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Five Types Of Dysregulation Linked To Childhood Trauma.

 

I have written extensively on this site about the link between the experience of significant childhood trauma and the possible later development of borderline personality disorder (BPD).

One of the leading experts on borderline personality disorder is Martha Linehan (who developed the treatment for BPD known as dialectical behavioral therapy, or DBT) and, according to her widely accepted theory, those who have developed BPD as a result of their adverse childhood experiences are often affected by all, or combinations of some, of the following types of DYSREGULATION:

(If we are dysregulated in relation to a quality, it means, in this context, that we have difficulty controlling and managing whatever the specific quality may be.)

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Above: DBT has been shown to be an effective therapy for helping people who suffer from BPD and problems connected to various types of dysregulation (see five types below).

The Five Types Of Dysregulation We May Experience If We Have Developed BPD As A Result Of Our Childhood Trauma :

1) Emotional dysregulation:

We may have very volatile emotions that are so powerful we can feel controlled and overtaken by them. We may experience particularly intense and fluctuating emotions in response to our relationships with others, particularly our closest relationships.

Also, we may have difficulty identifying what exactly we are feeling (ie. find it hard to name some emotions we experience) and have problems expressing and experiencing some emotions.

2) Interpersonal dysregulation:

This means we might experience significant difficulties both forming and maintaining relationships with others. We may, too, constantly fear rejection and abandonment, leading to us becoming ‘needy’ and ‘clingy’ which, most sadly, can often cause the very rejection we are trying so ardently to prevent.

We may, too, find our feelings for others often vascillate dramatically from idealisation one minute, to demonization the next, possibly apropos (objectively speaking) very little.

3) Cognitive dysregulation:

This type of dysregulation may lead us to experience dissociation, depersonalisation and paranoia.

 4) Behavioural dysregulation:

Our behaviour may become extremely self – destructive : we may self-harm, attempt suicide, have promiscuous and unsafe sex, take unnecessary risks (such as reckless driving), become addicted to drugs and/or alcohol in a desperate attempt to numb and temporarily escape from overwhelming mental anguish, or develop eating disorders.

5) Self – dysregulation:

We may feel confused as to who we are and have a very poor sense of identity. We may feel different aspects of our personality are not well integrated so we can find ourselves acting in rather one-dimensional ways.

Our self-image can be unstable as can our values. We may be confused as to who we really are and what are beliefs and principals are ( indeed, these may frequently alter).

This can leave us feeling lonely and empty.

To read my article on the therapy devised by Marsha Linehan called dialectical behavioural therapy, click here.

 

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Advice About Professional Help For Effects Of Childhood Trauma On Adults

 

MANUAL FOR TREATMENT OF BPD (Recommended) – Click image below for further details.

The effects of childhood trauma will vary depending upon a number of factors; however, in general, it is a good idea to consider obtaining professional help if:

– you feel empty and numb for an extended period

– you are socially isolated and therefore do not have others in whom you feel you can comfortably confide your feelings

– if you feel persistent and unremitting anxiety and tension

– if you feel the intensity of your feelings is overwhelming you

– if you feel constantly and deeply exhausted – your concentration is impaired and you feel confused/unable to concentrate

-you continue to have intrusive thoughts connected to your experience of trauma

– you often find that certain people, situations and events trigger disturbing memories of your trauma – especially if this is resulting in flashbacks

– you feel a strong need to avoid people, situations and activities that you fear will trigger unpleasant thoughts and feelings connected to the trauma that you suffered

– your sleep has been disturbed and non-refreshing for an extended period, perhaps involving nightmares, night terrors or sleep-walking

– you are finding it hard to form and maintain relationships

– you have become reliant on alcohol/narcotics/ over-eating etc in an attempt to reduce emotional suffering

– you are suffering from sexual problems connected to the trauma

NB. The above list is NOT exhaustive, but includes some of the main indications that professional help should be considered.

 

NATIONAL INSITUTE FOR CLINICAL EXCELLENCE IN HEALTH (NICE) TREATMENT RECOMMENDATIONS:

NICE provides national guidelines (UK) for the best way to treat health conditions. Their recommendations are based on high quality research and the accompanying scientific evidence.

For the treatment of the effects of trauma, the organization recommends TRAUMA-FOCUSED PSYCHOLOGICAL THERAPY. Examples of this type of therapy include:

1- TRAUMA-FOCUSED COGNITIVE BEHAVIOUR THERAPY – CLICK HERE

 

2 – EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY (EMDR) – CLICK HERE

 

3- EXPOSURE THERAPY (to help the individual cope with reminders of the trauma which trigger unpleasant feelings/bodily sensations). This can take the form of :

a) Exposure in imagination only

b) In vivo (real life) exposure (this form of exposure is graded – i.e. taken in small, manageable steps

 

4- COGNITIVE RESTRUCTURING – positively changes how we think about our experience of trauma and its implications

 

5- Also, MEDICATION AND DRUGS  may be appropriate. HOWEVER, NICE do NOT recommend this as a first-line treatment for PTSD

The above list of treatment options is NOT exhaustive.

SELFMANAGED HELP :

 – Hypnosis – This can be used as an adjunct to other therapies, in combination with other therapies (e.g. cognitive hypnotherapy) or as a standalone treatment to reduce symptoms of trauma such as anxiety and phobias.
Mindfulness Meditation – There is now a large body of evidence supporting the effectiveness of this technique for reducing symptoms of trauma including intrusive thoughts, excessive negative rumination and anxiety.

 

As well as seeking professional help, it is also useful to keep in mind the following tips when trying to manage the effects of trauma:

DOs

– talk about your thoughts and feelings with others you can trust and who are likely to be supportive

– be honest with your friends, family and work-colleagues about how you are feeling and the kind of help and support you feel you need

– try to keep your life as close to ‘normal’ as possible (i.e. as close as possible to how it would have been had the trauma not occurred). However, this may be extremely difficult or impossible if you are in the aftermath of a severe and intense trauma.

-get a lot of rest, relaxation and sleep; this is very important as the brain needs time to recover

– try to do as many things you enjoy (or used to enjoy) as possible

– try to avoid conflict as much as possible

– try to be as compassionate to self as possible

– if you possibly can, try not to avoid situations which remind you of your trauma – facing our fears is a very effective way of reducing them

– remind yourself that human beings are generally very resilient – think what man has endured and overcome throughout history

– accept that it is impossible for any person to control everything in their lives and that experiencing problems and difficulties is part of living

DON’Ts

– keep things to yourself and ‘bottled up’ – talking about experiences helps you to mentally process them

– expect symptoms such as intrusive memories and flashbacks to respond immediately  to treatment

– try not to ‘bury’ or suppress your painful thoughts, but try to accept them – actively trying to suppress unpleasant thoughts can actually increase their power

– remember that just because bad things may have happened in your life, this does not mean that the worst will always happen; therefore, try not to make negative predictions about the future without good evidence to do so

– do not blame yourself for how the experience of trauma has left you feeling – depression and anger, for example, are perfectly normal responses

– many people become very fearful about life in general after experiencing trauma – try not to over-estimate danger

– try to avoid unhelpful coping strategies such as drinking too much or over-sleeping – these things are very likely to make matters worse in the long-term

 

SELF-HELP:

Effective self-help can be obtained via :

bibliotherapy (gaining information about your condition through reading and, thus, improving your understanding of it).

mindfulness 

hypnotherapy (you can read more about mindfulness and hypnotherapy by visiting the FREE MINDFULNESS AND HYPNOTHERAPY ARTICLES section of this site – see MAIN MENU)

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2014 Child Abuse, Trauma and Recovery

Addressing The Effects Of Childhood Trauma With Dialectical Behavior Therapy. Part 2

dialectical behavior therapy

In part 1, I introduced the new and promising therapy called dialectical behavior therapy (DBT); as I said, there is growing evidence that it is a very effective treatment for conditions which may arise as a consequence of an individual having suffered childhood trauma (especially those who have developed borderline personality disorder -BPD).

As a quick reminder, five key skills which DBT endeavours to teach those who choose to undergo the therapy are:

1) CORE MINDFULNESS
2) TAKING THE ‘MIDDLE PATH’
3) DISTRESS TOLERANCE
4) EMOTIONAL REGULATION
5) INTERPERSONAL EFFECTIVENESS

dialectic behavioral therapy

In part one I covered 1 and 2 above. It seems quite logical then (!) that I should, in this post, move on to look at number 3 – DISTRESS TOLERANCE:

3) DISTRESS TOLERANCE

Practitioners of DBT try to instil the view in their clients that sometimes it is easier, and psychologically healthier, to stop struggling against reality, and,(they tell us) we need to accept that we, nor anybody else, for that matter, can prevent painful events from occurring in life (sometimes extremely painful ones, if we’re going to be up-front about it), nor can the painful emotions they bring with them. It is hardly a new idea, but practitioners of DBT also remind us that some painful things in life cannot be changed and that the only viable option we really have, therefore, is to accept the fact. This, of course, is difficult and requires considerable inner strength. By accepting the things which cannot be changed, though, it is reasoned, we free up energy which could have been wasted (by, say, being angry and bitter about the existence of these unchangeable facts) to deal with what CAN BE CHANGED.

DBT therapists tell us that there are certain skills we may wish to develop which will INCREASE OUR ABILITY TO TOLERATE DISTRESS; these are:

a) distraction/improving the moment
b) self-soothing
c) considering pros and cons of the situation
d) radical acceptance

Let’s briefly look at each of these in turn:

a) distraction/improving the moment – eg distracting ourselves with activities we enjoy, keeping our minds busy ; reminding ourselves of the good things in life ; reminding ourselves that it is better to think clearly and in a focused way about our problems ‘after the storm has passed’ (rather than try to make decisions when in the middle of an intense crisis which may be over-determined by our emotions) ; remind ourselves that difficult periods will pass

b) self-soothing – eg we can use postive self-talk (see my posts on cognitive behavior therapy for more on this – to access the posts just type ‘CBT’ into this site’s search facility) ; meditation/relaxation activities/breathing exercises ; using our imaginations to recall a soothing and comforting memory or place (if recalling a place it can be helpful to imagine, for a while, actually being there) ; thinking of things in life which are meaningful to us and give us the motivation to get through the difficult period.

c) considering the pros and cons of the situation : eg we may wish to consider how getting through a very difficult period may benefit us – for example, we may learn from it, it may strengthen us, it may make us more compassionate and sensitive towards others, we may be able to pass on the benefit of our experience to help others, it may even open up completely unexpected avenues in life which may not otherwise have been available to us (bad events do sometimes lead to positive outcomes, however indirectly – it is often worth keeping that in mind).

d) radical acceptance : this might involve trying to view what is happening, however undesirable, from as objective and detached a perspective as possible – a bit like watching the events unfold around somebody else in a movie ; another, perhaps surprising, technique suggested by DBT therapists is to try to, literally, half-smile. This sounds strange and even rather silly, but research shows that just as the mind can affect the body (eg thinking about something embarrassing and going red in the face) so too can the body effect the mind – in this case, the idea is that the half-smile ‘fools’ the brain into ‘believing’ things aren’t as bad as all that. It is obvious, however, that in certain situations this technique would be highly inappropriate (I need hardly list examples).

4) EMOTIONAL REGULATION :

The fourth skill that DBT teaches is how to cope with intense and overwhelming emotions – this skill is referred to by practitioners of DBT as emotional regulation.

This skill is made up of three sub-skills : a) increasing one’s understanding of one’s emotions; b) decreasing one’s emotional vulnerability; c) lessening the degree of distress caused by one’s negative emotions.

5) INTERPERSONAL EFFECTIVENESS

The final skill of interpersonal effectiveness helps the person undertaking DBT to communicate with others effectively when interacting with others in a way that helps to improve his/her relationships.

In order to achieve this, s/he is helped to communicate with others in a more controlled manner and to be less prone to speaking impulsively and without forethought due stress or overwhelming emotions (such as anger).

RESOURCE :
control your emotionsCONTROL YOUR EMOTIONS PACK – click here for further details :

 

DBT TRAINING MANUAL :

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Copyright 2013 Child Abuse, Trauma and Recovery

Addressing Effects Of Childhood Trauma With Dialectical Behavior Therapy : PART 1.

dialectic behavioral therapy(DBT)

DIALECTICAL BEHAVIOR THERAPY (DBT) has been found to be particularly effective in treating those who, in part due to their childhood experiences, have gone on to develop BORDERLINE PERSONALITY DISORDER (BPD).

Five skills are central to dialectical behavior therapy (DBT); these are as follows:

1) CORE MINDFULNESS
2) TAKING THE’MIDDLE PATH’
3) DISTRESS tolerances
4) EMOTIONAL REGULATION
5) INTERPERSONAL EFFECTIVENESS

dialectic behavioral therapy

In this introductory post, I will concentrate upon 1 and 2 above. I will go on to examine 3, 4 an5 above in PART 2. So let’s start by looking at 1:

1) CORE MINDFULNESS: DBT describes the mind as having 3 components (these are concepts, not actual distinct physical part of the brain, obviously). The 3 components are:

a) the reasonable mind
b) the emotional mind
c) the wise mind

Let’s examine each of these in turn:

a) the reasonable mind: this can be summed up, according to DBT, as the part of the brain which acts according to reason, logic and rationality

b) the emotional mind: according to DBT, this is the part of the brain which operates on the basis of our feelings (when the ‘heart controls the head’)

c) the wise mind: ideally, according to DBT, we should allow this part of the brain to guide us; it is A BALANCE BETWEEN 1 and 2 above, when the reasonable and emotional brain are operating in effective HARMONY.

If we are able to operate in ‘wise mind mode’, this will mean we can maintain control and prevent ourselves from becoming a victim of our own intense emotions. In order to see the importance of this, we need only consider times in our lives when our behaviour has been dominated by our emotions and the negative effects this may have led to. Indeed, not learning to control emotions can leave our lives in ruins, not least due to the frequent self-destructive effects of our emotional outbursts.

2) TAKING THE MIDDLE PATH: This is a metaphor for avoiding the trap of constantly seeing issues in terms of BLACK AND WHITE (eg all good/all bad and a marked tendency to perpetually think IN TERMS OF EXTREMES). DBT stresses the importance of teaching ourselves to FOCUS MORE ON THE GREY AREAS and to try to take A BROADER RANGE OF PERSPECTIVES when considering issues, to think more FLEXIBLY and to THINK LESS IN ABSOLUTE TERMS.

Taking the middle path, according to DBT, also involves BOTH VALIDATING OUR OWN THOUGHTS/FEELINGS AND THOSE OF OTHERS. Even if others don’t understand, DBT stresses that we need to comfort ourselves when distressed by reminding ourselves that how we are feeling is real and makes sense under the current circumstances we find ourselves in. We can remind ourselves, too, that no matter what others may think, NOBODY UNDERSTANDS US AS WELL AS WE UNDERSTAND OURSELVES (others can’t understand what it is ‘to be in our heads’; we should not be ashamed of how we feel). By applying this compassion and understanding to ourselves, as part of ‘taking the middle path’ it seems fair that we should extend similar understanding to others – we can accept what they feel, as non-judgmentally as possible, irrespective of whether we approve or not.

My next post (PART 2) will look at the other 3 key skills DBT teaches us (3,4 and 5 above) namely: DISTRESS TOLERANCE, EMOTIONAL REGULATION and INTERPERSONAL EFFECTIVENESS.

RESOURCE :

control your emotionsCONTROL YOUR EMOTIONS PACK – click here for further information.

 

DBT TRAINING MANUAL :

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2013 Child Abuse, Trauma and Recovery

Dialectical Behavior Therapy for Borderline Personality Disorder (BPD).

childhood-trauma-fact-sheet

DIALECTICAL BEHAVIOR THERAPY (DBT) is an exciting new treatment option for those suffering with BPD. It is a therapy which has elements in common with cognitive behavioral therapy (CBT).

It is an evidence-based treatment (ie it is backed by scientific research).

In the past, BPD was considered to be extremely difficult to treat, but, with the development of therapies such as CBT and DBT, the prognosis is now far more optimistic.

DBT was originally created by the psychologist Marsha Lineham; at first, it was developed with the treatment of females who self-harmed and were suicidal in mind. However, since then, its possible applications have become much broader; it is now used to treat both males and females suffering from a large array of different psychological conditions.

As already stated, DBT has many elements in common with CBT; in addition to this, it also borrows from ZEN and a therapy, which is becoming increasingly popular, called MINDFULNESS.

DBT has been particularly successful in the treatment of BPD (for information about BPD see Category 3 of the main menu : BORDERLINE PERSONALITY DISORDER AND ITS RELATIONSHIP TO CHILDHOOD TRAUMA). It is thought that one of the main CONTRIBUTING FACTORS of BPD is a traumatic childhood in which the child grows up in an INVALIDATING ENVIRONMENT (eg made to feel unloved and worthless). Such a childhood environment is especially likely to result in the child developing BPD in later life if he/she also has a BIOLOGICAL VULNERABILITY (carries certain genes making him/her particularly vulnerable to stress).

When a person is suffering from BPD the condition causes him/her to REACT WITH ABNORMAL INTENSITY TO EMOTIONAL STIMULATION; the individual’s level of emotional arousal goes up extremely fast, peaks at an abnormally high level, and, takes much longer than normal to return to its baseline level.

This condition leads to the affected individual – a victim of his/her uncontrollable, intense emotional reactions – prone to stagger in life from one crisis to the next and to be perceived by others as emotionally unstable. It is thought that, due to the invalidating environment which the sufferer experienced in childhood, the normal ability to develop the coping strategies needed to regulate emotions is blocked, leaving the person defenceless against painful emotional feelings and leading to maladaptive (unhelpful) behaviors.

It is this problem which DBT was is now used to address. The therapy teaches individuals how to cope with, and regulate, their emotions so that they are no longer dominated and controlled by them. This is vital as the inability to control feelings will often wreck crucial areas of life, including friendships, relationships and careers. It is because of these possible effects that DBT also helps individuals develop SOCIAL SKILLS to help reduce the likelihood of them occurring.

DBT has been found to be effective in helping people suffering from a large range of psychiatric conditions; these include;

– self-harming
– depression
– suicidal ideation
– bipolar
– anxiety
– ptsd
– eating disorders
– substance abuse
– low self-esteem
– problems managing anger
– problems managing relationships/friendship

-76_AA278_PIkin4,BottomRight,-69,22_AA300_SH20_OU02_childhood traumachildhood trauma therapies and treatments

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Best Wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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