Emotional Cascades and Understanding the Chaos and Complexity of Borderline Personality Disorder

if our in listen up good afternoon and welcome to the brain and behavior research foundations meet the scientists monthly webinar series I'm dr. Jeff Borenstein president and CEO of the foundation and your host and moderator for today's webinar today dr. Edward Shelby will present emotional cascades and understanding the chaos and complexity of borderline personality disorder the brain and behavior Research Foundation funds research around the world that identifies the causes in order to improve treatments for mental illness since 1987 the Foundation has awarded more than 328 million dollars in research grants we have the largest funder of Mental Health grants outside the federal government and 100% of all donor contributions for research are invested in these research grants and when researchers are working to find scientific breakthroughs in brain and behavior disorders such as ADHD anxiety autism bipolar disorder borderline personality disorder depression OCD PTSD and schizophrenia I'm delighted to introduce dr. Edward Selby dr. Selby is assistant professor of clinical psychology at Rutgers University and the recipient of a 2012 narf ed Young Investigator grant dr. Selby specializes in research and treatment of suicidal and self injurious injurious behavior personality disorders and eating disorders a major focus of his research on these disorders involves emotional dysregulation and the use of self sabotaging behaviors to distract from dealing with upsetting emotions today's webinar will begin with dr. Selby's presentation this will be followed by questions and answers to submit a question please use the questions tab on the control panel on your screen feel free to submit your questions throughout the presentation following the presentation I'll prevent your questions to dr. fell B and we will address as many of them as possible and now I'm pleased to present dr. Edward Selby Eddy the floor is yours great it's such a pleasure to be speaking to so many people around the world today I'm gonna be talking about borderline personality disorder today which is a complex disorder that people with the disorder and to their family and friends mother's around them can seem like a very chaotic condition but as we'll see we've developed the science quite a bit over the last decade or so particularly pinpointing the role of a process called emotional Cascades in driving much of these behaviors for those of you who are unfamiliar with borderline personality disorder it's a disorder that involves quite frequently that's okay if the disorder that quite frequently involves turbulent emotional experiences these individuals can get extremely upset much more so than the average individual in the same scenario this often results from things that might seem very minor but can result in an extreme emotional response they also display frequent problems with dysregulated behaviors these behaviors can include things such as aggressive behavior substance use self injurious behavior or even eating disordered behaviors boiling precise or is that the sort of also causes a lot of suffering and because of that a disorder with an elevated suicide rate many of these individuals end up struggling throughout their lives and unfortunately a number end up losing their life due to suicide another related concern with this is self injurious behavior which I'll get to in a moment and then another aspect of this disorder involves stormy personal relationships where they're often having very chaotic interactions with other people including family members friends and romantic relationships now my research focuses very heavily on the first two aspects up here trivial and emotions and dysregulated behaviors which we'll see I think are the core of this disorder and drive much of the problems that people experience with the disorder now I'm going to diverge here for a moment and talk a little bit about self-injury now folks injury is that the store that's gaining more and more public awareness and is a very prominent behavior in many Western settings this behavior involves purposely cutting burning hitting pinching or severely scratching oneself without any desire for dying by suicide so they're doing it without attempting to kill themselves and the sort of can seem very mysterious at first but fortunately it's the behavior that we've learned much about over views now self-injury is a behavior that can be found quite frequently in people with borderline precise disorder although it's not necessarily exclusive tubule and personality disorder I want to take a moment and go ahead and pull the audience to kind of get a sense of what the general audience is understanding of self injurious behavior is so you should see a pole popping up on your screen now and I'm going to read out to you the question as well as the answers if you have a moment I'd like you to go ahead and answer the question just giving it your best effort from what you know why do people engage in self-injury without suicidal intent please select one of the following to get out of doing something boring to feel a rush of excitement to get attention from someone they love or to escape from emotional distress so now go ahead and take a moment to think about each of these options and when you can go ahead and select one the poll will close here in about 20 to 30 seconds and then what I will do is I'll reveal what the general audience thinks is the sort of primary reason that people engage in self-injury and then I'll explain to you what the answer is and why so go ahead and finish uploading if you have can now I see on my screen that zero percent reported selected getting out of something boring so good free of audience only two percent reported getting rush or feeling of excitement four percent reported to get attention from someone they love and the ninety three percent of you said to escape feelings of emotional distress so the answer the correct answer is B although it's a little bit of a trick question and that people report all of these reasons but the key here is is that the primary reason that the majority of people who self-injure report is answered B to escape feelings of emotional distress answer B also happens through more commonly which is to get a feeling of rush or excitement the other two which involves social reasons happen but are much less common than the other two to highlight this i've got some graphs displayed on the screen for you and these are from some of our ongoing research in our lab where we have adolescent self injurers take our smartphone app and use it during their daily lives and when they do when they engage in self-injury they report how they were feeling before and how they were feeling after the self-injury what you can see here is that after self-injury they felt a decrease in negative emotion so they felt less upset after self-injuring and an increase in positive emotion after self-injury and you can see these emotions broken down below you now this is sort of interesting because it's sort of a paradox why would somebody when they're feeling really upset about something physically hurt themselves to feel better and that it's been a central theme to this to my research on not only self-injury but other behavioral problems are associated with four-alarm personality disorder now the place of the work that I do I'm borderline personality disorder in context I want to show sort of where the field stands for borderline personality disorder as you can see here we've established there's a number of vulnerabilities that many people have either genetic vulnerabilities biological vulnerabilities or social familial vulnerabilities growing up in a challenging family or in a bad neighborhood well we found that these various vulnerabilities increase the prediction of later development of psychopathology things like borderline personality disorder self-injury suicidal behavior and eating disorder behavior but one of the challenges in research is we don't really understand how someone goes from having a vulnerability to developing the disorder so we have a big black box of looking between well my work establish to establish what takes these vulnerabilities and turns it into the disorder through emotional mechanisms so people have these vulnerabilities experience and changes in emotions and behavior that ultimately leads to the development of these conditions like borderline personality disorder one of the primary mechanisms we've looked at with this involves what are called what we've called emotional Cascades so an emotional cascade is an emotional experience that we found tends to be very unique for people with extreme impulsive behaviour and particularly borderline personality disorder and it typically starts with the experience of an emotion typically a negative emotion this could be due to a variety of things getting some bad news getting a bad grade on a test being criticized about something some of these things we may understand we would also as a broad population feel upset about these events but sometimes they can be perceived problems as well as thinking maybe somebody meant something or reading in between the lines with the situation so this leads to negative emotion and when we think people with BPD differ from other people as the people with BPD tend to ruminate on these upsetting problems yeah rumination is a term that you might not be familiar with but what it refers to is repeatedly thinking about an upsetting problem the causes and the consequences of that problem over and over and over sort of chewing on it and not letting it go and what we've found is that when people ruminate and this will applies to people with depression people a four-line precise order and a number of other conditions they tend to experience an increased emotional intensity by ruminating it makes them more upset but what we've also found is that as people get more upset they tend to engage in more rumination so what we think is happening with people with BPD is a ruminating of our problem making themselves more upset and as a result they're thinking even more intensely and more frustratingly about the problem and this continues to build until they've reached what we've called an emotional cascade which has been extremely intense and very painful emotional experience that's very difficult to tolerate now it's during an emotional cascade then we think many of these individuals engage in what we call dysregulated behaviors once again the disraeli the behavior could be something like self-injury using a substance or binge eating or other eating disordered behaviors getting into a physical fight or yelling a variety of different behaviors now what we think is that these different behaviors all have in common a potent physical sensation so it could be the pain and self-injury or sometimes people report viewing the blood is something that draws them to self-injury using a substance the physical effects of the substance or binge eating on food feeling the effects of fullness tasting the food all these provide very strong physical sensations and what these physical sensations do we think is interfere with this rumination component it allows people to focus away from ruminating about the problem and onto the physical sensations what that then does is short-circuits the emotional cascade and makes it go away and then that's often associated with feelings of relief they've gotten rid of this extremely painful of experience and now they're feeling relieved because of this so just to sort of highlight our initial investigations into emotional Cascades and if people with BPD have them well the first experiments we did was a called a rumination induction and in this rumination induction we brought in people with BPD and people without BPD and then we have them engaged in a five-minute task where they thought about a personally relevant upsetting situation and we encourage them to think as much and deeply about the causes and that problem is possible now what you see grasp before you are the before and after results of this induction so as we can see here the yellow bars or the BP with the before group with this being the BPD group and as you can see here the BPD group is much more upset right off the bat than the control group maybe they just didn't want to come in for the experience experiment they were annoyed who knows now after the five-minute rumination induction what we saw was that people's BPD once again we're more upset than people without BPD but what's really important in a task like this is the amount of change from the Florida after because that gives us an index of reactivity to this task and when we compared the two groups we can see here that the BPD group was much more upset after this task than the control group so what that means is that even just asking these individuals with BPD to think about an upsetting problem they responded much more intensely than the control group and these numbers here what's important is to show this is a medium effect which means that they responded pretty decently strongly to a test involved in just thinking about a problem let alone actually experiencing a problem now I want to take a moment and talk about current research that we're doing in our lab and one of our big projects which was funded by the brain and behavior Research Foundation as well as the borderline families for borderline personality disorder research involves taking this previous task with rumination induction and comparing people with BPD to other disorders such as depression or bulimia and then also at the same time measuring their physiological responses which you can see displayed up here so this will be measuring their blood pressure their heart rate how much electricity is in their skin and what we're hoping to show with this project is that people with BPD show not only a greater psychological response of getting upset but also a greater physiological response showing that if both this sort of body reaction as well as a psychological reaction we're still working on the day after that so I don't know about to show you today but I have plenty of other good things building on our experimental research with borderline personality disorder we've also been working on more real-world have its how do we get into the real world of people with people with BPD and measure emotional Cascades and see how those energy influence behaviors one of the ways we do that is with a technique called experience sampling in this technique people carry a Palm Pilot which is now sort of a defunct technology now we're using more smartphone apps but a lot of the initial research was done with these Palm Pilots people would carry this around and it would beat them 5 to 6 times per day and then they would respond to the questions of how are you feeling what kind of behaviors have you engaged and have you had any interpersonal interactions that were problematic and they would respond to this multiple times per day now when we did this with a study of 50 people who were very impulsive many of which had borderline personality disorder we can uncover the number of behaviors so a number of people reported alcohol use reckless driving self-injury impulsive shopping substance use binge eating and some physical fighting and aggressive behavior so people were reporting a lot of these problematic behaviors and what we wanted to show was that emotional Cascades experience now will predict a future behavioral problem so the way we looked at this was we looked at one signal how did someone feel or thinking that this one signal predict a future signal so I'll come back to that so how does someone feeling now does that predict they're engaging in substance use binging behavior assault of injury two to three hours down the road and what we found was that the more people were ruminating about a problem or the more negative emotion they had the more likely they were to engage in these behaviors so we were essentially predicting their behavior out in the real world that the more upset they got the more likely they would be to engage in these behaviors now what we see here is that this effect was even larger for those with borderline personality disorder well you can fear this top line as indicated by the orange arrow those are people with BPD and the more someone with BPD was ruminating about a problem and the more upset they were feeling about the problem the more likely they were to engage in one of these different behaviors in fact it was going to be almost 90 percent that they would do one of these behaviors so once again we were able to show that people the way they were feeling predicted at their future behavior now another way of looking at emotional Cascades is done with what we call the instability of rumination now this is sort of a tricky concept to understand and the best way to sort of discuss is by looking at a graph so here we have someone's rumination levels over time down here's different recordings so reporting one through recording seventy and each time they reported how much they were ruminating and what you see is they have some peaks and some missing points is where they didn't respond but they're kind of going up and down now this person would be classified as being stable by rumination even if it doesn't quite look like it let's compare that to someone with borderline personality disorders so we see right here that by comparison they're all over the place they're having these huge bursts of rumination and calling back down huge bursts of rumination and calling back down and what you can see with these little plus signs here or when they engaged in this rated behavior so it's kind of like they're experiencing this bursts of rumination engaging in just regular behavior calming down so you can see that they're much more unstable in terms of their rumination experience much more so than an average or stable person now I have a second poll for the audience and I'm gonna go ahead and read this out loud view but I just kind of want to get a sense of what people's understanding of Beuerlein personality disorders and what the treatment for it can be so people with BPD should be able to control their emotions just as well as anyone else if they put their mind to it true or false and remember there's no wrong answer we're just trying to get a sense of sort of general perceptions of this disorder and and then I will read the results once they show up so another 20 seconds or show and then we'll we'll present the results of the poll so if you haven't done so already go ahead and select an option and submit your results for the poll and then I will read them out okay so about twelve percent of the audience said that that was true that people can control their emotions just as well as anyone else whereas eighty eight percent said that that was false the answer is oh and i what i mean when i say that is that individuals with BPD experience extreme emotions much more so than someone without BPD can often sort of appreciate or understand they often have many vulnerabilities that result in them experiencing emotion in a much more on intense way than often family members understand but the good news is is that with a lot of practice and learning healthy skills for emotion regulation people with BPD can learn to manage these intense emotions so it's often going to be a challenge for them for a long time now i want to take a moment and talk a little bit about some recent directions my lab has been taking in this research in particularly looking at what's called the butterfly effect which i'm sure a number of you have heard of before if you've seen Jurassic Park so the butterfly effect is a topic that comes to us from chaos theory and it's more precisely known as sensitive dependence on initial conditions to make it easier for people it's good to think of it as it's a compounding effect where even small differences can lead to very extreme outcomes let me give you an example here we have sort of your typical investment to time compounding interest graph so what we see here is the bottom graph down here's time over a year so again zero to twenty five years and then the amount of and and ranging from ten thousand to a hundred thousand so we have three different initial investments here we have somebody who didn't invest very much somebody who invested a little bit more and then somebody who invested quite a bit less or more but not necessarily that much one and what happens is with compounding interest over time this money grows so you can see the person who didn't really invest that much of a start do you really have that much more after 25 years versus the person who's invested just a few thousand or more at the start had substantially more money at the end of 25 years because of compounding interest so what we figured that even just small differences in the start resulted in major outcome differences over time so how is this relevant to borderline personality disorder well some people we see an extremely strong and sensitive connection between negative thoughts and negative emotions particularly those of BPD so we've been looking at the butterfly effect in BPD to try and demonstrate this one way we've looked at this is once again with experience sampling research and in this research we looked at again how did someone how are they feeling right now so they're what's often called laggg rumination so how are they feeling a few hours ago with a ruminating Alanna and that they have a lot of negative emotion and did that predict even higher levels of rumination and negative emotion two to three hours later well what we found it's graphed out here for you and I'll walk you through these paths because they can be a little bit hard to digest but what we've done here is lag rumination which was how they were ruminating a few hours ago and their current rumination in the future so so time one time two and what we see here is that people the more they were ruminating at the start the more that compounded over to the next two to three hours to make them even more upset we can see the same thing down here with lag rumination predicting later rumination the more they were ruminating a few hours ago the more intensely they're ruminating a few hours later now I'm sure this graph can be a bit tricky but let me sort of give you a way to think of this people off who don't have this problem with family members clinicians friends we tend to be in this lower line down here so maybe they got really you know that they were thinking about a problem they were gang upset but it didn't necessarily make them that much more upset where somebody with BPD would be more along this upper line where the more they thought about this problem the more exponentially made them more upset particularly down here you can see this dramatic effect of sort of going off the charts with their emotion and rumination similarly when we look at negative emotion and later rumination we can see that once again the person with tends not to have BPD you know they got more more ruminative the more they got upset but once again the person with BPD is shooting off the charts here because they're experienced such an extreme compounding effect of their emotions and their thoughts so the takeaway from this is is that they sort of get into this feedback loop that makes them more and more upset and more and more focused on the thoughts about the problem they're having that it results in a really extreme emotional response now once again this applies to the behaviors that those people are reporting so we looked at the rumination and negative emotion before and a future dysregulated behavior two to three hours later and once again we see the same effect people down here with lower experience with this they didn't really shoot much up even if they so even if they were ruminating a lot about a problem they weren't necessarily going to engage in a disarray of behavior people with BPD on the other hand shut off the charts in terms of now they were gonna because they were so upset it led them into an emotional cascade and then they engaged in this regulated behavior and you can see the same down here so this is the the purpose of this is to show that oftentimes for family members or clinicians or friends even when we without this disorder might get really upset it doesn't make us as prone to engage in these behaviors because we're not as experiencing this dramatic experience and emotion that the people with BPD are so it sort of can help to understand why people might become so upset over something that might have seemed so small the start so the takeaway of this research is that we were able to show that the butterfly effect applies to borderline personality disorder and it suggests once again that these emotional Cascades are driving a lot of this emotional chaos and the people in people with BPD lives this same effect of having these emotional Cascades is also part of what appears to be driving their dysregulated behaviors like self-injury binge eating substance use etc this part here where disraeli behavior may serve as an attractor point what that means is that people with BPD tend to become so upset as a result of this process that oftentimes the only thing they can think of to make themselves feel better and to get rid of this painful experience is a dysregulated behavior so that's often the challenge with the disorders how do we help individuals with BPD calm down and manage these intense emotions in a way that's healthy without those problematic behaviors now what I've been talking about emotional Cascades I've been talking about them and sort of you know you have an emotional experience someone has emotional cascade they engage in integrated behavior that's sort of one sequence of events but it's important to understand that more or a person I disorder and emotional Cascades exist in a very broad environment with a lot of things going on and a lot of things contributing to the disorder in addition to emotional Cascades so we gotta take the small to the large and one way we've done that in our lab is by doing some theoretical work I'm trying to understand how borderline personality disorder emerges from the experience of emotional Cascades now emergence is a topic that also comes from the chaos and complexity literature and it's it's what it's trying to say is that an emergent phenomenon is something that is more than just the sum of its parts let me give you an example in ecosystem its consists of a whole variety of things things like water precipitation plant an animal life so the amount of Sun that there it's getting but you know the geography and the climate and all of that interacts in a way that creates what we think of as an ecosystem all of these little pieces are contributing in an interacting way to create this larger experience well we think the same thing applies to borderline personality disorder and so I thought here is sort of what we think is the heart of this whole experience where people are having emotional Cascades and then they're engaging in dysregulated behaviors and this is often contributed to by a variety of other things so things like biological vulnerabilities environmental vulnerabilities and different cognitive vulnerabilities now I've just highlighted a couple here to try and keep the this model which is gonna get big in a second to keep it more focused so we've got over here what's called invalidation and criticism from others oftentimes people with BPD live in environments where they're getting criticized a lot whether it's by people at work by friends or by family members and often times this is very legitimate criticism in terms of somebody's saying something that will set pretty much anyone on the other hand a lot of times this can also be perceived where somebody sort of reads into the way someone was acting or reads into what was said so it's sort of a perceived invalidation now on the other hand people with BPD often have distorted cognitions and views of others so they often have thoughts like you know I'm I'm not a good person or I always mess things up or people are always mean and out to get me and so they have a number of these different thoughts both of which are going to promote having emotional Cascades if you have these factors they're likely to contribute to an emotional cascade experience and the subsequent dysregulated behavior now there's a whole lot more going on in this mall which just got very big but I once again want you to keep focused on what we think is sort of the heart of this model the emotional Cascades and the dysregulated behaviors and then the two components that I was just highlighting although the others are certainly relevant so what we see is the experience of invalidation and criticism from others or distorted cognitions and views of others feeds into the experience of emotional Cascades and promotes disraeli other behaviors the more this happens over time whoops I went wrong way the more this happens over time we start to see the emergence of what we think of as borderline personality disorder people are acting in this sort of chaotic emotional behaviorally problematic way and they start to develop what we think of as boil and precise or but where this thinking of the disorder is really enhanced by this idea of emergence is once the disorder starts to emerge it starts to make everything else worse so by having this experience of having borderline personality sorter it makes people more prone to even more invalidation and criticism people might respond to them by saying why do you always act so crazy why do you have to behave in such a bad way why can't you control yourself and similarly as a result of these experiences they might start to develop more distorted thoughts about themselves or others people are always going to yell at me or I am completely worthless and I can't behave myself in a way that works and so basically the experience of blowing precisely starts making all the things that led to the development even worse so it just shows how complex of a disorder this can be and why treatment can be such a challenge for individuals with BPD because there's so many targets to try and help improve with the person that it's hard to figure out what's the one thing to do so that's what I'm going to talk a little bit about what are the treatment implications of emotional Cascades and this sort of model of understanding borderline precise order and I think there are numerous treatment implications as well as some sort of ways that can help families interacting with people with BPD and I'm going to go through those now the place I want to start at the moment is in discussing what's the leading the treatment for borderline personality is what's called dialectical dialectical behavior therapy or DBT which was created by Marsha Linehan and has shown over numerous numerous studies to be extremely effective in borderline personality disorder it's definitely of the gold standard treatment for the disorder however I want to note that there are a number of other emerging treatments that are also showing important promise for borderline for science order including transference focused psychotherapy mineralization focus therapy and schema focused therapy so a lot of these treatments are proving to be very important for helping people with borderline personality now where I think the emotional cascade model interfaces very nicely with dialectical behavior therapy is dialectical behavior therapy often says people with a BPD or their emotional and they engage in problematic behaviors but it doesn't necessarily say why some of the techniques and used in DBT are helping those with BPD and I have a number of thoughts on that the first one being mindfulness a major focus of DBT treatment for BPD involves the development of what we're called mindfulness skills now mindfulness is your ability to sort of step back from your thoughts step back from your emotions and observe them and just experience them without reacting to them and oftentimes many people including myself are not very mindful about their daily lives and their interpersonal reactions and their emotional experiences a great example this is driving if you're like me I'm often driving thinking about all the things I have to get done where I'm going to have for dinner I'm gonna do for the weekend and I'm not being very mindful about paying attention to the traffic around me we're making sure that I make the correct make a correct turn etc so the more someone can develop mindfulness skills the more that they're focused on the present and the more they can step back from emotions and experience them without reacting to them now what our lab has shown is that people with BPD experience deficits and mindfulness as a function of rumination so what this means is part of the reason they're not very mindful about things is because they're ruminating on a regular basis about a variety of different problems now why would teaching someone to be more mindful help reduce an emotional cascade well the the thinking is is that if someone can engage in mindfulness it gets them to stop feeding into the rumination psyche go in an emotional cascade and it helps prevent them from going into the full-blown emotion cascade and sort of stops that as a cognitive level as opposed to letting it go full-blown and lead to a problem behavior so mindfulness is a great skill for anyone to learn but especially people with BPD another major focus of dialectical behavior therapy is helping people with BPD engage in activities that are considered more healthy than the disarray of behaviors they tend to engage in so DBT helps coach these individuals to come up with a variety of different healthy coping activities so exercise often tends to be one of the most promising but I think there's a variety of other activities that can be done but the key is is when someone with BPD starts to become upset that is when they need to start engaging in these alternative activities because these activities help distract them from an emotional cascade so the sooner someone when they become upset can engage in a distracting the activity as opposed to going into a full-blown emotional cascade so easier it's going to be to manage that negative emotion some of the things I often recommend and you know these are still sort of preliminary and we haven't gotten love research done on this but things that I think would be particularly good for this include both puzzles and games so I have here Sudoku the puzzle and a crossword puzzle and the reason I suggest puzzles to help distract from an upsetting emotional experience is because to solve one of these puzzles you really have to focus on the puzzle and really be sort of completely mindful about the puzzle as opposed to drifting off and thinking about upsetting problems if you want to have any chance of convenience so it's a very engaging and engrossing activity that has a good chance of sort of short-circuiting an emotional cascade right away one of the things that I think is really great for anyone by including younger people who often have smartphones and a variety of smartphone apps is to pull out your smartphone and pull out a smartphone app game like Angry Birds here or Tetris and it might seem like kind of a silly idea that if you're feeling upset us I mean it just happen well go attack some things with Angry Birds but what happens it's a very engaging and fun game and by playing in that for a little bit it can help distract from the emotional experience that someone's having and give them a chance to calm down from an emotional cascade without going all the way into engaging in a dysregulated behavior so I think this is a really promising future Avenue in a way that we can sort of reach out and engage younger patients and treatment as well now there are some other clinical applications that I want to mention with this research and and this is a really growing area of concern for people with BPD involves sleep problems more and more research is showing that people with BPD have a number of sleep problems even beyond things like depression or anxiety disorders and we think that at least I think that this makes sense when you think about this tendency toward emotional Cascades for example one study we did recently showed that people with BPD reported significant problems with insomnia at night and especially initial insomnia where they were having trouble falling asleep at night or even they were waking up in the middle of the night because of uh concerns so we think that once again this could be due to rumination or emotional Cascades they're trying to sleep but they're so upset about a problem they had and just going over and over in their mind about it that's leading to sleep problems similarly we also have shown that emotional Cascades may actually contribute to nightmares unborn person I disorder borderline for science or is actually disorder that it has much more frequent nightmares than the average person or even people with depression or some anxiety problems and this has been sort of a mystery but we think of what what's going on is emotional Cascades are actually carrying over into the night what often happens is when someone experiences an upsetting problem and then they're spending all day being upset about it if that problem then haunts them again at night sort of show this using our experience sampling data again we measured how people were feeling during the day and then looked at how they slept that night and if they reported nightmares and so what you can see here is this bar here is if someone has a BPD diagnosis they had a rough day and they were thinking about a lot of problems and feeling very upset they tended to have more nightmares that night as a result so it's this idea that emotional Cascades can even be causing nightmare disruptions in the middle of the night so with a little bit of time that we have left I want to highlight what family members can do because many many in the audience have family have family that are afflicted with this really challenging diagnosis and as a family member who cares about the individual with borderline precise order it can be very challenging because you want to help them cope with this disorder but it's also very challenging in terms of the way they respond to you and to their emotional states so one of the key factors I really hope to stress here is that understanding this emotion and the emotion process of borderline precise or that when people with BPD get upset it's not just because they are making too much of something or because their need to get a hold of themselves because they are experiencing a phenomenon that results in extremely intense emotional responses that are just you know when people say oh just get over it they pretty much can't without some extra help so knowing what's going on reduces negative reactivity in terms of a family member responding to a patient with BPD and it can improve empathy even in challenging situations when you know that the individual is experiencing this extreme response it helps you under give some more empathy and understand that maybe they're trying to control but it's very difficult I also think it's really helpful to give this process a name such as an emotional cascade because often times when I work with patients when I discuss this with them they're like wow I always knew something was going on but I didn't have a name for it it just seemed like complete my life was in complete chaos and I didn't know what's going on by being able to give it a name it helps give you something that can be managed a second point would be to help your loved ones distract when upset so I covered a number of different activities that could be used to help people distract from upsetting emotions but it's also as a family member it can help to really encourage them to engage in those activities so you work with them to come up with different activities that they can do that they'll enjoy and that are easily accessible for them and another thing that can be helpful is to develop what's called a coping card and this is often like a little list of activities that are right there in front of the person that they can do because when people are very upset they're easily distracted they easily forget their strategies so by having either a physical coping cards that's or now a piece of paper or maybe it's written down as a reminder and a smartphone app or even just telling someone these different activities they can do can help sort of give someone some options when they're feeling really upset finally as a family member it's really important to try not to get frustrated and that can be very challenging as a clinician working with patients with BPD often is equation it can be very challenging not to get sort of frustrated with someone when they're responding an emotional way something I said that was sort of misinterpreted so I've seen this experience from the clinical end and many family members report this as a problem when working with their loved one so the more you can try not to get frustrated the more it can help when we get frustrated we often make things worse with the patient's we can say things that we didn't mean to be hurtful or didn't mean to say but we ended up upsetting them even worse so if you don't get frustrated that helps decrease the feeding into the into that sort of cycle and the other thing that's important to remember for family members and clinicians is that when individuals with BPD are building emotion regulation skills that takes time it's not done with just one or two skill uses it's done with multiple skill uses per day for months and sometimes even for you know a few years but the more people practice using those skills and the more they utilize those skills the better they're going to get at it and the better they're going to be able to manage those intense emotional reactions so there's a lot of hope for people with borderline personality solder and our treatments are shown to be very effective but that's something that we as a researchers of the disorder and as well as researchers of treating with this order continue to work on to help anyone including the people with the disorder as well as the families so with that I want to go ahead and acknowledge fundings I've received for this research from a variety of organizations including the brain and behavior Research Foundation with a young investigator grant the families for borderline personality disorder research National Institute of Mental Health and the Neil s Jake Jacobson Award for outstanding an innovative clinical research from the Association for cognitive and behavioral therapies down here I've got my contact information with my email address you're more than welcome to email me if you had a question you'd like me to try and answer or if you just wanted to let me know anything that you think might be helpful and then I've also got listed my website here that you're more than welcome to visit and you can download it many of the papers for this research we've been doing so I'll just click on that there it goes so here you can see my website and if you just come over here to lab publications we have a list of a variety of publications and publications that are listed here in blue or downloadable right off the internet if there's something you're interested in this I Oh didn't believe you just email me and I'm happy to send the copy of that to you as well so with that I'd like to go ahead and open the floor for questions great Eddie thank you very much you took some complex complicated issues and we're able to explain it in a way that's very user friendly and engaging and I think really can be helpful to people both people who have borderline personality disorder and also family members friends clinicians who want to help people that have borderline personality disorder well one of the things that a couple of people asked has to do with a childhood and are there any identifiable early signs BPD in childhood and then along with that if so any research or suggestions in terms of preventative measures for high-risk children that's a fantastic question and first I'll start by saying as it used to be thought that borderline personality disorder was only relevant to adults but we're finding more and more that the signs of boil aren't precise order or become more visible in early adolescence so working with teenagers on a lot of these skills is definitely an important thing to do if you've got someone you think might be sort of on the path developing this disorder there are some signs and early childhood that cleans us the disorder is if you've got a child that seems to just have problems sort of regulating their emotions even at a young age that increases risks for the development of this disorder so the more you can help children and young young adolescents and young adults learn to regulate emotions and to understand emotions and help find healthy ways to cope with those emotions the better chance you are going to be of reducing the risk for development of this disorder all right there for people who have developed a disorder sometimes it can be difficult for family members to get them engaged in treatment and each suggestions as to how to get somebody into treatment when the family sees that need for their loved one you know that's oh that's a fantastic question and one of the biggest challenges for not only boiling personality disorder but for a variety of mental health conditions because often times our society has a very stigmatized view of therapy but I would say first that we actually did a study on this and it showed about on average about 50% people in any given year with BPD are interested in seeking treatment but only about 20% those actually reach out and go get treatment and what I think often means about that that percent that interested in treatment but doesn't pursue is oftentimes scared or worried about what treatment involves so the my recommendations for this would be is if you have been speaking to a loved one and you have been trying to encourage them to get treatment is to first let them know that we have successful treatments that can help them learn how to manage their emotions in a healthy way as I mentioned earlier dialectical behavior therapy has been shown to be very effective and very helpful for most people with 4om for science over in addition to the other treatments now if they still wouldn't be interested in going into treatment with an individual provider another recommendation might be to have them search for some smartphone apps that are involved with helping regulate emotions on online our lab has been working on this sort of for a while although it's it's a challenge in terms of the climate to get one of these apps built but what we found is that the more people use apps to monitor their emotions and their thoughts the better they are managing them and and avoiding problem behaviors as a result of those emotions so even if the individual were to use a smartphone app that's involved with sort of emotion regulation skills that might give them some help and might encourage them to further develop those skills in clinical things with a provider all very good suggestions one of the areas of questions relates to medication you've really spoken I think very eloquently about DBT about the fact that there are other forms of treatment that have been proven to be effective and you really spoke about how in some ways how a DBT works in the context of the research that you've conducted I'm curious about use of medication on its own or along with DBT or other effective therapies that's another great question well first I want to state that I I'm actually a big fan of using both medication and psychological treatment as in most cases bagless what provides the best effect for patients and with a variety of conditions the problem with borderline personality disorder is that we haven't actually identified a medication that specifically helps specifically and consistently helps those with borderline precisely so there's no one medication that can necessarily recommended for Bordeaux in precise order but what can be really helpful is that oftentimes people with blue and personas or anxious where they're depressed or having some other conditions and that can be where it can be really helpful to to get medication so in a case where somebody maybe had a co-occurring diagnosis of depression or anxiety or bipolar disorders those will be scenarios where medication would likely be very helpful but it might not necessarily treat this emotional reactivity that you see in borderline precise order we're still as a research field looking to identify more helpful medications that specifically help with BPD and self-injury but unfortunately we right now we sort of have to rely on standard antidepressants and anti-anxiety medications and hope that those might get some effect as well they you spoke about the issues related to self-injury type behavior I'd like to actually just think a little bit about the important issue of suicide and suicide prevention for people with borderline personality disorder yeah that's a fantastic question so as I noted before people with both self-injury and with four-line precise order or at much higher risk for suicidal behavior and that includes suicidal thoughts or d--ation so my attempts and actual death by suicide in terms of preventing that there's a number of steps that both clinicians and family members can take and the the first moment will be that is to take any sort of indication of suicidality seriously there's a sort of stigmatization and a misbelief for borderline precise order that people with this disorder Beit suicidal behavior and attempts and I can't emphasize enough that that is incorrect when someone with more line percentage sort of expresses that they're feeling suicidal they very much mean it and they often want help but don't know what to do about it so take any sort of indication of suicidal ideation or thoughts very seriously don't dismiss it for sure the other thing that can help is if you if you suspect this but has that the individual hasn't actually said anything about it is to just ask them study after study has shown that if you ask somebody who's suicidal if they're feeling suicidal they feel better because it shows that somebody cared enough to ask them and they were they also want to tell someone but they're very afraid to so don't be afraid to ask and to constantly as much of needed check with your loved one or your individual and treatment to see if they're feeling that way because it the more we can monitor it and help someone who's coping with it the better their outcomes will be I think that's a very important point that you're making about asking someone I think sometimes people feel that by asking the question may give the idea where evidence is that by asking the question you're actually encouraging the person to get help and not suffer in silence exactly you don't don't worry about them becoming suicidal because you ask because all you haven't suggests that that doesn't happen what it does suggest is that the individual will respond much more favorably than in a negative way and I want to ask you about ways that family members can get support for themselves so that they can do a better job supporting their loved one that's a great question and one I had and follows much more but there's a sort of put this in perspective dialectical behavior therapy has a component where the treatment providers working with people with BPD meet on a regular basis to work on only how can they do better but sort of provide support for each other because oftentimes the the sort of emotional chaos of this disorder can be a challenge for both families and clinicians to deal with so I think that's why it's good to look into contacting organizations like the families for Boyle emphasizing the sort of research and having contact with people who are going through the same situation and who are struggling with the same problems for their family members because it can be a challenge and the more we can support each other as clinicians and families the better we can help those who are afflicted with the disorder if they try to improve and get hold of a very challenging condition the one of the the issues has to do with the HIPAA laws and family members of adults whether it be a sibling or a child and interactions with their health care professionals if you have any suggestions with regards to how there's a family get involved in the treatment of their loved one well I think that the the the best approach there would be to especially if the patient as an adult to ask the individual if they would like to have you be involved whether that would involve coming to some of your treatment sessions or some of the patient's treatment sessions or even having the provider sign a release form that allows the provider to speak with family members about the treatment but if someone's an adult unfortunately it's sort of up to the patient to decide if they want family to be involved or not and this is sort of a struggle where I've worked with patients who their families have contacted me wanting to know about the Asians progress and wanting to help out but the patient has been reluctant to involve the family and in that case as a provider all I can do is work with the patient and encourage them to to reach out to family for support but I can't go beyond that so that's why I think it's important to sort of make it clear with the patient that you want to help them and then if they are interested in that making sure that you've both connected with the clinician to make sure that that the appropriate release forms have been signed to have you involved in the treatment there are you very good guidance Eddie I want to thank you so much first of all for taking the time to have such an outstanding presentation and second of all for the work that you've done to improve the understanding and the treatment of borderline personality disorder it certainly gives a tremendous hope to people with BPD and to their loved ones to know that you and others are conducting research to improve the care of people so thank you very much there's no absolutely my pleasure good thank you thank you I also want to thank all the people who joined us today all of the research we fund is made possible from private donations so if you'd like to make a gift please visit our website at BB our Foundation org or call one eight hundred eight to nine eight to eight nine this webinar has been recorded if you missed any portion of the presentation or would like to share it with a family member or friend please visit the webinar page at our website I hope you'll join us again next month when dr. Nora Volkow foundation's Science Council member and director of the National Institute of drug abuse at the National Institute of Health will talk to us about addiction this will take place not on a Tuesday but on a Wednesday and it will be Wednesday August 19th two o'clock Eastern Time I hope you'll be able to join us then once again thank you and enjoy the rest of your day take care

Channel: Brain & Behavior Research Foundation

Views: 59,550

Keywords: bipolar disorder, anxiety, brain research, narsad grants, symptoms, recovery, behavior research, warning signs, treatments, cure, diagnosis, hope, borderline personality disorder, understanding borderline personality disorder, borderline personality disorder documentary, borderline personality, research, mental illness, mental health, mental health research, bbrf, brain & behavior research foundation, #bbrfwebinar

Id: saT6KxbkDEY

Length: 60min 4sec (3604 seconds)

Published: Thu Jul 16 2015