuse or neglect by a parent or other caregiver at some point during their lifetime.
It is well-established that experiencing childhood maltreatment is associated with a variety of negative physical, emotional, and psychological outcomes, including subsequent harsh and/or neglectful parenting in adulthood. Childhood maltreatment is associated with higher risks for obesity, substance use, depression, anxiety, eating disorders, and over 40 medical conditions, including heart disease, diabetes, and cancer. This is what we know and have known for over a decade.
What has not until recently been part of the conversation is the impact of inter generational or historical trauma—trauma passed down through generations. Trauma from the Holocaust, from studies on American Indians and Alaska Natives (AIAN), and trauma from slavery, racism, and oppression in African-Americans can be transmitted to future generations through epigenetics, parental modelling, and cultural experiences. Dr. Maria Yellow Horse Brave Heart describes historical trauma as “…the cumulative emotional and psychological wounding over one’s lifetime and from generation to generation following the loss of lives, land, and vital aspects of culture.”
This type of trauma was initially studied in children and grandchildren of Holocaust survivors in the 1960s. The offspring of Holocaust survivors showed a variety of trauma response pathology and experienced themselves as “different or damaged” by their parents’ experiences (Sotero, 2006). Studies on families of Holocaust survivors show an association between eating disorders and Holocaust exposure and also the transmission of trauma down through the third generation (Bar-On et al., 1998).
More recent studies in American Indian and Alaska Native (AIAN) populations have shown the trauma of what one researcher has called the American Indian Holocaust. Researcher Brave Heart also developed a lexicon of terminology to describe the AIAN experience, including “historical unresolved grief,” to describe how the losses they suffered had never been mourned and the “survivor’s-child complex” to describe the similar dynamics among children of survivors and their descendants (Brave Heart and DeBruyn, 1998).
Researcher J.D. Leary (2005) described what she called post-traumatic slave syndrome (PTSS) in African-Americans—to reflect a condition that exists as a consequence of centuries of chattel slavery followed by institutionalised racism and oppression. Generations after slavery, children were witness to their parent’s or grandparent’s daily degradation at the hands of the broader culture.
The notion of traumatic effects of enslavement being transferred to successive generations starts with the idea that slavery was not only a dreadful individual ordeal, but also a cultural trauma to African-American people—a syndrome which occurs when a group has been subject to an unbearable event or experience, thereby undermining their sense of group identity, values, meaning and purpose, or their cultural world views, and is manifest in symptoms of hopelessness, despair, and anxiety (notably, among indigenous people subject to colonization and genocide and Holocaust survivors).
Cultural trauma can be described as a “loss of identity and meaning, a tear in the social fabric” (Eyerman, 2001). Maya Angelou (1976) has said, “It is collective memory of slavery that defines an individual as a “race member.”
For people with historical trauma, the transmission of their trauma to their children is unintentional but stems from their own pain which has not been dealt with. Unwanted behaviours, such as eating disorders or addictions, may have their roots in this inter generational trauma, which creates a vicious cycle of unprocessed grief and shame leading to unwanted behaviours, which only cause more pain, guilt, and shame. But the good news is that we possess the power to change when we are willing to address these painful memories and move from surviving to thriving.
When people think, talk, or share about trauma, it usually takes on the form of all the harm it causes. While this is all true and important to acknowledge, it is also true that there are often gifts that can come from trauma, even the trauma that is passed down through generations. If we embrace the scars as a way of affirming our survival and recognise that by surviving the pain of the past, we know we are able to face anything that life has to throw at us, then our past experiences can become gifts that we can also teach to our children and grandchildren. The CDC has identified the promotion of safe, stable, nurturing relationships (SSNRs) as a key strategy for the public health approach to child maltreatment prevention. SSNRs begin with healing from your own trauma, so that you are more able to use what you learn to help prevent the cycle of trauma in subsequent generations.
For too many individuals, trauma carries a stigma that they may feel forever like victims stuck in a life that they do not deserve. When you are able to own your entire experience—cultural and historical—you may find that the gifts from trauma have made you the powerful human being you are today.
Breaking the Cycle of Inherited Family Trauma
By Mark Wolynn
Can we Inherit Pain?
Emerging trends in psychotherapy are now beginning to point beyond the traumas of the individual to include traumatic events in the family and social history as a part of the whole picture. Tragedies varying in type and intensity—such as abandonment, suicide and war, or the early death of a child, parent, or sibling—can send shock waves of distress cascading from one generation to the next. Recent developments in the fields of cellular biology, neurobiology, epigenetics, and developmental psychology underscore the importance of exploring at least three generations of family history in order to understand the mechanism behind patterns of trauma and suffering that repeat.
The following story offers a vivid example. When I first met Jesse, he hadn’t had a full night’s sleep in more than a year. His insomnia was evident in the dark shadows around his eyes, but the blankness of his stare suggested a deeper story. Though only twenty, Jesse looked at least ten years older. He sank onto my sofa as if his legs could no longer bear his weight.
When I first met Jesse, he hadn’t had a full night’s sleep in more than a year.
Jesse explained that he had been a star athlete and a straight-A student, but that his persistent insomnia had initiated a downward spiral of depression and despair. As a result, he dropped out of college and had to forfeit the baseball scholarship he’d worked so hard to win. He desperately sought help to get his life back on track. Over the past year, he’d been to three doctors, two psychologists, a sleep clinic, and a naturopathic physician. Not one of them, he related in a monotone, was able to offer any real insight or help. Jesse, gazing mostly at the floor as he shared his story, told me he was at the end of his rope.
When I asked whether he had any ideas about what might have triggered his insomnia, he shook his head. Sleep had always come easily for Jesse. Then, one night just after his nineteenth birthday, he woke suddenly at 3:30 a.m. He was freezing, shivering, unable to get warm no matter what he tried. Three hours and several blankets later, Jesse was still wide awake. Not only was he cold and tired, he was seized by a strange fear he had never experienced before, a fear that something awful could happen if he let himself fall back to sleep. If I go to sleep, I’ll never wake up. Every time he felt himself drifting off, the fear would jolt him back into wakefulness. The pattern repeated itself the next night, and the night after that. Soon insomnia became a nightly ordeal. Jesse knew his fear was irrational, yet he felt helpless to put an end to it.
I listened closely as Jesse spoke. What stood out for me was one unusual detail—he’d been extremely cold, “freezing” he said, just prior to the first episode. I began to explore this with Jesse, and asked him if anyone on either side of the family suffered a trauma that involved being “cold,” or being “asleep,” or being “nineteen.”
He was freezing, shivering, unable to get warm no matter what he tried.
Jesse revealed that his mother had only recently told him about the tragic death of his father’s older brother—an uncle he never knew he had. Uncle Colin was only nineteen when he froze to death checking power lines in a storm just north of Yellowknife in the Northwest Territories of Canada. Tracks in the snow revealed that he had been struggling to hang on. Eventually, he was found face down in a blizzard, having lost consciousness from hypothermia. His death was such a tragic loss that the family never spoke his name again. Now, three decades later, Jesse was unconsciously reliving aspects of Colin’s death—specifically, the terror of letting go into unconsciousness. For Colin, letting go meant death. For Jesse, falling asleep must have felt the same.
Making the connection was a turning point for Jesse. Once he grasped that his insomnia had its origin in an event that occurred thirty years earlier, he finally had an explanation for his fear of falling asleep. The process of healing could now begin. With tools Jesse learned in our work together, which will be detailed later in this book, he was able to disentangle himself from the trauma endured by an uncle he’d never met, but whose terror he had unconsciously taken on as his own. Not only did Jesse feel freed from the heavy fog of insomnia, he gained a deeper sense of connection to his family, present and past.
He gained a deeper sense of connection to his family, present and past.
In an attempt to explain stories such as Jesse’s, scientists are now able to identify biological and psychological markers — evidence that traumas can and do pass down from one generation to the next. Rachel Yehuda, professor of psychiatry and neuroscience at Mount Sinai School of Medicine in New York, is one of the world’s leading experts in posttraumatic stress, a true pioneer in this field. In numerous studies, Yehuda has examined the neurobiology of PTSD in Holocaust survivors and their children. Her research on cortisol in particular (the stress hormone that helps our body return to normal after we experience a trauma) and its effects on brain function has revolutionized the understanding and treatment of PTSD worldwide. (People with PTSD relive feelings and sensations associated with a trauma despite the fact that the trauma occurred in the past. Symptoms include depression, anxiety, numbness, insomnia, nightmares, frightening thoughts, and being easily startled or “on edge.”)
Yehuda and her team found that children of Holocaust survivors who had PTSD were born with low cortisol levels similar to their parents, predisposing them to relive the PTSD symptoms of the previous generation. Her discovery of low cortisol levels in people who experience an acute traumatic event has been controversial, going against the long-held notion that stress is associated with high cortisol levels. Specifically, in cases of chronic PTSD, cortisol production can become suppressed, contributing to the low levels measured in both survivors and their children.
Yehuda discovered similar low cortisol levels in war veterans, as well as in pregnant mothers who developed PTSD after being exposed to the World Trade Center attacks, and in their children. Not only did she find that the survivors in her study produced less cortisol, a characteristic they can pass on to their children, she notes that several stress-related psychiatric disorders, including PTSD, chronic pain syndrome, and chronic fatigue syndrome, are associated with low blood levels of cortisol. Interestingly, 50 to 70 percent of PTSD patients also meet the diagnostic criteria for major depression or another mood or anxiety disorder.
Children of Holocaust survivors were likely to relive PTSD symptoms.
Yehuda’s research demonstrates that you and I are three times more likely to experience symptoms of PTSD if one of our parents had PTSD, and as a result, we’re likely to suffer from depression or anxiety. She believes that this type of generational PTSD is inherited rather than occurring from our being exposed to our parents’ stories of their ordeals. Yehuda was one of the first researchers to show how descendants of trauma survivors carry the physical and emotional symptoms of traumas they do not directly experience. That was the case with Gretchen. After years of taking antidepressants, attending talk and group therapy sessions, and trying various cognitive approaches for mitigating the effects of stress, her symptoms of depression and anxiety remained unchanged. Gretchen told me she no longer wanted to live. For as long as she could remember, she had struggled with emotions so intense she could barely contain the surges in her body. Gretchen had been admitted several times to a psychiatric hospital where she was diagnosed as bipolar with a severe anxiety disorder. Medication brought her slight relief, but never touched the powerful suicidal urges that lived inside her. As a teenager, she would self-injure by burning herself with the lit end of a cigarette. Now, at thirty-nine, Gretchen had had enough. Her depression and anxiety, she said, had prevented her from ever marrying and having children. In a surprisingly matter-of-fact tone of voice, she told me that she was planning to commit suicide before her next birthday. Listening to Gretchen, I had the strong sense that there must be significant trauma in her family history. In such cases, I find it’s essential to pay close attention to the words being spoken for clues to the traumatic event underlying a client’s symptoms. She struggled with emotions so intense she could barely contain the surges in her body. When I asked her how she planned to kill herself, Gretchen said that she was going to vaporize herself. As incomprehensible as it might sound to most of us, her plan was literally to leap into a vat of molten steel at the mill where her brother worked. “My body will incinerate in seconds,” she said, staring directly into my eyes, “even before it reaches the bottom.”
I was struck by her lack of emotion as she spoke. Whatever feeling lay beneath appeared to have been vaulted deep inside. At the same time, the words vaporize and incinerate rattled inside me. Having worked with many children and grandchildren whose families were affected by the Holocaust, I’ve learned to let their words lead me. I wanted Gretchen to tell me more.
I asked if anyone in her family was Jewish or had been involved in the Holocaust. Gretchen started to say no, but then stopped herself and recalled a story about her grandmother. She had been born into a Jewish family in Poland, but converted to Catholicism when she came to the United States in 1946 and married Gretchen’s grandfather. Two years earlier, her grandmother’s entire family had perished in the ovens at Auschwitz. They had literally been gassed—engulfed in poisonous vapors—and incinerated. No one in Gretchen’s immediate family ever spoke to her grandmother about the war, or about the fate of her siblings or her parents. Instead, as is often the case with such extreme trauma, they avoided the subject entirely.
Her grandmother’s entire family had perished in the ovens at Auschwitz.
Gretchen knew the basic facts of her family history, but had never connected it to her own anxiety and depression. It was clear to me that the words she used and the feelings she described didn’t originate with her, but had in fact originated with her grandmother and the family members who lost their lives.
As I explained the connection, Gretchen listened intently. Her eyes widened and color rose in her cheeks. I could tell that what I said was resonating. For the first time, Gretchen had an explanation for her suffering that made sense to her.
To help her deepen her new understanding, I invited her to imagine standing in her grandmother’s shoes, represented by a pair of foam rubber footprints that I placed on the carpet in the center of my office. I asked her to imagine feeling what her grandmother might have felt after having lost all her loved ones. Taking it even a step further, I asked her if she could literally stand on the footprints as her grandmother, and feel her grandmother’s feelings in her own body. Gretchen reported sensations of overwhelming loss and grief, aloneness and isolation. She also experienced the profound sense of guilt that many survivors feel, the sense of remaining alive while loved ones have been killed.
Gretchen reported sensations of overwhelming loss and grief, aloneness and isolation.
In order to process trauma, it’s often helpful for clients to have a direct experience of the feelings and sensations that have been submerged in the body. When Gretchen was able to access these sensations, she realized that her wish to annihilate herself was deeply entwined with her lost family members. She also realized that she had taken on some element of her grandmother’s desire to die. As Gretchen absorbed this understanding, seeing the family story in a new light, her body began to soften, as if something inside her that had long been coiled up could now relax.
As with Jesse, Gretchen’s recognition that her trauma lay buried in her family’s unspoken history was merely the first step in her healing process. An intellectual understanding by itself is rarely enough for a lasting shift to occur. Often, the awareness needs to be accompanied by a deeply felt visceral experience. We’ll explore further the ways in which healing becomes fully integrated so that the wounds of previous generations can finally be released.
Trauma can lay buried in a family’s unspoken history.
An Unexpected Family Inheritance
A boy may have his grandpa’s long legs and a girl may have her mother’s nose, but Jesse had inherited his uncle’s fear of never waking, and Gretchen carried the family’s Holocaust history in her depression. Sleeping inside each of them were fragments of traumas too great to be resolved in one generation.
When those in our family have experienced unbearable traumas or have suffered with immense guilt or grief, the feelings can be overwhelming and can escalate beyond what they can manage or resolve. It’s human nature; when pain is too great, people tend to avoid it. Yet when we block the feelings, we unknowingly stunt the necessary healing process that can lead us to a natural release.
Sometimes pain submerges until it can find a pathway for expression or resolution. That expression is often found in the generations that follow and can resurface as symptoms that are difficult to explain. For Jesse, the unrelenting cold and shivering did not appear until he reached the age that his Uncle Colin was when he froze to death. For Gretchen, her grandmother’s anxious despair and suicidal urges had been with her for as long as she could remember. These feelings became so much a part of her life that no one ever thought to consider that the feelings didn’t originate with her.
Currently, our society does not provide many options to help people like Jesse and Gretchen who carry remnants of inherited family trauma. Typically they might consult a doctor, psychologist, or psychiatrist and receive medications, therapy, or some combination of both. But although these avenues might bring some relief, generally they don’t provide a complete solution.
Not all of us have traumas as dramatic as Gretchen’s or Jesse’s in our family history. However, events such as the death of an infant, a child given away, the loss of one’s home, or even the withdrawal of a mother’s attention can all have the effect of collapsing the walls of support and restricting the flow of love in our family. With the origin of these traumas in view, long-standing family patterns can finally be laid to rest.
This article is an excerpt from Mark Wolynn’s book: “IT DIDN’T START WITH YOU: How Inherited Family Trauma shapes who we are and how to end the cycle”
So there you go. Ancestral trauma. Another avenue of investigation I am looking at in order to find dome deeply buried answers to some deeply buried and confusing questions.
We also spoke about somatic trauma and somatic healing relating to psychological trauma, abuse and healing and recovery employing a somatic approach hand in hand with DBT. This is Kathryn C Holt's speciality. Kathryn is one of the DBT_paths therapists that hold the live sessions and Q and A and bla bla bla. She's great.
somatic /səˈmatɪk/ Learn to pronounce
adjective relating to the body, especially as distinct from the mind. "patients completed a questionnaire about their somatic and psychological symptoms"
BIOLOGY relating to the soma.
“soma” which means living body
In a nut shell....
How Somatic Therapy Can Help Patients Suffering from Psychological Trauma
By Kauser Khan
Whatever happens in our lives impacts our mind either consciously or unconsciously. Sometimes events — such as the unexpected death of a loved one, illness, fearful thoughts, near-death accidents or experiences — result in traumas. Psychological trauma causes damage to the psyche that occurs as a result of a severely distressing event.
How Somatic Psychotherapy Helps
Somatic psychotherapy is one of the best ways to help patients suffering from psychological traumas cope, recover and live a normal life. The word somatic is derived from the Greek word “soma” which means living body. Somatic therapy is a holistic therapy that studies the relationship between the mind and body in regard to psychological past. The theory behind somatic therapy is that trauma symptoms are the effects of instability of the ANS (autonomic nervous system). Past traumas disrupt the ANS.
According to somatic psychologists, our bodies hold on to past traumas which are reflected in our body language, posture and also expressions. In some cases past traumas may manifest physical symptoms like pain, digestive issues, hormonal imbalances, sexual dysfunction and immune system dysfunction, medical issues, depression, anxiety and addiction.
However, through somatic psychotherapy the ANS can again return to homeostasis. This therapy has been found to be quite useful in providing relief to disturbed patients and treating many physical and mental symptoms resulting from past traumas.
Somatic psychology confirms that the mind and body connection is deeply rooted. In recent years neuroscience has emerged with evidence that supports somatic psychology, showing how the mind influences the body and how the body influences the mind.
How it Works
The main goal of somatic therapy is recognition and release of physical tension that may remain in the body in the aftermath of a traumatic event. The therapy sessions typically involves the patient tracking his or her experience of sensations throughout the body. Depending on the form of somatic psychology used, sessions may include awareness of bodily sensations, dance, breathing techniques, voice work, physical exercise, movement and healing touch.
Somatic therapy offers a variety of benefits. It re-frames and transforms current or past negative experiences, inculcates greater sense of oneself, confidence, resilience and hope. It reduces discomfort, strain and stress while developing a heightened ability to concentrate.
Some of the somatic methods that therapists use are titration and pendulated method. Titration uses a resource state, a place of safety. The patient is guided through traumatic memories and then the therapist asks the patient if he or she notices any change in the way they feel when the memory is revived. The physical stimulus is usually gentle and small. However, if physical symptoms occur, they are then attended to at length.
On the other hand, pendulated method refers to the movement between homeostasis and instability. Unlike titration, in this type of method, the patient is moved from a state of homeostasis to a state where physical symptoms are present. Then the patient is helped to return to the state of stability. In this method, discharge occurs. Discharge is stress that is stored by the nervous system. It can include discomforting experiences, nausea, twitching and flushing of the skin.
When somatic therapy sessions are completed, the patient often reports a feeling of being free, less stressful and more engaged with life. It decreases the level of physical pain and mental stress, too.
Kathryn C Holt's : trauma somatic skills
Once I have completed this run DBT_path I will need a break from DBT per se and I will sign up to Kathryn's Somatic course assuming I can do it all online as she is in America and I don't want to be flying there once a week and I'm not a great swimmer so i hope he has a good dial up modem at least (remember them?). Her course will help me understand and get to grips with my own:
True hunger: Food relationships, which has been a problem. Keto diet is my current attempt to address this as far as IBS goes and addressing my body type and fat storage things I am concerned about, visceral fat stuff. This is a concern for health purposes, not vanity and I just find it fascinating.
True Hunger is focused on helping you reconnect with, and reclaim, your body, mind, emotions, and soul from diet culture. This means learning what you are truly hungry for, and trusting your hunger, instead of staying stuck in body insecurity and preoccupation with food.
Kathryn C Holt - https://www.kathryncholt.com/
Psycho spiritual work I want to address.
It was good to discuss the above subjects. I will research and dib up on these subjects and the available materials I want to order. I will create a blog entry my findings.
Good to know: the problem with being labelled with BPD or even EUPD:
Borderline personality disorder (BPD) is a highly stigmatised and misunderstood condition. People with BPD face considerable barriers to accessing high-quality and affordable care, according to new research published today.
For every 100 patients we treat in inpatient psychiatric wards, 43 will have BPD. People with this condition are vulnerable, impulsive, and highly susceptible to criticism – yet they continue to face stigma and discrimination when seeking care.
We have come a long way since the days of viewing mental illness as a sign of weakness, but we are lagging behind in our attitude towards BPD. At least part of this stems from the way we frame the condition, and from the name itself.
Rather than as a personality disorder, BPD is better thought of as a complex response to trauma. It’s time we changed its name.
EUPD is the "other" title it has been given, Emotionally Unstable Personality disorder but this name beings unwanted attention and stigma to this illness more often than not that is a reaction to trauma, especially childhood, early adulthood trauma(s).
How common is BPD?
BPD in it's varying degrees is strikingly common, affecting between 1% and 4% of the population. It is characterised by emotional regulation, an unstable sense of self, difficulty forming relationships, and repeated self-harming behaviours.
This link with trauma – particularly physical and sexual abuse – has been studied extensively and has been shown to be near-ubiquitous in patients with BPD.
People with BPD who have a history of serious abuse have poorer outcomes than the few who don’t, and are more likely to self-harm and attempt suicide. Around 75% of BPD patients attempt suicide at some point in their life. One in ten eventually take their own life.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) does not mention trauma as a diagnostic factor in BPD, despite the inextricable link between BPD and trauma. This adds to viewing BPD as what its name suggests it is – a personality disorder.
Instead, BPD is better thought of as a trauma-spectrum disorder – similar to chronic or complex PTSD.
The similarities between complex PTSD and BPD are numerous. Patients with both conditions have difficulty regulating their emotions; they experience persistent feelings of emptiness, shame, and guilt; and they have a significantly elevated risk of suicide.
People with BPD are highly susceptible to criticism.
Why the label is such a problem
Labelling people with BPD as having a personality disorder can exacerbate their poor self-esteem. “Personality disorder” translates in many people’s minds as a personality flaw, and this can lead to or exacerbate an ingrained sense of worthlessness and self-loathing.
This means people with BPD may view themselves more negatively, but can also lead other people – including those closest to them – to do the same.
Clinicians, too, often harbour negative attitudes towards people with BPD, viewing them as manipulative or unwilling to help themselves. Because they can be hard to deal with and may not engage with initial treatment, doctors, nurses and other staff members often react with frustration or contempt.
What could a name change do?
Explicitly linking BPD to trauma could alleviate some of the stigma and associated harm that goes with the diagnosis, leading to better treatment engagement, and better outcomes.
When people with BPD sense that people are distancing themselves or treating them with disdain, they may respond by self-harming or refusing treatment. Clinicians may in turn react by further distancing themselves or becoming frustrated, which perpetuates these same negative behaviours.
Eventually, this may lead to what US psychiatric researcher Ron Aviram and colleagues call a “self-fulfilling prophecy and a cycle of stigmatisation to which both patient and therapist contribute”.
Thinking about BPD in terms of its underlying cause would help us treat its cause rather than its symptoms and would reinforce the importance of preventing child abuse and neglect in the first place.
If we started thinking about it as a trauma-spectrum condition, patients might start being viewed as victims of past injustice, rather than perpetrators of their own misfortune.
BPD is a difficult condition to treat, and the last thing we need to do is to make it harder for patients and their families.
What is DBT? - nicked from: https://www.dbt-training.co.uk/what-is-dbt/
DBT is an innovative and unique treatment model for Borderline Personality Disorder (BPD), developed by Professor Marsha Linehan at University of Washington, Seattle.
Its popularity has grown rapidly in the USA and increasingly in Europe, chiefly due to its success in effectively treating client groups whose emotional problems are particularly difficult to manage within a therapeutic relationship or an institutional setting.
Treats patients with a history of chronic suicidal behaviour.
Is a unique, team-based Cognitive Behavioural Therapy.
Enhances the morale and effectiveness of the therapist.
Can be adapted for specialities such as Eating Disorders, Adolescents and Substance Misuse amongst others.
Is recognised to treat women and now also men with BPD for whom reducing recurrent self-harm is a priority (NICE, 2009).
Is cited as an evidence-based intervention in A Vision for Change
Standard comprehensive DBT comprises 4 components:
Individual therapy (approximately 60 minutes/week)
Group educational skills training (approximately 120 minutes/week)
Team meeting (approximately 90 minutes/week)
Unscheduled telephone calls (average duration approximately 6 minutes)
Research shows that DBT leads to improvement in various problems related to BPD, such as self-harming, suicide attempts, depression, eating problems and feelings of hopelessness. The latest National Institute of Health and Care Excellence (NICE) guidelines propose DBT as the treatment of choice for people with BPD who want to reduce self-harming and self sabotaging and/or destructive behaviours.
Providing a Dialectical Behaviour Therapy (DBT) Programme to your patients teaches them DBT skills necessary to regulate emotions, control self-destructive behaviours and improve interpersonal relations. It was developed for patients with severe personality disorders, including borderline personality disorders. With an ever-expanding evidence base, the scope of DBT has been widened to reach individuals for whom BPD might be a co-morbid problem such as with severe depression, eating disorders or substance misuse and has been adapted to function in a variety of settings, working with children and adolescents, people with intellectual disabilities or in prisons for example.
Development of DBT
The Development of DBT
(Nicked from Behavioural Tech Website)
In the late 1970s, Marsha M. Linehan (1993) attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of, initially, adult women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm, and self-mutilation. Trained as a behaviourist, she was interested in treating discrete behaviours; however, through consultation with colleagues, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD).
In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:
Clients receiving CBT found the unrelenting focus on change inherent to CBT invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop out rate. And, obviously, if clients do not attend treatment, they cannot benefit from treatment.
Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. In other words, therapists were unwittingly under the control of consequences outside their awareness, just as all humans are. For example, the research team noticed through its review of audio taped sessions that therapists would “back off” pushing for change of behaviour when the client’s response was one of anger, or emotional withdrawal, or shame, or threatened self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they didn’t want to discuss to one they did want to discuss.
The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients – suicide attempts, urges to self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, etc, — AND have session time devoted to helping the client learn and apply more adaptive skills.
Adding Validation and Dialectics to CBT.
In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT. They added in new types of strategies and reformulated the structure of the treatment (see below, next section). In the case of new strategies, Acceptance-based interventions, frequently referred to as validation strategies, were added. Adding these communicated to the clients that they were both acceptable as they were and that their behaviours, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviours were “perfectly normal”, helping clients discover that they had sound judgement and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: Clients also must change if they want to build a life worth living. Thus, the focus on acceptance did not occur to the exclusion of change based strategies; rather, the two enhanced the use of one another. In the course of weaving in acceptance with change, Linehan noticed that a third set of strategies – Dialectics –came into play. Dialectical strategies gave the therapist a means to balance acceptance and change in each session and served to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviours that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD.
Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become mired in arguments, polarising positions, and extreme positions. Thus, these three sets of strategies and the theories on which they are based from are the three foundations of DBT.
Restructuring the Treatment.
As noted above, very significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT. Below we discuss how DBT treatment is organised by Functions and Modes and by Stages and Targets. The treatment we are describing is the treatment that is considered to be Standard and Comprehensive DBT. It is the form of DBT that has been subject to the most rigorous research in terms of randomised controlled trials (RCTs). The variations of DBT that differ from the structure described below is being researched but has not yet been subjected to as rigorous a test as standard DBT. Thus, the reader should keep in mind that this is how comprehensive DBT is defined and that variations from this structure are not considered comprehensive or standard.
Functions and Modes.
Briefly, Linehan (1993) hypothesises that any comprehensive psychotherapy must meet five critical functions. The therapy must: a) enhance and maintain the client’s motivation to change; b) enhance the client’s capabilities; c) ensure that the client’s new capabilities are generalised to all relevant environments; d) enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities; and, e) structure the environment so that treatment can take place. Due to space considerations, we will not review every possible mode (method) that can meet these functions. Rather, we offer the most common examples of how these functions are met in standard outpatient DBT. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most salient individual for the client. Skills are acquired, strengthened, and generalised through the combination of skills groups, phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments. Therapists’ capabilities are enhanced and burnout prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheer leading the therapist in applying effective interventions. (In DBT, a therapist is not considered to be meeting the requirements of the treatment unless he or she meets weekly in a DBT consultation team). Finally, the environment can be structured in a variety of ways, say by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviours or punished for effective behaviours in the home.
Stages and Targets.
DBT also organises treatment into stages and targets and, with very few exceptions, adheres strictly to the order in which problems are addressed. The organisation of the treatment into stages and targets prevents DBT being a treatment that, week after week, addresses the crisis of the moment. Further, it has a logical progression that first addresses behaviours that could lead to the client’s death, then behaviours that could lead to premature termination, to behaviours that destroy the quality of life, to the need for alternative skills. In other words, the first goal is to insure the client stays alive, so that the second goal (staying in therapy), results in meeting the third goal (building a better quality of life), partly through the acquisition of new behaviours (skills). In short, we have just described the targets found in Stage I. To repeat, the first stage of treatment focuses, in order, on decreasing life threatening behaviours, behaviours that interfere with therapy, quality of life threatening behaviours and increasing skills that will replace ineffective coping behaviours. The goal of Stage I DBT is for the client to move from behavioural dyscontrol to behavioural control so that there is a normal life expectancy. In Stage II, DBT addresses the client’s inhibited emotional experiencing. It is thought that the client’s behaviour is now under control but the client is suffering “in silence”. The goal of Stage II is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated. Stage III DBT focuses on problems in living, with the goal being that the client has a life of ordinary happiness and unhappiness. Linehan has posited a Stage IV specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfilment or a sense of contentedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.
It was useful to talk again about what DBT actually is and how, to put it in very simplified terms, is built and modelled around Zen Buddhism and CBT to create DBT.
Always good to remind ourselves of what wise mind actually is and is not. As opposed to a black and white view of emotional mind and rational mind.
The 3 components of of what DBT addresses was addressed and was again a great reminder and re motivator of my behavioural goals:
"Wise mind" is my goal.
Emotions and Trauma:
Retraining the nervous system.
This section of our session about retraining the nervous system discussed further from our previous unit was another mind opener about the links between our thinking processes and bodily psycho-physical reactions, the affects emotions have on our bodies. Having what trauma does to the body over the course of years explains a lot about my physical ailments and body shape and eating habits and so on. I tick the boxes and I find that both intriguing and i want to learn more and I also find it a bit hard to take as it makes me feel even more resentful towards the abusers. I'll deal with that though, another day. Retraining the nervous system has been and is going to be a long process. Hard work but totally possible. I'm on the right path and I have changed a lot of habits and lifestyle choices and I have been practising as hard as I can, the DBT skills being taught in DBT_path. Since I did this unit the first time around, I have in all honesty made progress.
The hard work continues (and will probably never end).
Session Slides from our discussions:
Does child abuse cause borderline personality disorder (BPD)?
There is no simple answer. In fact, we don't yet know exactly what causes BPD, though it is believed to be a mix of biological and environmental factors. There is evidence that people with BPD are more likely to report a history of some type of child abuse or other distressing childhood experiences. Yet many people who have experienced child abuse do not have BPD and many people with BPD were not abused or maltreated as children.
What Is Child Abuse?
The term "child abuse" covers a wide range of mental and physical injuries done to a minor. Experts generally assign a set of experiences to this category:
Physical abuse: Physically hurt or injured, such as bruising or broken bones
Sexual abuse: Being subjected to a sexual experience or exploited in a sexual manner by someone older
Emotional abuse: Undergoing emotional attacks, such as verbal abuse or degradation
A large percentage of people with BDP report experiencing child abuse during their childhoods:
Forty to 76% of people with BPD report that they were sexually abused as children, and 25% to 73% report that they were physically abused. So, while there is a good deal of research that links childhood abuse to BPD, there is also evidence that about a third of people with BPD report no abuse.
Other forms of abuse can be more passive, such as in the case of physical neglect where the child is denied basic necessities, like food or water. There is also emotional neglect, where a child's emotional needs are ignored. No form of abuse is necessarily considered more severe than another; all forms of abuse can have long-lasting implications for the person and can shape their mental state.
Both child abuse and neglect can be related to the development of psychological disorders. Sometimes the term "child maltreatment" is used to describe both abuse and neglect of children.
Research on Child Abuse and BPD
Research does indicate that there is a relationship between child abuse and borderline personality disorder (BPD). People with BPD report high rates of childhood sexual abuse, emotional abuse, and/or physical abuse.
There is also evidence to link BPD to other forms of child maltreatment, such as emotional and physical neglect. In fact, some research suggests that emotional and physical neglect may be even more closely related to the development of BPD than physical or sexual abuse. However, this is difficult to determine, since children who experience abuse also often experience some form of neglect.
How Childhood Abuse Might Lead to BPD
If childhood abuse is a risk factor for BPD, what are the way in which these childhood experiences lead to the development of BPD? A 2016 study found that emotional abuse was the most significant type of abuse in later BPD and that preoccupied adult attachment may be a mediator between the abuse and BPD.
Other studies have likewise investigated the role of emotional abuse in later BPD. While these studies are important in looking for causes that may be preventable, they are also helpful in determining how treatment may help people currently coping with the disorder, in particular, approaches involving emotion regulation.
Is BPD Different in Those Who Suffered Childhood Abuse?
When comparing the symptoms of BPD in those who were abused as children and those who were not, it's been found that sexual abuse in childhood specifically appears to be linked to an increased risk of suicidal attempts in people with BPD.
What the Research Says
Research has fairly conclusively demonstrated a relationship between BPD and childhood maltreatment. That said, there is no clear evidence that maltreatment causes BPD. Research that demonstrates an association between two things doesn't necessarily prove that there is a cause between them. Clearly, with child abuse statistics indicating that abuse is much more common than we would think, it is important to determine whether or not it is one of the causes of borderline personality disorder.
More research is needed to evaluate the precise relationships between childhood abuse and BPD, and if abuse is a cause, what types of child maltreatment are most closely associated with the development of BPD.
A Word From Verywell
BPD is a highly misunderstood disease. If you are living with BPD or know someone living with the disorder, take the time to learn what you can. Contrary to popular opinion, BPD is treatable, and those living with the disease can live meaningful lives.
While there can be significant problems with interpersonal relationships, this aspect as well can be improved greatly with understanding on the part of both the person living with the disorder and those who care about him or her.
Session slides from discussion:
We discussed trauma in depth ⬆⬆