Mindfulness and borderline personality disorder
How does mindfulness help?
One of the most prominent factors of Borderline patients is the difficulty coping with intense affect. Consequently self-injury and other dysregulated behaviors often provide short-term relief from the intense distress that is common in BPD , these behaviors are negatively reinforced and have an increased probability of recurring – until they may become automatic responses to potential discomfort of any type. (Berking et al., 2009) |
First, mindfulness fosters awareness, attention, and acceptance of ongoing experience, thus facilitating emotional processing, distress tolerance, and habituation to intense affect and urges (e.g., Teasdale et al., 2002).
Second, mindfulness fosters decentering, or the ability to “step back” mentally from automatic judgments and reactions to become aware of alternate ways of responding (e.g., Bowen et al., 2009; Teasdale et al., 2002). Third, mindfulness increases the ability to recognize early signs of escalating negative arousal, thus allowing individuals to engage in adaptive coping while emotions and urges are more man- ageable (e.g., Bowen et al., 2009). Fourth, increasing evidence indicates that mindfulness is associated with enhancements in neural pathways involved in behavioral and affect regulation (e.g., Creswell, Way, Eisenberger, & Lieberman, 2007; Ho ̈lzel et al., 2011). |
Mindfulness...
Mindfulness training is a component of dialectical behavior therapy, DBT, an empirically supported borderline personality disorder treatment (Linehan et al., 2006). Thus, mindfulness might be a protective factor against the harmful dysregulated behaviors that are often associated with BPD features. Mindfulness may allow an individual to experience intense and dysregulated emotions without resorting to the dysregulated behaviors. Instead, mindfulness may allow the individual to utilize more-adaptive mechanisms for coping with intense emotions, which may involve regulating the emotions or even tolerating the emotions until they naturally diminish. Individuals with high affect intensity and low levels of mindfulness may attempt to avoid potentially unpleasant experiences, either in response to the initial cue or after attempts at coping have not fully alleviated the experience. In other words, an individual with BPD features and mindfulness deficits may chronically attempt to avoid the experience of potentially upsetting situations, which may involve the use of harmful dysregulated behaviors to down-regulate emotions when such situations can’t be avoided. These findings may explain how some individuals with strong BPD features may experience negative affect without engaging in self-injury or other harmful behaviors. Finally, these findings are also consistent with research showing promising results for mindfulness-focused treat- ments targeting a variety of dysregulated behaviors, such as alcohol/drug-use disorders ( ,2013 Journal of clinical psychology) cite:Wupperman, P. B. (2013). Borderline Personality Features and Harmful Dysregulated Behavior: The Mediational Effect of Mindfulness. Journal Of Clinical Psychology, 69(9), 903-911. |
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Borderline is rarely found alone...some other disorders often seen with borderline personality disorder
BPD and Depression
Self-focused attention has been defined as awareness of internally generated information, including bodily sensations, cognitions, and emotional states ( Ingram, 1990). The tendency to focus attention on oneself has both maladaptive and adaptive consequences. Among the most dysfunctional forms of self-focus is rumination, a type of repetitive thinking about symptoms of distress and their causes, consequences, and implications ( Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Watkins, 2008). Rumination prolongs and intensifies negative moods and is associated with many forms of psychopathology, including self-harm, disordered eating, substance abuse, aggressive behavior, and posttraumatic stress ( Nolen-Hoeksema, 2004; Watkins, 2008).
How mindfulness helps
In contrast, mindful self-focused attention appears to be adaptive. The regular practice of mindful self-observation appears to have many beneficial outcomes, including symptom reduction and improved well-being ( Baer, 2003; Brown, Ryan, & Creswell, 2007). Because mindfulness involves nonreactive and nonjudgmental observation of thoughts as they come and go, rather than engaging with their content, it prevents the repetitive, analytical processing typical of rumination. Thus, although rumination and mindful self-observation are both described as forms of self-focused attention, they appear to have contrasting effects.
Self-harm, binge eating and substance use
Recent studies show that rumination is prominent in persons with borderline personality disorder (BPD) and correlated symptom severity ( Baer & Sauer, 2011; Smith, Grandin, Alloy, & Abramson, 2006). Selby, Anestis, and Joiner (2008) suggest that people with BPD become trapped in a vicious cycle, in which rumination intensifies negative affect, which leads to more rumination. The cycle is eventually interrupted by impulsive behavior such as self-harm, binge eating, or substance use. Present findings suggest that engaging in mindful self-focus may enable a quicker decrease in emotional arousal following an anger provocation and that being less aroused may, in turn, facilitate greater tolerance of subsequent frustrating task demands.
Sauer, S. E., & Baer, R. A. (2012). Ruminative and mindful self-focused attention in borderline personality disorder. Personality Disorders: Theory, Research, And Treatment, 3(4), 433-441. doi:10.1037/a0025465
BPD and Anxiety:
Sachse, S. J. (2011). A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder. Psychology & Psychotherapy: Theory, Research & Practice, 84(2), 184-200.
Mindfulness based cognitive therapy has been applied to individuals who currently suffer with anxiety and/or depression (Finucane & Mercer, 2006; Kenny & Williams, 2007; Ree & Craigie, 2007) with demonstrable improvements. The successful application of MBCT to clients at high risk of suicide (Barnhofer et al., 2007; Williams et al., 2006) and psychiatric in-patients (York, 2007) suggests that MBCT may also prove helpful to clients meeting BPD criteria. Further evidence suggests that deficits in mindfulness skills may explain variability in different BPD features (Wupperman, Neumann, & Axelrod, 2008).
Borderline personality disorder may be co-ocurring with other disorders including depressive and bipolar disorders, substance use disorders, eating disorders, post-traumatic stress disorder and attention-deficit/hyperactivity disorder. It also frequently co-occurs with the other personality disorders. DSM-5