PDs: Treatment Flashcards
(39 cards)
Which personality disorder has the most evidence for treatment?
Borderline Personality Disorder.
What is one reason why personality disorders have received the most stigma from health professionals?
Because (historically) they were considered untreatable. Many professionals felt helpless and became burnt out from treating them. They would inadvertently reinforce the behaviours and perpetuate a cycle.
What was the original treatment used for personality disorders (in particular BPD)? And did it work?
For many years (up until the 80s) CBT was used with little benefits or improvements.
Today, in what way do clinicians understand the function of maladaptive behaviours within personality disorders?
Maladaptive behaviours are considered to be ADAPTIVE behaviours at one point. They originally were essential for the individual to get their emotional needs met, but are no longer useful.
What are three common (stigmatising) labels that have been used to describe personality disorders?
- ‘acting out’.
- ‘manipulative’.
- ‘self-destructive’.
Instead of using stigmatising language to describe someone’s behaviour, what is used now?
Behaviour that is trying to ‘get their needs met’.
What is ‘small t’? What does it involve?
Complex trauma. It involves repeated, cumulative experiences in childhood that stem from a difficult environment. It often carries out with the dominant attachment relationship.
As complex trauma is often a ‘subjective’ experience, the ways in which it plays out can be subtle. Give some examples of complex trauma.
A caregiver who is constantly dismissive, neglectful, or abusive. They might not be sensitively attuned to the child, or have the capacity to meet the child’s emotional needs.
How does psychoanalytic theory understand personality disorders and complex trauma? From an object relations viewpoint.
An infant is instinctually always oriented toward attachment with their caregiver. If the caregiver is not attuned to the needs of the child, these two pieces of information (I need them + they don’t love me) can disrupt the child’s sense of self.
Respond to this quote: ‘…repeated trauma in childhood forms and deforms the personality. The child trapped in an abusive environment is faced with formidable tasks of adaption. S/he must find a way to preserve a sense of trust in people who are untrustworthy, safety in a situation that is unsafe, control in a situation that is terrifyingly unpredictable, power in a situation of helplessness… unable to care for or protect herself, she must compensate for the failures of adult care and protection with the only means at her/his disposal, an immature system of psychological defences…’.
Behaviour that is now problematic and maladaptive was once used to help the child self-sooth and cope with the neglect.
How does the ‘transactional model of Borderline PD’ describe the development of maladaptive behaviours?
Patterns of problematic behaviours form from the patterns of family dynamics. The original behaviour may have been normative but when the environment repeatedly responds in a certain way it shapes the behaviour to have bad response styles and emotional dysregulation.
What is the actual model within the ‘transactional model of Borderline PD’?
Pervasive History of Invalidating Responses –>
Emotional vulnerability (sensitivity, reactivity, slow return to baseline) –>
Heightened Emotional Arousal (increased likelihood of emotion dysregulation) –>
Inaccurate Expression –>
Invalidating Responses –> (which leads back to the first one).
Why are the emotions of some with BPD heightened?
Because they are often sensitive to noticing emotional things and have a predisposition to having a heightened emotional arousal that doesn’t reflect a normal response.
Why are the heightened emotions of someone with BPD often dismissed?
Because their emotional reaction doesn’t reflect a normal response. They are often dismissed but this is upsetting because they are genuinely distressed. This can cause their emotional arousal to increase.
What often happens to a child that consistently had their emotions dismissed or was told they were overreacting?
Overtime they might find it difficult to know how they were feeling, or understand their emotions.
What is a way that extreme emotional displays in a child might be reinforced?
Because the milder emotional displays might be ignored or dismissed but the extreme gestures are responded to with genuine care and concern. If the child was nurtured during heightened distress, that might reinforce their behaviour.
What is the process involved in an episode of heightened emotional arousal in BPD?
- Sensitivity (more likely to notice the emotional stimuli at a lower threshold than others).
- Reactivity (have a stronger emotional reaction than others, go from 0-10 in a minute).
- Slow to return to baseline.
What is the APS?
The Australian Psychological Society. They release a review of all the literature every year, every psychologist needs to be ethical and thus, must follow APS guidelines on the best treatments.
What is the only treatment for BPD that has APS level evidence? The second best treatment?
- Dialectical Behaviour Therapy (DBT).
2. Schema Therapy.
Who developed Dialectical Behaviour Therapy and when? How long does DBT last?
It was developed by Marsha Linehan in 1993. She has BPD herself. It follows a 12-month treatment protocol.
In Dialectical Behaviour Therapy, what does ‘Dialectical’ mean? What does ‘Behaviour’ reflect?
- ‘Dialectical’ or dialectic is about a synthesis or integration of two opposites.
- ‘Behavioural’ is about using rewards to reinforce the likelihood of good behaviour. The patient needs to have their skills positively reinforced in order to keep progressing.
What is the main dialectic in DBT?
The central dialectic in DBT is both ‘acceptance’ (I am doing my best) and ‘change’ (I can do work harder).
What are the main goals of DBT?
To enhance behavioural, emotional, cognitive responses and interpersonal interactions.
What are the four treatment components in Dialectical Behaviour Therapy?
- Individual therapy (1 hour/week).
- Group skills training (2.5 hours/week, takes 24 weeks, do the sessions twice).
- Phone coaching (as needed 24/7).
- Therapist consultation team (1-1.5 hours/week).
