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Over 850 free, concise articles about childhood trauma and its link to various psychological conditions, including : complex posttraumatic stress disorder (complex PTSD), borderline personality disorder (and other personality disorders), anxiety disorders, depression, physical health conditions, psychosis, difficulties forming and maintaining relationships, addictions, dissociation and emotional dysregulation (such as dramatic mood swings and outbursts of rage). The site also comprises articles on treatments for childhood trauma and related mental health problems as well as articles on posttraumatic growth and other relevant topics. There is a search facility on the site to facilitate exploration of subjects covered.

Mindfulness Meditation: An Escape Route Away from Obsessive, Negative Ruminations.

 

mindfulness meditation

Mindfulness :

MINDFULNESS is a very effective and evidence-based therapy for the treatment of anxiety, depression and other conditions related to childhood trauma. Mindfulness helps individuals to develop the skill to DELIBERATELY FOCUS ATTENTION AND AWARNESS on THE PRESENT MOMENT. WHILST BEING INTENSELY AWARE OF THE PRESENT MOMENT, MINDFULNESS TEACHES US TO ACCEPT THINGS AS THEY ARE IN A NON-JUDGMENTAL WAY.

Mindfulness helps us to become aware of our CURRENT experience, of things we would normally take for granted. These may include becoming aware of our breathing, of the feeling of our clothes against our skin, the furniture on which we sit, the feel of the temperature in the room etc; anything, in fact, which we are presently experiencing through one of our five senses. It teaches us, as I have said, to accept things as they are rather than to fret about want them to be. We may, too, become aware of our thoughts; again, we are encouraged to accept them non-judgmentally – to simply observe them floating through our minds in a detached manner and not get caught up in them.

Negative Ruminations :

This state of mind of existing intensely in the present, accepting it as it is in non-judgmentally, is, at its best (it takes time to master the skill), the polar opposite of obsessive, negative ruminative thinking which can be so painful and destructive.

mindfulness meditation

Below, I summarize the principles which underpin MINDFULNESS :

1) IT IS INTENTIONAL – it helps us to become aware of current reality and the choices which are open to us. This is in direct contrast to rumination (in which we are caught up and trapped in the destructive downwaed spiral of our automatic negative thoughts).

2) IT IS EXPERIENTIAL – mindfulness trains us to experience the present moment (unlike rumination, which fills us with concerns about the past and the future and causes us to be preoccupied with abstract thoughts detached from present experience).

3) IT IS NON-JUDGMENTAL – mindfulness helps us to accept things as they are right now rather than to get caught up in judgments and frustrations about how we think things should be.

By cultivating MINDFULNESS, it stops us from becoming stuck in a futile cycle of depressive and anxiety creating negative ruminations; instead, it helps us to develop new and wiser ways to relate to our actual experience IN THE PRESENT MOMENT.

However, MINDFULNESS is about more than noticing things around us that we had previously taken for granted and ignored; it also helps us to develop awareness of THE HABIT OF A PARTICULAR STATE OF MIND WE USED TO FIND OURSELVES IN, WHICH GOT US STUCK AND CAUGHT UP IN RUMINATIONS DESTRUCTIVE TO US AND TO OUR EMOTIONAL LIVES. The skill of mindfulness allows us to DISENGAGE from such destructive, ruminative thinking and shift to an enormously healthier frame of mind which frees us from our self-defeating emotional struggles. Mindfulness allows us to accept the different emotions which drift through our minds non-judgmentally and with self-compassion.

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

Some Lesser Known Therapies for Treating Effects of Severe Trauma

trauma therapy

There are some less well known treatments for trauma which I thought it would be useful to take a brief look at in this post (I have covered the more mainstream treatments in other posts in the THERAPIES AND SELF-HELP category of this site. The specific therapies I am going to outline are:

1) THE COUNTING METHOD (intense, short-lived recollection)
2) MULTIPLE CHANNEL EXPOSURE THERAPY
3) TRAUMATIC INCIDENT REDUCTION

Let’s look at each of these in turn:

1) THE COUNTING METHOD (intense, short-lived recollection) :

This therapy derives from cognitive behavior therapy (CBT). Its two main benefits are – a) it is a fast form of therapy ; b) it affords the individual undergoing the therapy a significant degree of PRIVACY.

The therapist begins the therapy by asking the client which specific trauma s/he wishes to recall. When this has been agreed upon, the client is asked to intensely recall the traumatic incident whilst the therapist counts aloud to one hundred (one count lasts about one second so the client recalls the incident for approximately 100 seconds). During this 100 seconds, the incident is recalled intensely for about the first 90 seconds ; the last 10 seconds are used to ‘mentally come back’ to reality.

After the one hundred seconds are up the therapist asks the client what s/he recalled and what was learned by revisiting the trauma.

therapy for severe trauma

HOW THIS THERAPY HELPS :

– the voice of the therapist has the comforting effect of keeping the client safely mentally rooted in the present whilst s/he is recalling the trauma

– because the memory of the trauma is strictly contained witin an ‘experiential period’ of 100 seconds, its power is weakened

– intensely mentally revisiting the trauma helps the client become desensitized to it and to gain mastery over it

One study showed that 80% of those who underwent this therapy gained benefit from it.

2) MULTIPLE CHANNEL EXPOSURE THERAPY :

This therapy focuses primarily on the treatment of panic attacks (which are extremely common amongst those who have undergone extreme trauma). It involves educating the client about what panic attacks are and then helps them develop breathing techniques to control the panic. One technique the therapy uses is to recreate the symptoms of a panic attack artificially in the client. For example:

a) the therapist gets the client to breathe through a straw for a while (this mimics the adverse effect of how we breathe during a panic attack) ; b) the client spins on a swivel chair (which mimics the dizziness which is often felt during panic attacks), and c) the client is asked to repeatedly tense and untense the stomach (this mimics the queasy feeling we often experience in our stomachs when we are having a panic attack).

Artificially recreating the feelings which accompany a panic attack help to DEMYSTIFY them in our minds and help us to see them as merely a temporary inconvenience which is not dangerous and can be easily dealt with (after the artificial symptoms have been brought on, the therapist guides the client through the breathing exercises which stop the symptoms. The client can apply the same breathing exercises the next time s/he experiences a real panic attack).

Once the client has been shown how to overcome the symptoms of panic, s/he need no longer fear them and they start to lose their power over him/her.

3) TRAUMATIC INCIDENT REDUCTION :

This therapy encourages the client to confront their trauma. It is a short therapy and usually allocates on session per traumatic incident. The therapist acts more as a FACILITATOR and the client does most of the work. The therapy consists of the following stages :

a) The client is asked to specify the particular trauma s/he wishes to confront.

b) The client is then asked to mentally view the trauma as if it was a film being watched on DVD (so the client feels MENTALLY DETACHED from it).

c) The client is asked to say what happened and what s/he felt about it

d) The client mentally views the imaginary film again and again explains to the therapist how s/he feels about it.

In the case of complex post traumatic stress disorder (meaning the client will usually need to address multiple traumas), 10-15 sessions may be necessary.

Therapists typically report that the client’s emotional response will increase during the first few imaginary viewings of the trauma but this will then start to fade so that, eventually, there is no negative emotional response. The therapy continues until the client reaches the point at which s/he feel calm about their imaginary viewings of the traumatic incidents.

Research into the effectiveness of this type of therapy is at an early stage.

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

The Vicious Cycle of Adult Problems Stemming from Childhood Trauma

childhood trauma

‘WE NEED TO SEE THE SYMPTOMS WE HAVE AS A RESULT OF OUR CHILDHOOD TRAUMA LESS AS THE RESULT OF SOME CHARACTER FLAW, AND MORE AS THE RESULT OF HAVING SUFFERED EXTREME AND PAINFUL EXPERIENCES WHEN WE WERE LEAST ABLE TO COPE WITH THEM. BY CONSIDERING THE IDEA THAT OUR SYMPTOMS COULD BE SEEN AS NORMAL REACTIONS TO ABNORMAL AND TRAUMATIC EVENTS IN CHILDHOOD, IT IS POSSIBLE TO USHER IN THE IDEA OF CHANGE.’

– CHARTED CLINICAL PSYCHOLOGIST AND EXPERT ON EFFECTS OF CHILDHOOD TRAUMA.

People who have suffered childhood trauma frequently go on to develop multiple problems in adult life which tend to build up over the long-term. A range of difficulties like the ones given in the fictional scenario below would not be untypical:

Losing interest in school and unable to concentrate resulting in leaving at age 15 ; becoming disruptive and difficult leading to home-life problems, so leaving home at 16 ; this could then lead to homelessness or insecure housing (eg sleeping on friends’ sofas) ; depression and unsettled life style and lack of direction could then lead to abuse of drugs and alcohol ; unable to hold down job for long (eg due to having problems getting on with authority figures (stemming from problems with relationship in childhood with parent/s) and inability to accept criticism (eg becoming angry and aggressive when criticized, this, again, stemming from earlier relationship with parent/s, perhaps because they were physically abusive leading to a an intense need to ‘stand up for self’ and protect self).

The above example of how life can unravel as a result of childhood trauma, a whole string of problems feeding in to one another and compounding one another, are likely, too, to be underpinned by feelings of LOW SELF-ESTEEM, EMOTIONAL INSTABILITY and EMOTIONAL SCARS, A POOR SENSE OF OWN IDENTITY, AN INABILITY TO TRUST AND ‘PUT DOWN ROOTS’ – all these factors, also, stemming from the problematic childhood.

imagesCAEH7Z1BimagesCA24B8VY

STOPPING THE VICIOUS CIRCLE : The key to BREAKING OUT OF THE VICIOUS CYCLE IS TO BECOME AWARE AND RECOGNIZE THAT OUR PROBLEMS IN ADULT LIFE HAVE THEIR ROOTS IN OUR DISTURBED CHILDHOOD. By doing this, we can begin to understand that our unhelpful behaviours are rooted in our disturbed childhood and start to discard them. By understanding the enormous, destructive impact the past has – up until now – had upon our life, we can begin to loosen the past’s invidious grip on us.

We need to understand that our traumatic childhood experiences have affected how we THINK, FEEL and BEHAVE as adults. Apart from all the potential effects I have already described, our disturbed childhood is likely, too, to have had a VERY ADVERSE IMPACT UPON THE RELATIONSHIPS WE HAVE HAD, SO FAR, IN ADULTHOOD, perhaps due to feelings of FEAR, SHAME, FRUSTRATION, MOOD DISORDERS, ANXIETY and DEPRESSION. Again, these symptoms will almost certainly have their roots in our adverse childhood experiences.

LEARNING NEW WAYS OF COPING : Because our childhood experiences, the effects of which then become compounded by the adult experiences we have which stem from these childhood experiences, we are likely to have suffered EXTREME EMOTIONAL DISTRESS in our adult life, at worst leading to such horrors as compulsive self-harm and suicide attempts. Due to such intolerable distress, we are likely to have turned, in desperation, to any WAYS OF COPING possible. Often, these will have been unhelpful in the long-term and will have made matters yet worse. The coping mechanisms may have included alcohol abuse, drug abuse, withdrawal from society etc. These coping mechanisms may have become habits which we find difficult to change. We may, too, have become so enmeshed in the damaging life-style we now find ourselves in, it is difficult to step back and reassess why we are suffering our futile, negative, repeating pattern of thoughts, feelings and behaviour.

Often, the only viable option will be to seek therapy and start the process of stepping back, understanding how our lives have become as they have, stop blaming ourselves and feeling bad about ourselves, and, gradually, seek new and more positive ways of approaching life.

We may have come to see the personal characteristics we have displayed up until now (our anxiety, our depression, our bleak outlook, our problematic relationships etc, etc) as just ‘who we are.’ This, though, is a mistake which will only perpetuate matters. We need to detach these SYMPTOMS of our traumatic childhood from our TRUE IDENTITY. We may need to realize we are not ‘bad’ even though are childhood experiences and the symptoms they have caused may have made us (FALSELY) believe that we were ‘bad’.

CONCLUSION : AN IMPORTANT NOTE OF CAUTION:

Those who played a part in causing the childhood trauma (parents, step-parents, siblings etc) will often ENTER A STATE OF DENIAL to PROTECT THEMSELVES FROM THEIR OWN GUILT. It will often suit them to regard you as ‘innately bad’, and to regard this ‘badness’ as having nothing whatsoever to do with their treatment of you. Freud, of course, would regard this as a flagrant example of the psychological defense mechanism known as PROJECTION. I am inclined to concur.

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

Rational Emotive Behavior Therapy (REBT).

rational emotive behavior therapy

Rational Emotive Behavior Therapy :

People are disturbed not by things, but by their view of things.

-Epictetus

REBT emphasizes that the key to emotional health, even in the face of life’s adversities, is RATIONAL THINKING. In the context of REBT, it is useful to consider the reasons the 4 words: RATIONAL, EMOTIVE, BEHAVIOUR and THERAPY have been used to make up the name:

1) RATIONAL – REBT stresses that irrational thinking leads to emotional problems. Irrational thinking, in the context of the therapy, has the following characteristics: it is rigid, it is extreme, it is false and it is unconstructive. Rational thinking, on the other hand is seen to be flexible, true, non-extreme and constructive.

Irrational thinking tends to lead to unhelpful emotional responses such as anxiety, which, in turn, lead to unhelpful behaviours.

2) EMOTIVE – in this context, the word ’emotive’ means ‘relevant to emotions’. REBT is concerned with reducing feelings of emotional distress, but, importantly, it also recognizes the fact that, in life, people will, inevitably, experience NEGATIVE FEELINGS WHEN FACED WITH ADVERSITY, BUT THESE NEED NOT BE UNHEALTHY.

REBT sees NEGATIVE EMOTIONS AS BEING SPLIT INTO TWO DISTINCT CATEGORIES:

i) UNHEALTHY NEGATIVE EMOTIONS (UNEs)

ii) HEALTHY NEGATIVE EMOTIONS (HNEs)

The theory states that UNEs we experience as a reaction to adversity are a result of IRRATIONAL BELIEFS ABOUT OURSELVES, OTHERS and THE WORLD IN GENERAL. We need to change our irrational beliefs to rational ones so that we may experience HNEs rather than UNEs. The theory incorporates the ABC model to help illustrate this. In the ABC model A,B and C stand for the following:

A : Adversity

B : Beliefs

c : Consequences of beliefs (eg emotions)

Let’s consider, with this model in mind, the following scenario :

First, an adverse event occurs (A) – a colleague at work snaps at you

this leads to you having a belief (B). The belief (B) may be IRRATIONAL or RATIONAL. Let’s look at examples of both:

(B) IRRATIONAL : ‘It is imperative that my work colleague likes me’

or

(B) RATIONAL : ‘I would prefer it if my work colleague liked me, but it is not a catastrophe if she does not.’

These opposing two responses then give rise to commensurate emotional responses:

(B) IRRATIONAL leads to UNEs eg Anxiety

and

(B) RATIONAL leads to HNEs eg Concern (the emotion of concern, whilst a negative emotion, is also a healthy one).

In order to illustrate further how negative emotions can be both healthy and unhealthy, below are two lists. The left hand column is a list of unhealthy negative emotions (UNEs), whilst the list on the right gives the healthy negative emotion equivalents (HNEs):

UNEs — HNEs

ANXIETY — CONCERN

DEPRESSION — SADNESS

GUILT — REMORSE

SHAME — DISAPPOINTMENT

HURT — SORROW

 

INTELLECTUAL VERSUS EMOTIVE UNDERSTANDING : it has already been stated that REBT views irrational beliefs as rigid, false, not sensible and non-constructive. The example given of an irrational belief was ; ‘it is imperative that my work colleague likes me’ whereas the rational response would be : ‘it would be nice if my work colleague liked me but it is not a catastrophe if she does not.’ REBT states that we need to understand ON AN INTELLECTUAL LEVEL that the second response is the rational one but that this INTELLECTUAL UNDERSTANDING is not sufficient on its own.

rational emotive behavior therapy

 

Above : A diagrammatic representation of the mental process encouraged by REBT.

If we only understood intellectually, our ‘head would understand but our heart wouldn’t’ – this would mean we would not FEEL any different : we would still have a UNE (ie anxiety), consistent with an IRRATIONAL BELIEF. So, REBT emphasizes that our understanding that the rational belief is the correct one needs to be not only INTELLECTUAL, BUT ALSO EMOTIVE. Only then can we feel, think and act in a way that is consistent with the rational belief (ie in a CONCERNED rather than ANXIOUS manner).

3) BEHAVIOR : REBT states that IRRATIONAL BELIEFS lead to NON-CONSTRUCTIVE BEHAVIOR whereas RATIONAL BELIEFS lead to CONSTRUCTIVE BEHAVIOR. In our example about the work colleague, this idea might be illustrated by the irrational belief leading us to AVOID our work colleague whereas the rational belief might lead us to approach her assertively and talk the problem through calmly and maturely.

Below are examples of how UNEs can lead to unhelpful behavior whilst HNEs can lead to helpful behavior:

UNE – DEPRESSION leading to withdrawal from enjoyable activities/EQUIVALENT HNE – SADNESS leading to participation in enjoyable activities after period of adjustment

UNE – GUILT leading to begging for forgiveness/EQUIVALENT HNE – REMORSE leading to asking for forgiveness

UNE – SHAME leading to withdrawal from others/EQUIVALENT HNE – DISAPPOINTMENT leading to contact with others and talking things over

UNE – HURT leading to sulking/EQUIVALENT HNE – SORROW leading to assertiveness and communicating with others.

4) THERAPY – in order to get the most out of REBT it is necessary to first address one’s maladaptive (unhelpful) responses to life’s adversities BEFORE dealing with the practical side of the actual problems. The rationale behind this is that otherwise the unhelpful responses will impede the individual’s ability to deal with the particular adversities in an effective way.

 

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

Treating Conditions Related to Childhood Trauma by Getting Right Fats in Diet.

trauma and diet

As far as diet is concerned, there are good fats and bad fats. The fats we put into our bodies are of particular importance because of their effect upon brain functioning. Again, some fats have a very positive effect upon the brain, whilst others have a damaging effect.

Fats of great benefit to the brain include OMEGA-3 FATTY ACID – such fats are vital to good mental functioning (in fact, the composition of the brain is 60% fat).

An intake of the correct fats enables the brain to manufacture its cells effectively – the specific type of fats required are called LIPID FATTY ACIDS. A lack of these has a detrimental effect upon brain function. The type of fat required by the brain cannot be manufactured by the body so needs to be taken in by the diet. Food sources for the fat include:

– vegetable oils
– sesame oils
– corn
– walnuts
– green leafy vegetables

diet and childhood trauma

Lack of OMEGA-3 leads to neurons (cells in the brain) not working properly; at worst, it can even mean some neurons will die.

SATURATED FATS:

This type of fat can be damaging to the brain. It can lead to brain cell membranes becoming rigid – this undesirable occurrence, in effect, means that communication between the brain cells becomes inefficient; the brain, therefore, develops problems transmitting information between these cells.

CONCLUSION: RESEARCH SHOWING BENEFITS TO BRAIN FUNCTION OF GOOD INTAKE OF OMEGA-3:

Research has shown that as intake of OMEGA-3 goes up (within limits, obviously), so to does the quantity of the neurotransmitter known as SEROTONIN available in the brain. This is of great benefit as SEROTONIN helps to keep our mood CALM, STABLE and POSITIVE. Research has also shown that OMEGA-3 improves the effective functioning of another neurotransmitter in the brain known as DOPAMINE – this helps us to REGULATE OUR MOOD AND EMOTIONS.

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

Mindfulness : A Very Effective Technique for Treating Conditions Related to Childhood Trauma

childhood_trauma_effects

What Is Mindfulness?

 

MINDFULNESS is an exciting technique, its effectiveness supported by much research evidence, which is now becoming very popular as a tool for the treatment of conditions related to childhood trauma, including depression, anxiety, difficulties regulating emotions and borderline personality disorder (BPD). It derives from Buddhist philosophy.

The technique teaches people to improve their coping ability and resilience by concentrating on :

– how they breathe

– observing

– accepting

– adopting a non-judgmental attitude

Individuals are encouraged to just accept and observe their thoughts, their physical sensations (perhaps caused by anxiety) and their emotions as they come and go in the mind.

mindfulness for childhood trauma

The technique emphasizes the importance of just observing these phenomenon in a detached way, stepping back from them, avoiding engaging with them or getting caught up in them. A metaphor for this would be watching leaves on a stream float by.

Mindfulness is also all about being intensely involved in the MOMENT (rather than thinking about the past or future). It is about accepting the moment as it is and being fully involved in it – for example, becoming aware of our breath going in and out, the feel of the temperature on our skin, the feel of the seat we are sitting in, the feel of the clothes against our skin, the colour of the walls – everything, in fact, which is currently impinging upon the senses. By existing in the moment, unconcerned by the past or present, we can just dispassionately, non-judgmentally ‘watch’ our concerns and worries as they pass through our mind.

In this way we can detach ourselves from stressors, and, with practice, we can prevent our previously unhelpful, ‘automatic responses’ to stress. The technique also encourages us, as we simply observe, in a detached manner, thoughts and feelings passing through our minds, to label them. For example, ‘worry’, ‘fear’ etc; the reason for this is explained below:

NEUROLOGICAL EXPLANATIONS ABOUT WHY MINDFULNESS WORKS:

As I have already said, there is a lot of evidence showing MINDFULNESS to be a very effective coping technique. In terms of how the brain works, this has been explained in the following way: – labelling our emotions rather than engaging with them activates the PREFRONTAL CORTEX (an area of the brain) which reduces anxiety – a high level of MINDFULNESS correlates positively with the level of neural activity in the PREFRONTAL CORTEX; this has the effect of dampening down acivity in the AMYGDALA (high activity in the brain area known as the AMYGDALA is associated with intense emotions); in this way, we become much calmer. – the effects of practicing MINDFULNESS, and the subsequent effects on the brain given above, result in us being able to achieve much greater emotional regulation (emotional control).

As well as reducing anxiety, depression and helping us to master our emotions, MINDFULNESS, research has shown, also benefits the immune system, helps people control obsessive-compulsive disorder (OCD) and is also used to help control chronic pain. Furthermore, people who continue to practice mindfulness have been found to have stronger coping skills and greater resilience than others.

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

Dialectical Behavior Therapy

DIALECTICAL BEHAVIORAL THERAPY (DBT), devised by Marsha Linehan,  the founder of Behavioral Tech, 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 behavioral therapy (DBT); these are as follows:

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

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.

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).

Research Suggests That DBT Can Beneficially Alter Brain Functioning :

THE STUDY :

Research conducted by Schnell and Herpertz (2006) involved looking at the effects of DBT (specifically, training in emotional regualation, see number 4, above) on female patients’ brain functioning (this was done by taking magnetic resonance images, or MRIs, a type of brain scan) after they had spent 12 weeks undergoing an inpatient treatment program.

RESULTS OF THE STUDY :

The female, BPD patients who improved following the DBT / emotional regulation skills 12 week inpatient program were found (by analysis of their MRIs) to show:

REDUCED ACTIVITY IN CERTAIN BRAIN REGIONS ASSOCIATED WITH THE GENERATION OF INTENSE EMOTIONS, INCLUDING THE AMYGDALA AND THE HIPPOCAMPUS.

Such a reduction of activity in these brain regions is associated with an increase in the individual’s ability to prevent themselves from overreacting to stressful situations (overreacting to stressful situations, also known as impaired emotional regulation, is one of the hallmark features of BPD).

Conclusion :

The above can be interpreted as further evidence for the effectiveness of DBT for treating patients suffering from borderline personality disorder (BPD).

Useful Link :

A LINEHAN INSTITUTE TRAINING COMPANY

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

Childhood Trauma Recovery