Social Learning in Borderline Personality Disorder

I'm dr. Jeff Bernstein president and CEO of foundation and your host and moderator for today's webinar today dr. Sarah Feinberg will present social learning in borderline personality disorder the brain and behavioral research foundation is committed to improving the lives of those with mental illness and ultimately enabling people to live full happy and productive lives we accomplish this by awarding grants that lead to advances and breakthroughs in scientific research the foundation is the largest private funder of mental health research grants for 30 years the foundation is empowered progress in those areas of brain research that need it most by awarding more than three hundred and forty six million dollars to research scientists 100 percent of all donor contributions for research are invested in grants to scientists who are working to find breakthroughs in disorders such as ADHD anxiety autism bipolar disorder borderline personality disorder depression OCD post-traumatic stress and schizophrenia now I'm delighted to introduce dr. Sarah Feinberg dr. Feinberg is an instructor in the department of psychiatry at Yale University and a 2014 Young Investigator grantee dr. Feinberg will discuss the various issues that can make the social world tumultuous for people with borderline personality disorder today's webinar will begin with dr. Feinberg presentation this will be followed by a Q&A period to submit your questions please use the questions tab on the control panel of your screen please feel free to submit your questions throughout the presentation following the presentation I will present your questions to dr. Feinberg and we will address as many of them as possible in the time allotted so at this point I am pleased to introduce dr. Sarah Feinberg Sarah the floor is yours thank you I'm just getting this presentation up quick can everybody see it hmm uh well I'm going to be talking today about social experience in borderline personality disorder and I I wanted to just start out by thanking the many people who helped me do this work and helped me think about this problem clinically starting with the brain and behavior Research Foundation which has financially supported my starting out in borderline personality disorder science over the last couple of years and continues to be a source of inspiration for me also I have the pleasure of being part of the Yale Department of Psychiatry where my mentor is dr. Philip coilette and I have a wonderful research assistant Jake Leavitt without whom I couldn't do this work there have been many other people in the department has been extremely supportive of my progress I also want to thank some of the folks at McLean Hospital Mary's in irini who's been supportive of my research ideas and John Gunderson and most I can who have taught me a lot about BPD clinical work some of the folks who have advocated greatly for people with BPD over the last couple of years and have talked to me kindly about those interactions at the gals and emotions matter and its families for BPD research also I really want to take a moment to thank the people who participate in my studies and the patients who helped me learn about the struggles of having borderline personality disorder lastly and certainly not least I started out my training in clinical medicine and in papaya tree and the Iowa Department of Psychiatry and I had a lot of good teachers but especially just the Dora with who got me started doing psychotherapy with a borderline patient in medical school so today I'm looking forward to spending time with all of you talking about borderline personality disorder what it is what we can expect over time for people who have it and what the currently available treatments are and then I like to shift to talking about science and I think I'm going to focus it on three examples of science in borderline personality disorder this web is not meant to be comprehensive or to describe the entire field but I hope it'll help us all think together about what science can do to help us understand there are three ideas I have to talk about today one is brain signals another is brain chemicals and the last is the brain in the body and how they relate to each other in everybody in particularly how this might happen in borderline I wanted to draw your attention to the lower right corner of the screen where I'm going to place article references and suggestions for further reading on each slide throughout the talk and so you can make note in that lower corner of ideas for further reading so I think of borderline personality disorder according to a rubric that other people have developed and in this way we would describe BPD as having sort of four symptom clusters so first effective symptoms that means are the mood symptoms which specifically in BPD can change greatly from minute to minute or hour to hour in addition to the more chronic study depressed and anxious mood that might be more like someone with a depression or anxiety disorder and chronic feelings of emptiness people with BPD can also have impulsive symptoms in a variety of domains including impulsive anger in the realms of driving or sexual activity using alcohol or drugs financial decisions and even impulsive harm against themselves or suicide attempts there are also cognitive symptoms of borderline personality disorder which can take the form of odd or magical ideas feelings that other people are out to harm one or get one and hallucinations including hearing voices lastly and importantly BPD involves problems in the interpersonal domain people can have difficult relationships with lots of ups and downs lots of conflicted feelings about the relationships and importantly other symptoms can come and go together with those interpersonal problems so when interpersonal things are going better symptoms can lessen and when interpersonal things are going worse other kinds of symptoms including effective impulsive and cognitive symptoms can get much worse I wanted to point out that BPD is very common and many is 1 in 20 people in the general population may have it and as many as one in five in mental health settings people get better from borderline personality disorder and I'll direct your attention here to this blue line which describes how many people have gotten better in terms of not any longer meeting criteria for the disorder over a 16 year period and you can see the line is going up many many people no longer meet criteria for the disorder by 16 years out however if you look at the difference between this blue line and the red line you can see that there's a gap between how many people have had remission meaning they no longer meet criteria and how many people have actually gotten to the point where they have at least one emotionally sustaining relationship and full time engagement in either work or school so there are 40% of people here who have remission by counting up criteria but haven't had a functional recovery BPD is also quite heritable and does not seem to be related to schizophrenia or bipolar disorder other major causes of mental illness people with borderline personality disorder are experiencing symptoms that are real and that are terribly painful I'm Mary Lisa Johnson who is a memoirist and beautiful writer who has borderline person I disorder wrote that having BPD is like bleeding out we need treatments that work better so let's think about what's being done now for treatment people are being prescribed medications many people with BPD are taking in the blue line antidepressants and continue to take them over 16 years and about a third of people with BPD are being prescribed anti-anxiety benzo the peen type medications mood stabilizers antipsychotics and even lithium and they're being prescribed them continuously over over many years however data about what helps in terms of medications for BPD are very recent remain inconclusive and medical practice guidelines still recommend no meds in many cases nonetheless people are being prescribed multiple medications and for many people the more medications that one's taking the less well someone might do however single medications focused on specific problematic symptoms can be helpful and um here's a summary of that data as I currently understand it mood stabilizers can be very helpful for those changeable moods and for impulsivity and antipsychotics can be helpful for psychotic symptoms you can see there are some other small benefits as well to other medications there are some considerations about prescribing in BPD that are relatively specific to this disorder so it's very important to consider whether medications could be helpful because symptoms can be debilitating however symptoms also fluctuate as part of the disease and BPD so it can be a little hard to focus on which symptom to target with medication also the impulsivity that accompanies BPD can place patients at risk of overdose from dangerous medications many people do have thoughts of suicide and self-harm and may intentionally overdose on available medications and many people with BPD suffer from other disorders at the same time such as post-traumatic stress disorder panic disorder and substance use disorders that may change the appropriate choices of medication I wanted to end the talk about medication on this question which is the meaning of medications it's important to consider that being given something from your healthcare provider has meaning and adding or taking away medications can trigger strong feelings of being helped being not helped being understood being not understood and we should really think carefully about those choices psychotherapy is the mainstay of treatment for borderline personality disorder and for people encountering BPD patients some generalists techniques can be found in good psychiatric management which can help us not do harm and perhaps be helpful to people with borderline personality disorder however some people with BPD would benefit from more specific specialized treatment and three commonly used specialist treatments are dialectical behavioral therapy which is developed by Marsha Linehan and it comes from a cognitive behavioral framework transference focus psychotherapy which was developed by Otto Kern Berg and others in the Cornell group and derived from a more psychodynamic perspective mentalization based treatment developed by Peter Funaki and Anthony Bateman also more dynamic model I also wanted to take a moment to talk about the important role of psycho education for families and the people who surround patients with BPD and also advocacy groups which can be extremely empowering for people who have BPD and I just placed it here in alphabetical order on some of the organizations which I think are doing great work in this area to help families understand more about the disorder get out the word of that people have BPD that they can get better with BPD and that science is happening to try to learn about it so what can we do to better understand and treat BPD I come from the perspective that both the emotional basis of BPD and the changes that occur in treatment happen in the brain and science will help us enrich our understanding of the experience of people with BPD and their loved ones and that brain science will help us develop more effective and accessible treatments for the disorder so let's move on to the science I'm going to start with this first example of brain signals but then we'll move on to talk a little bit about oxytocin and bodily perception so it's really important to detect threats and some threats are less clear than others people with BPD can find threats in more places than other people might and feel that people are more untrustworthy than other people might and this can have profound consequences for trying to get along for people with BPD it can even feel as though people are generally unhelpful or against them and sometimes this perspective is really different from what the people around them perceive but scientists have been able to try to develop some ways of measuring this in the lab a computer program was used to make a range of faces from neutral here all the way to happy or from happy all the way to angry and people with BPD or without BPG were invited into the lab and shown these faces one at a time like this and what the scientists found is that people with BPD quickly notice and pay more attention to angry faces than might people without BPD they judge ambiguous meaning faces kind of in the middle that don't have so clearly a strong emotion to be angry and they have more trouble distinguishing the close detail about negative faces in practical terms this may suggest that people with are good at noticing negative emotions but not as good at other people not as good as other people at getting a more detailed sense of what's going on this could put them at risk of confusing another person's negative expression which clear which could have a variety of meaning such as physical discomfort disappointment or puzzlement someone with BPD might see it as certainly angry this result that people with BPD understand ambiguous faces that faces without one clear specific emotion as angry may already suggest some things that we can do when these may seem these may be popping up in your own mind like we may be able to use our own faces more clearly when we talk with people who have BPD and we may be able to use clear language to augment our facial expressions when we're interacting with people who have BPD use words to describe what we mean people with BPD may also be able to learn to ask for clarification when someone seems angry to help make sense of what's going on but science may help us understand why this angry biased interpretation of faces and in particular I wanted to talk to you about a brain region called the amygdala and it's pointed out here this red spot here and the amygdala is interesting to us because all of us have one one on each side of the brain and it sits in here deep right behind your eye and years of research have found that when people look at frightening things their amygdala turns on also people who are missing an amygdala are not afraid in the face of danger and this can lead them into dangerous situations so the amygdala then is a brain region that responds to threats and in BPD the amygdala is more active all the time and more active than it would be in control subjects when seeing faces so there's another brain region that we now should talk about called the prefrontal cortex or PFC and this brain region is great because it can quiet the amygdala so when the amygdala starts to respond to a threat the pretense of core attacks can say hmm maybe this one isn't so bad and interestingly people with borderline personality disorder have less connectivity and when I say connectivity I mean communication between two brain regions between the amygdala and the prefrontal cortex which if it were connected might be able to help quiet the amygdala so these ideas about the amygdala being on all the time might help us think about some potential treatments and I'm going to show you the results of one study that tries to do that so participants in this study were shown an upsetting picture and they were asked to either view the picture so just look at it and respond normally or to regulate meaning try to suppress that strong feeling and try to suppress the amygdala activation and clearly no one would know how to suppress amygdala activation without some feedback so the participants were lying in a brain scanner during this experiment and they were shown in real-time whether it was working as they tried to suppress their amygdala and here's what happened DPD patients were able to learn to decrease their own amygdala signals in response to upsetting images a little bit so here's the condition where they didn't try - and here's the condition where they did try - and you can see a small decrease from the view to the regulate conditions excitingly BPD patients were also able to learn to increase the connectivity that's that communication between the amygdala and the prefrontal cortex and you can see that right here this is the connectivity initially and then after they got some training it increased and it stayed up across the experiment so this suggests the kind of thing we might be able to do when we know more about brain regions that respond to threats and brain regions that differ between people with BPD and people without more work will certainly need to be done in this area but this is a potential kind of therapeutic so let's move on and talk about brain chemicals see Tosun is an interesting hormone that has been found to increase during bonding and actually can increase bonding some people have described it as a love hormone because levels increase in people in late pregnancy and increase in moms and in dads and in kids when they play with each other and express affection and to increase this socialist so sort of being part of a group feeling part of a group and enter personal intimacy however it's a little complicated about oxytocin because effects might differ by gender and by personality for example in one study people who took oxytocin as a medication had decreased attention to angry faces and increased attention to happy faces and that might seem promising so many of us might like to feel that way however a different study focused only on women found that women who took oxytocin actually had more amygdala signal when they saw negative faces so that might be actually problematic for people with BPD and interestingly a genetic difference in the oxytocin receptor altered people's ability to recognize faces and facial emotions correctly so it's unclear exactly what effect oxytocin might have on any given person without more information but we might be interested to know what do we know about oxytocin in borderline personality disorder in fact blood levels of oxytocin are decreased compared to healthy control subjects in BPD and in young people who have been part of high-risk families a variation in the oxytocin receptors in can increase risk for developing BP so if your genes one way you're at higher risk than if your genes another way and after having been in a lab experiment that included feeling socially excluded people with BPD had their oxytocin levels fall as opposed to people without BPD who had their oxytocin levels rise and this is a sort of tempting data in terms of interpretation we we might be encouraged to think that maybe healthy control subjects can use that boost in oxytocin to feel better feel more included after having been excluded and maybe people with BPD don't have access to that chemical brain change however further data will need to be collected to understand this more completely so but this can make us wonder would it actually help to increase oxytocin in people with BPD well people have tried and what they did is they gave oxytocin through a nasal inhaler and after that people with BPD have less of an overreaction to stress both by their own report and by the blood levels of a stress hormone cortisol they had less avoidance of rapidly presented angry faces but spent less time than dwelling on them however and perhaps concerning ly people with BPD who had high avoidance behaviors were less trusting and less cooperative after getting AXI toshin and some people with BPD who were more trusting of others we're only trusting specifically of more physically attractive people after taking oxytocin so again it's unclear exactly what effect oxytocin will have in BPD we probably need to understand more about which subsets of people could benefit before this could be a therapeutic that's widely used but it's certainly interesting to think about the impact that oxytocin can have on the various brain networks and we're showing four different brain networks here one about social attention one about social effect regulation one about social reward the pleasure that people get from social experience and one about empathy all four of these networks can be changed by taking oxytocin and each of these networks includes one of our brain regions that we're interested in today either the amygdala or the prefrontal cortex all right so what about the body in BPD people with BPD and people who know them are aware that borderline symptoms can include quite a lot about body and we know from other science that signals from the body are used to help process emotions I'll say more about that in a minute so we might get to one wondering how bodily signals are processed in the brain in borderline personality disorder so here's an example of how we can learn about that so intro section is the sensation of signals from your own body and so one group looked at a particular kind of interoception brain responses to heart beats so the heart beat evoked potential or AGP is a brain signal that responds to one's own heartbeat and what these researchers did is they looked at the strength of a GP in BPD in people who are in remission by had BPD before and control subjects and they found that as people recover from BPD they're well in people who currently have BPD that the HCP is the weakest and people who have gone into remission it's a bit stronger and in people without BPD it's the strongest and this might suggest that people with BPD have a difficulty feeling their own body more work would be mean to other areas but this is interesting and suggestive and we know that in healthy people facial muscles are actually involved in matching emotions during sentence reading so we're transitioning here to think from thinking about feeling your own heartbeat to using maybe your face to help figure out emotions so the way that these experiments are done is that the strength of squeezing or the strength of muscle movement is measured in forehead muscles that are like for wrinkling up your forehead during frowning up here and cheek muscles that are used for pulling on your cheeks while smiling so we have a frown muscle and the smile muscle and if we look at the activity of that frown muscle during sentence processing as people read sad angry or happy sentences we can see that the frown muscle is activated it squeezes four sad sentences to wrinkle the forehead and it's relaxed during happy sentences to smooth out the forehead and the opposite is true for smile muscles smile muscles are turned on while people read happy sentences and relax while people read unhappy sentences but what about if you can't move your facial muscles I mean do they just move or do you really need them it turns out you need them if you can't move your facial muscles you are slower to process emotions that go with those muscles so the way that scientists studied this is they took women before and after Botox and so when Botox is applied to the forehead people look like this at the bottom when they're frowning therefore had no longer wrinkles because those muscles are paralyzed and so when these people tried to read angry sentences they were slower after Botox look at the gray bar as opposed to the white one and when people tried to read sad sentences after Botox they were slower again the gray bar it took longer than the white bar however happy sentences were not affected you don't need to wrinkle your forehead to express happy so these data can suggest some research questions to us like will people with BPD actually move their faces or will that stealing the day describe of being apart from their body or not being able to feel much will that impact on their ability to use their face when they're reading emotional sentences and we have some data out there about this already so this isn't from sentence reading this is from faces and this is the same as the experiment we looked at earlier phases were morphed from neutral all the way to completely angry and as subjects saw faces that looked angrier and angrier both groups the control group and the BPD group activated their frown muscles but the BPD subjects in black activated their frown muscles much more than the control subjects did if we look at smile muscles by contrast the control subjects activated their smile muscles much more than the BPD subjects did but they both did activate them so the BPD subjects are responding with their face when they see emotions so we might ask how does this facial feedback get used in the brain and does it actually impact on behavior in BPD the way that it would in healthy subjects and so we can study this in the lab without botoxing people we can just ask them to hold their face in a particular posture either a frown kind of a face or a grin kind of a face and we can ask them to read Pleasant and unpleasant sentences and we can time them and this will allow us to test in our own group of control subjects and BPD subjects how facial posture impacts on emotion processing this is work that's actually ongoing in my lab now with help from the NAR side Young Investigator grants so today we've talked about borderline personality disorder we've talked about the four core symptom clusters and that people often get better but they're but not enough people recover to functional social relationships and work and school psycho therapies are the mainstay of treatment for borderline personality disorder and medications can be used as adjunctive treatment family interventions are very important and advocacy groups are helping restore social communication and humanity to people with BPD I've talked to you about three examples of BPD science today brain signals we talked about the amygdala and how it responds to threats and maybe over detects threats in BPD and the prefrontal cortex and how it quiets the amygdala but maybe those two regions aren't talking to each other enough in BPD we talked about brain chemicals in particular oxytocin and the reasons we might think that it could restore social connectedness in BPD but the caveats being that gender personality genetics may impact on the specific ways that oxytocin acts in people and we talked about the brain body connections that are so important in social and emotional processing and the ways that these may differ in borderline personality disorder making it harder for someone with BPD to use this mechanism to learn about the social world encourage everyone to continue following treatment approaches and examples of BPD science these and others and I you can do this by keeping up with the websites of research organizations and supporting those organizations to allow further science to go forward and in particular I would encourage you to look at the brain and behavior Research Foundation and the BPD projects being funded in collaboration with the families for BPD research also keep track of the National Institutes for mental health and encourage them to fund more personality disorder work and the American Foundation for Suicide Prevention is relevant here as well so I want to thank everybody for tuning in and listening and I would be happy to take questions or comments talk with folks now great Sara thank you for just an outstanding presentation you were able to take some complicated issues and describe it in a way that is readily accessible to people so thank you why so many funds opportunity yes well thank you and one of the key points is the science behind this and I think that's an important at a number of levels but for people to understand that that number one people do get better with treatment and number two there's a scientific basis for this and a need for more research about that is very important one of the areas of questions that a number of family members parents have asked is what what should parents do often it's hard to get their loved one engaged in treatment what should they do what's the best approach that you've seen for family members this is this is tough but it's so important and I'm just so glad that family members took the time to listen today and to be part of the BPD advocacy world and I think that that's the first step members need support themselves and I think it's really really important to be learning about BPD partly because for many people I think there's some relief in knowing that this is real this is not anyone's fault and that understanding some simple things about how to interact with someone who has BPD can decrease suffering for the affected person and their family members who can really become affected by the symptoms as well so I would encourage people to look into the various family advocacy organizations in particular I know that in the New York area that Tara is running workshops and also the family connections series through the NEA BPD is available in many cities on the East Coast and around the country and I think that those organizations provide not just support and mentorship from other people who might have gone through similar things but actually concrete strategies for interacting that can help people really get what it might be like to have BPD and get how to be more helpful and less sort of less likely to make symptoms get bigger or worse very very good guidance and can I ask you even just a specific situation where a family member is having a disagreement over whatever issue with their loved one who has vpj what's the best way to sort of rather than have a disagreement become exaggerated and escalated to sort of simmer it down yeah so I think that you know one thing that we can take from the science that we talked about today is the the idea that people with BPD might perceive things that someone else might see as neutral or even helpful they might perceive those things as negative and so it's not that they're trying to be difficult it's that they actually think that your face looks like it's frowning or they actually think that what you're saying is intended to be hurtful when you might mean it actually to be kind and so I think that one thing is to take things slowly be very deliberate and clear about your intentions not just the content so rather than saying I want you to do X you might say I'm feeling like I really want to help you and I can see that you're very upset and you might even comment on how you can tell that the person's upset from what their face looks like and how their voice sounds and then you might say and so I'm trying to listen to you and I'm trying to I'm trying to think of ways that I can respond to this thing that you said and then another thing is I would say strategies that are helpful for all of us which are having our emotions acknowledged and having our experiences taken seriously I think in dialectical behavioral therapy the word validation is used a lot and I think that's a really useful idea that you can you know you may not agree about what someone wants or what they should do but you can agree that they're having a feeling and you know and you can agree that that having feelings is okay and it's a part of a negotiation in a family and so you know you can say I can see that you feel really angry and that's hard for you so I think those kinds of things are are perhaps helpful does that answer the question Jeff yes very much I think very good practical specific guidance but also just sort of a broader stroke of guidance that's very helpful hey when um when do the first symptoms of BPD often appear how old is the person who has it what's the sort of that typical course you know I think that this is something we're still learning a lot about I think classically you know people have thought that BPD emerged in adolescence and sort of crystallized in early adulthood in the sense that you know many of us as teenagers probably had some things that were BPD like symptoms it's normal as a teenager to have up-and-down moods or to have impulsive behaviors however for some people those persist or they're more severe or they get people into dangerous or painful situations enough that they might seek treatment and um you know for some people I think for many people that happens in sort of late adolescence and early adulthood and then and then persists through adulthood and although many people do have symptom remission meaning that they no longer have five borderline personality disorder criteria many people live their lives with two or three of these criteria and all of them are painful to live with however I think that you know many family members with BPD actually would report that they knew that their child was sensitive very early on and you know we think that probably the way that people come to have BPD is partly to do with being very sensitive to environmental stimuli so you know their amygdala is probably turned on and sort of loudly detecting things from very early in childhood and that may put them at risk for having upsetting social experiences throughout childhood and early adolescence and really make it harder for people to maintain and make use of the supports that otherwise would be available are there things if a parent of a younger child sees that the child may be overly sensitive or extra sensitive and have another child who isn't as what types of steps can they take to help smooth the path for that child to decrease the risk of developing full-blown BPD's right well you know really just make make the path better for that child well I'll start basing we have so much more work to do in terms of prevention we don't know very much about prevention for BPD I know that there are some studies ongoing and I think that there are lots of interesting possibilities in terms of learning about this but I think that you know most parents I think have experienced that every child's a little different it can be hard to tell it first if you know this child just has a different personality or if they're really sort of having such a different personality that they're suffering and that the family is starting to suffer it I guess what I would suggest is that for anyone who's finding that things aren't seeming right or things are seeming overwhelming or the family is struggling I would encourage everyone to seek a consultation with a mental health provider because I think even sometimes a few brief consultations can really be informative in terms of helping to orient you know what's normal variation and what's really starting to get into an area where mental health treatment in general could be helpful and you know I think that lots of people can benefit from from getting mental healthcare treatment early so that they can learn skills both the family members and and an affected child can learn skills to help them communicate and undo that negative feedback loop that can develop when threats are detected everywhere and the people around you might not be as sensitive or understand how that can feel so I think a very good advice that sometimes even if things aren't really totally off but maybe a little bit yeah I'd be a good time to get some professional help see if there's some steps that could be taken to smooth the path that's not for the individual for the family a couple of people have asked questions about the issue of sleep was insomnia difficult for sleeping and borderline so I want to ask you to speak a little bit about that about sweep I do you know I don't actually know any specific data about sleep particularly in BPD so I'm not sure that I can speak to that from a comprehensive perspective and there may be data out there I just don't know it but what I can say is that the experience of anxiety and the experience of depression which can commonly accompany BPD and also maladaptive use of alcohol or other drugs can certainly impact on sleep and so people with VPD are I think because of each symptom cluster the mood cluster the impulsive cluster the perceptual cluster and the interpersonal cluster at risk of having sleep problems and in fact this can lead to using sleep medications which can you know become a really difficult thing to you know recover from during the day people can feel groggy and this can actually get in the way of functional recovery getting back to work or school in a full-time way so and sleepiness can - so I would say that I although I'm not sure that insomnia is a symptom that's specific to BPD I do think it's a symptom that can commonly happen in BPD and I think the best thing out there for insomnia now is an psychotherapy which is readily available on your smartphone and it's called CBT for insomnia and there are a variety of apps out there for this and it's something you can learn yourself or you can learn together with a therapist and it basically helps you think about the body rhythms that you have and that you need to get into to help your body know how to sleep and go to sleep and stay asleep long enough and then you know if that doesn't work I would say just as for all of the other symptoms in BP medication should be thought of a second line after psychotherapy and sleep training to help people get back on track and but getting back to steady and and regular sleep I think is critical to feeling well so I would really encourage people to take that seriously and to work with their providers to come up with manageable sustainable solutions good very good advice and just people laughing it is you refer to the CBT for insomnia and that this is something that could be useful not only for people with BPG but really in the general population if all of us and everybody and and I think the issue of adequate sleep is not something well is an added stress for the system that for anybody is an issue and certainly it's been proven that the CBT for insomnia does work for people and it's safe effective and I'm not addicting so it's a it's something for people to really look at what one of the things that increasingly those of us who are in the mental health field and and helping people recommend is the issue of exercise and having a regular exercise routine I want to ask you just about your experience with exercise with regards to people who are BPG oh no I'm glad that you didn't ask me about my experience with exercise I think like all of us I don't exercise enough and I think it's hard to get back to exercising and so it's the one thing I would say is you know all of us should be trying to exercise and all of us should cut ourselves a break because it's easy to feel bad about how much you can do or or that that you didn't get started last week and so I think the most important thing is that we keep trying to encourage each other and we get out there and for a variety of reasons I'm so glad that you raised this I think that one of the things that I think is really cool in good psychiatric management and the the McLean program is that they asked people which gym they're gonna as I understand it at least they ask you which gym they're going to enroll in when they arrive not if they're going to and I started trying to do that here with my patients we run a 7-minute morning exercise group here on our unit and we all try to encourage each other to get going and the reason is it helps with sleep and it helps with mood and it helps with you know one thing we didn't talk about today which is I think really important and understudied is that borderline personality disorder gets worse with stress but also having borderline personality disorder is a stress and this has profound implications for heart health and blood-vessel health and we need to be careful about the medical consequences of BPD and so in particular for people with BPD and others stressful mental health conditions it's extremely important to be doing exercise to fight back against those cardiovascular computations that can occur over time so those are those are some of things but the other thing is exercise is a great way to socialize in a low pressure setting you have something to do it's very healthful it's a great way to hang out in a group and so from from many different perspectives more is better but doing it at all is the most important thing good good excellent point I want to come back round to an issue a very important issue that you spoke about in the presentation which is the issue of suicidal thoughts and suicide prevention people harming themselves well what should a family do if their loved one expresses thoughts of wanting to hurt themselves well I think the most important thing is to ask about it and to talk about it and I think that you know some people worry that if they talk about suicide that they might suggest it to someone or that they might put it on to someone's mind and there's strong evidence that that's not the more thing we should be most worried about the thing we should be most worried about is people having suicidal thoughts and not having people to talk to about it or not getting access to help and so I would encourage people to talk openly about the fact that sometimes people have suicidal thoughts and sometimes they have thoughts of harming their body sometimes they do harm their body in ways that are not intended to be suicidal I would encourage people to ask for detail like when you cut on your arm did you mean to kill yourself and maybe it can be there can be ways that families can learn to talk with someone about the difference between self-harm and suicide thinking and suicidal planning and then I think that every person who's had suicidal thoughts needs a plan and it needs to be a written down plan that they can carry with them in their wallet or post on their fridge because sometimes during periods of desperation it can be hard to think and when it's hard to think it's hard to figure out what to do about feeling that bad and so I encourage everyone to write down a plan and even to give it to some of the people that they trust so I think family members can work on a plan that would feel manageable to someone with BDD maybe like three steps like try to call this family member try to do something relaxing to get your mind off of it and if that doesn't work and you think you're going to hurt yourself call 9-1-1 or go to the emergency room and some people can put in its intermediate step in there of a 24 hour provider line at at their mental health provider not everyone has access to that and so I think that family members can get comfortable using language to talk about suicide and self-harm openly they can learn to distinguish between self-harm and suicide and they can participate in future planning for times when it might be harder to think I think that's excellent advice and in particular the key point that we know that talking about suicide doesn't cause by talking about it is a method of preventing it by putting it out there not keeping it a secret so family members shouldn't afraid to ask and you are suggesting about having a plan in place these are my sauce to have those ideas is it is a key component of improving safety so excellent guidance we have a question of going back to the issue of psychotherapy asking about the effectiveness of group therapy for DPG I'd like you to say a little bit about your thoughts on that yeah so what I think is that it's probably really hard to get yourself to start going to a group and I think many people resist going to groups initially because it might feel weird and it might feel exposing and yet groups are extremely helpful in borderline personality disorder partly because learning to voice just we were saying about suicide another learning to voice things about these difficult emotions and concepts can be a way to combat shame so many things in BPD can feel too awful to talk about and one thing that can happen in group therapy is that you and other people talk about them and you find that actually you can say that stuff and other people have had those thoughts too and other people who have had those thoughts or similar experiences might have good ideas about what to do and some people who go to group therapy find that attending those groups actually they get more confident about trying things because other real people who have shared experiences have tried them and they report back that it works or they report back that continuing to do things the way that they had been doing them that isn't working doesn't work and sometimes that's easier to believe in from some stuffy professional and so I think that I could really understand why people would have never been to a group therapy might not want to try and I would encourage them to try anyway and to stick it out for a couple of weeks before they make a final decision about whether to stick with it or not because I think that um you know that we've known for a long time that groups can be really helpful for for a variety of reasons and I think just some that that I've mentioned good points and I think for just to make reference to your statement about stuffy professionals I think anybody and everybody listening to this presentation know that you are not that say that in case there was a question about it we have a couple of questions about whether or not there are any nutritional supplements or vitamins or in dietary aspects that could be helpful for people with BPD oh boy we're getting a little out of my wheelhouse here let me think about what to say I think that general health is super important eating a well-balanced and healthy diet is important in BPD certain kinds of medications can come with nutritional requirements or restrictions especially the need to stay well hydrated especially as summer comes up but you know not aware of researching maybe maybe you know something that focus on specific dietary supplements with strong evidence for benefit in BPD I suppose what I would say is that I would refer you back to the idea that at the current state of science psychotherapy is the mainstay of treatment and although medications can certainly be helpful staying healthy is certainly important I think that if I were going to do one thing for my BPD it would get into a psychotherapy that I was willing to stick with okay I think that's excellent advice and I think that the the having psychotherapy with a therapist that is collaborative and works well makes all the difference in the world for the person I think that's excellent excellent guidance as a as a researcher as a clinician and the researcher what do you see as where will we be in five years from now or 10 years from now with regard to our understanding and improve treatments of DPJ well my biggest hope is that people who have BPD who don't live in New York City or Boston or London places where there's good access or better access at least to focus specialized treatment will have access to will have closer and easier and more affordable access to specialized treatment for BPD if they need it and I think that's where the science can be especially exciting because I think that we're starting to learn some BPD tracking techniques that may not involve expensive technology and we're starting to learn ways to hone in on the parts of the specialized treatments that are most valuable we're starting to learn which people will respond to which treatments based on their biology in addition to their psychology and I think in the next five or 10 years people who live in places like Montana and Idaho and North Dakota and in the South people are gonna all over the country and all over the world have more access to effective treatment for BPD because we're going to be able to hone in with much more precision and personalized approaches well I I think you're absolutely right about that and I think that that in part we're going to get there because of the work that you're doing and as a as a young scientist focused on this issue it gives me great hope for the future of people with BPD I want to thank you for the work that you've done for your presentation today and most importantly for the work that you're going to continue to do on this very important topic so Sara thank you so very very much thank you so much for having me it's really been my pleasure I also want to thank everybody who's joined us today it really is our caring donors and supporters who make the brain and behavior research foundations work possible and bring all of us closer one discovery at a time to better approaches to understanding and managing mental illness and helping people live full productive and happy lives all of the research we fund is made possible through private donations and if you'd like to make a donation please visit our website BDR foundation org or call us at 818 I hope you would you'll join us again next month when dr. Perry Renshaw who is a member of the Foundation Scientific Council and professor of psychiatry at the University of Utah School School will present a webinar entitled light elevated examining the altitude related effects on Mental Illness this will take place on Tuesday July 12 at 2:00 p.m. Eastern Time once again thank you all for joining us and have a good day take care

Channel: Brain & Behavior Research Foundation

Views: 18,403

Keywords: schizophrenia, depression, bipolar disorder, anxiety, autism, post-traumatic stress disorder, ptsd, obsessive-compulsive disorder, ocd, adhd, brain research, narsad grants, symptoms, recovery, behavior research, warning signs, treatments, cure, diagnosis, hope

Id: JpL71Vr-xnw

Length: 58min 33sec (3513 seconds)

Published: Wed Jun 15 2016