Wednesday, November 21, 2012

November Book Giveaway

Update: After seeing all the lovely comment's about Debbie Corso's work I have decided to give away 10 copies of her book instead of 5

It was a great success last month, with 5 people winning Debbie Corso's last book (1 person even paid it forward giving away another 5 copies!)  On November 30th her new book Stop Sabotaging a 30 Day DBT Challenge to Change Your Life will be available for purchase on Smashwords.

And I am happy to announce I am the introduction writer!

Starting on Friday November 23rd at 11:59pm until Friday November 30th at 11:59pm I will be giving away 10 copies of Debbie's new book as well as 1 copy of Brene Brown's The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are and the 1 copy of Buddha and The Borderline

There are 2 ways to win one of *10* of Debbie Corso's book:
1) Leave a comment here with an e-mail address stating which book your prefer
2) Become a fan of my twitter then tweet: "Just entered to win 1 of 10 copies of Stop Sabotaging by Debbie Corso.  Follow @APazMA and RT to enter #BPD #DBT"

There are 2 ways to win the other 2 books:

1) Leave a comment here with an e-mail address stating which book you prefer. 
2) Become a fan of my twitter then tweet: "Just entered to win 1 of 5 copies of (book title).  Follow @APazMA and RT to enter #BPD #DBT"

Rules: After I receive 200 entries or by 11/30/2012 at 11:59pm EST, whichever comes first I will contact the 7 winners and ask for an e-mail address for those on twitter so I can "gift" the Stop Sabotaging e-book to you.  I will not use your e-mail address for anything else besides sending the book and an e-mail confirming the book was sent if there are any issues.  If I can not get in touch with any winner within a week (and I will try my hardest to do so) I will give the remaining book(s) to another contestant.  The winners of the other 3 books will need to send me their physical address to have the book shipped from Amazon via DM on twitter or e-mail.  The winners will be selected at random from my blog and twitter.  2 entries per person per day allowed (1 on here and 1 on twitter, so 14 total max.) Failure to comply with rules, such as tweeting your entry more than once a day will make you disqualified.  If you have questions tweet me!

Please play fair as I plan on doing this once a month with different books I purchase.  Next month I might give away Linehan's DBT workbook & 3 months of DBT coaching for the holidays....will update!

Wednesday, November 14, 2012

DBT Coaching Chat

I have talked for a while about helping those doing self-taught DBT, whom are learning DBT without the benefit of a group or a DBT Counselor.  Here are some great resources for those taking this path.  I have also started a DBT Chat room so you can ask me questions and they can be answered publicly for others to see.  I will answer as soon as I can, but it might take a day to get a response.  Feel free to help each other out as well.  There is no sign-up, nothing to download and you can remain anonymous!

Disclaimer: I am a licensed Mental Health Counselor in Michigan, specializing in DBT and BPD. This chat is intended to assist those doing self-taught DBT with coaching. I am not able to provide any personal counseling on this site.

*Please begin any question with "TW" if the content may trigger someone else*

Monday, November 12, 2012

Dealing with trauma issues with BPD

Although the DSM IV-r criteria for Borderline Personality Disorder does not include trauma, it is often a common thread in those with the disorder.  Often on Twitter I see a tweet started with "TW" (trigger warning) before something that may be triggering, it's a safety boundary for many in the BPD community.  In DBT we strictly enforce the rules about saying things that can be triggers, sometimes those who don't have BPD don't realize how harmful what they say can be, sometimes people try to stir up some drama and some are so disconnected from their trauma they don't understand how someone could be hurt by what they are saying.
Adults with borderline personality disorder (BPD) showed excessive emotional reactions when looking at words with unpleasant meanings compared to healthy people during an emotionally stimulating task, according to NIMH-funded researchers. They also found that people with more severe BPD showed a greater difference in emotional responding compared to people with less severe BPD. The study was published in the August 1, 2007, issue ofBiological Psychiatry[source]

This week myself and a client came to the conclusion that talking about her trauma only continues to hurt her more than help her.  Creating a boundary became necessary since other clients continue to push her to speak about the horrific trauma thinking that like them she needs to "get it out and give it away." In group she announced this decision and the overall look was puzzled, so we decided to allow questions as this appeared to go against everything they have been taught since being in therapy.  The questions were in 3 categories; 1) doesn't keeping it in, keep us sick? 2) How does talking about it make it worse? 3) So what are you going to talk about then?  The group decided to respect her boundary, although they were skeptical.  I decided to not go into the details of Borderline Personality Disorder since the client had told me she was not comfortable with that.

The end question was then "Ms. Paz, how is she going to work on her trauma issues without talking about it?"  I spoke about working on how the trauma affects you now; relationship issues, boundaries, PTSD symptoms and focusing on coping skills and grounding techniques instead of living in the past.  The group was still unsure about this plan as it goes against what they have (thought) they have known for most their life.  HEre are some ways to work on your trauma without talking about the trauma [source]

1. Tell yourself that you are having a flashback  
2. Remind yourself that the worst is over.  The feelings and sensations you are experiencing are memories of the past.  The actual event has already occurred and you survived. Now it is the time to let out the terror, rage, hurt, and/or panic.  Now is the time to honor your experience.  
3. Get grounded.  This means stamping your feet on the ground to remind yourself that you have feet and can get away now if you need to.  (There may have been times before when you could not get away, now you can.)  Being aware of all five senses can also help you ground yourself.  
4. Breathe.  When we get scared we stop normal breathing.  As a result our body begins to panic from the lack of oxygen.  Lack of oxygen in itself causes a great deal of panic feelings; pounding in the head, tightness, sweating, feeling faint, shakiness, and dizziness.  When we breathe deeply enough, a lot of the panic feeling can decrease.  Breathing deeply means putting your hand on your diaphragm, pushing against your hand, and then exhaling so the diaphragm goes in.  
5. Reorient to the present.  Begin to use your five senses in the present.  Look around and see the colors in the room, the shapes of things, the people near, etc.  Listen to the sounds in the room:  your breathing, traffic, birds, people, cars, etc.  Feel your body and what is touching it: your clothes, your own arms and hands, the chair, or the floor supporting you.  
6. Get in touch with your need for boundaries.  Sometimes when we are having a flashback we lose the sense of where we leave off and the world begins; as if we do not have skin.  Wrap yourself in a blanket, hold a pillow or stuffed animal, go to bed, sit in a closet, any way that you can feel yourself truly protected from the outside.  
7. Get support.  Depending on your situation you may need to be alone or may want someone near you.  In either case it is important that your close ones know about flashbacks so they can help with the process, whether that means letting you be by yourself or being there.  
8. Take the time to recover.  Sometimes flashbacks are very powerful. Give yourself time to make the transition form this powerful experience. Don't expect yourself to jump into adult activities right away.  Take a nap, a warm bath, or some quiet time.  Be kind and gentle with yourself.  Do not beat yourself up for having a flashback.  
9. Honor your experience.  Appreciate yourself for having survived that horrible time.  Respect your body's need to experience a full range of feelings.  
10. Be patient.  It takes time to heal the past.  It takes time to learn appropriate ways of taking care of yourself, of being an adult who has feelings, and developing effective ways of coping in the here and now.
 Stay safe.

Saturday, November 10, 2012

Grieving The Death of Your Counselor

This week I received an e-mail from my boss stating my co-worker (of a team of 4) passed this week.  I was at first dumbfounded and was unable to continue the conversation I was at the time having with one of the inmates.  Two hours later we held a "Family Meeting" to announce it to the 95 total clients, and her group of 17 clients.  The moment it was announced the room feel apart; women were sobbing and the staff was still in disbelief and shocked.

I worked as a grief counselor at a hospice about 6 years back in which my primary job duty was to call the next of kin listed and "check in;" how are you eating? sleeping? coping?  It was a difficult job at times and at age 20, I often went to the bathroom to cry between calls.  In my life I have not experienced loss to the extend that many of my client's have, and I have the coping skills to handle some things the clients/inmates do not.  The e-mails began at 4pm on Friday about what to do to provide the client's closure and a place to express their feelings about the grief.  They have had 2 process groups since, and have had been talking about it among each other, each client is in their own place with the grief cycle.  The ideas have been back and forth including having a memorial ceremony, creating a paper quilt/banner to display at graduation and having them 'bury' goodbye letters to her.  I am open to ideas about what we can do in a prison to help these women with the process, as a ex-grief counselor I feel like I "should" know what to do/say to these women and yet with 17 different views, mental illnesses, and past trauma related to loss it is a difficult task to begin unraveling as each person handles grief differently.

If you are dealing with grief here are some ideas of how to work through it [source]

Coping with grief and loss tip 1: Get support

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

Finding support after a loss

  • Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Draw loved ones close, rather than avoiding them, and accept the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them what you need – whether it’s a shoulder to cry on or help with funeral arrangements.
  • Draw comfort from your faith – If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you – such as praying, meditating, or going to church – can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
  • Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers.
  • Talk to a therapist or grief counselor – If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.

Coping with grief and loss tip 2: Take care of yourself

Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

  • Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to him or her.
  • Look after your physical health. The mind and body are connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.
  • Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.
  • Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.

When grief doesn’t go away

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as you accept the loss and start to move forward. If you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.
Symptoms of complicated grief include:
  • Intense longing and yearning for the deceased
  • Intrusive thoughts or images of your loved one
  • Denial of the death or sense of disbelief
  • Imagining that your loved one is alive
  • Searching for the person in familiar places
  • Avoiding things that remind you of your loved one
  • Extreme anger or bitterness over the loss
  • Feeling that life is empty or meaningless

The difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.
Other symptoms that suggest depression, not just grief:
  • Intense, pervasive sense of guilt.
  • Thoughts of suicide or a preoccupation with dying.
  • Feelings of hopelessness or worthlessness.
  • Slow speech and body movements
  • Inability to function at work, home, and/or school.
  • Seeing or hearing things that aren’t there.

Can antidepressants help grief?

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process.

When to seek professional help for grief

If you recognize any of the above symptoms of complicated grief or clinical depression, talk to a mental health professional right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.
Contact a grief counselor or professional therapist if you:
  • Feel like life isn’t worth living
  • Wish you had died with your loved one
  • Blame yourself for the loss or for failing to prevent it
  • Feel numb and disconnected from others for more than a few weeks
  • Are having difficulty trusting others since your loss
  • Are unable to perform your normal daily activities

Wednesday, November 7, 2012

Hopelessness and Suicide

At the women's prison I work at they have a new job, essentially life sentenced inmates who have had specialized training are now "observing" other inmates who are in segregation due to suicide (talk of it, paraphernalia or an attempt.)  This is a controversial plan; inmates watching other inmates and when necessary calling for an Officer.  The inmates who have just started this say more than anything it is boring; lots of downtime, odd shift hours- but they get paid for it and these are "mentors," in our program.  I spent part of this week talking to one of these inmates about her shift last night which began at 2am and she told me about the training and what she had learned about suicidal risk factors.  She did not mention the #1 risk factor for suicide, which is hard to assess as an observer- hopelessness.
From this amazing documentary interviewing people who jumped
Hopelessness is the despair you feel when you have abandoned hope of comfort or success.  I often refer to hopelessness of being in a black box and being able to see a way out.  Hopelessness is the #1 indicator of suicide; more than age, gender or even past attempts.  When someone does not see a way out, or things improving they are more likely to hurt themselves.
The Beck Hopelessness Scale is a 20-item self-report inventory developed by Dr. Aaron Beck. It is designed to measure three major aspects of hopelessness: feelings about the future, loss of motivation, and expectations. The test is designed for adults aged 17 – 80.Individuals completing the scale are asked to answer the questionnaire based on their attitudes during the preceding week. It may be administered in written or oral form, and each item is scored with a true/false. Total scores range from 0-20 with higher scores indicating a greater degree of hopelessness. 
Beck’s cognitive model of depression focuses on a “cognitive triad” which includes negative thoughts about self, the world/environment, and the future. Hopelessness is the experience of despair or extreme pessimism about the future. As such, hopelessness is part of the “cognitive triad” of depression, but it also plays an important role in predicting suicide. [source]
Although I typically advise against taking any online quizzes to determine any mental health diagnosis, there is a copy of the "test" here if you are interested to see where you might be at this moment on the scale.  I would advise that if you feel you are at risk for hurting yourself you immediately call your local crisis line or go to the hospital to keep yourself safe.

I always tell client's who are suicidal, that by taking their own life they won't ever know if it gets better; their mood improves naturally, situation at home/relationship change or if new medications will hit the market.  They will never know what their life is going to be like in 2 or 20 years, if they end it right now.

Tuesday, November 6, 2012

DBT Handouts

Just a fast update, I am working on creating pdf handouts of all DBT skills and setting up a separate website just for that.  It is a lot of work and will update when it is complete.  I also had a great friend create a logo for me and have begun doing some advertising. 

I will also be giving away more DBT and/or BPD books the week of Nov 11-17th

Sunday, November 4, 2012

Borderline Personality Disorder and Hallucinations

I often (maybe too often) talk about the misdiagnosis of those with BPD and along with many other diagnosis I find those with BPD have been diagnosed with Schizoaffective Disorder due to the hallucinations.  Part of this I believe is also the disassociation those with Borderline Personality Disorder deal with from past trauma. The term Borderline came from the original belief that those with BPD were  on the border between psychosis and neurosis.  Although this is no longer the belief, some still suffer with the psychosis elements.  

[source] A study of 171 Borderline personality disorder (BPD) patients revealed that 29.2% reported hallucinations. Most patients expressed that the hallucinations were distressing, occurred with great frequency over prolonged periods, took control of actions or behavior (especially, self-harming behavior) and had a critical quality. Although the majority of hallucinations were auditory, visual and olfactory hallucinations were also reported.

Hallucinations: Coping Strategies [source]
When voices are distressing, some patients may self-adjust their prescription medications or use drugs or alcohol to minimize the hallucinations. But there are better ways to deal with this issue.
  • Fighting back. This technique involves yelling or talking back to the hallucinations. While resisting the voices may seem like a good idea, studies show that the "fight or flight" response can lead to depression, since the voices typically don't go away on their own.
  • Passive acceptance. Although accepting that the voices are part of life for a person with schizophrenia seems to have more positive emotional effects, some argue that the danger of acceptance is that the hallucinations may start to consume your life.
  • Mindfulness techniques. In a trial of a therapy called Acceptance and Commitment, participants significantly reduced the effects of their symptoms, and had slightly fewer re-hospitalizations, than a control group using traditional therapy. With this philosophy, the patient agrees to acknowledge the voices but does not agree to accept guidance from them.
For coping with delusions, not all strategies work for every person, and many people report using more than one strategy.
  • Distraction. Focusing on a task, reciting numbers, taking a nap, or watching television can help distract the person from delusional, often paranoid, thoughts. A recent study showed that the choice of distraction is important. Researchers found that choosing favorite music or a news program was a more effective distraction tool than white noise. The study also reported that a personal music player with headphones might be the best way to listen to music when trying to ignore delusions. Headphones minimize other distractions, and people who used them tended to stick with this technique even after the study was completed.
  • Asking for help. Some people with schizophrenia seek out the company of friends and family when they are experiencing delusions. Friends and family can help by providing a distracting activity, or even just a listening ear.
  • Religion and meditative activities. People who are religious believers report using prayer or meditation to help deal with their active schizophrenia symptoms. Yoga, exercise, or walking can also shift the focus from the delusions and provide a sense of calm.
  • Be selective. Some voices are positive and some voices are negative. An organization called Hearing Voices takes an interesting approach: The voices may not be physical beings, but they should still treat you with the respect that you expect from other people. This group recommends engaging with the voices, but politely. The patient should ask the voices to make an appointment, or tell the negative voices that they are not welcome until they have useful information.