Month: January 2016

man thinking with eyes closed with visual thoughts coming from his head.

Therapy Techniques for Borderline Personality

According to the National Institute of Mental Health (NIMH), Borderline Personality Disorder, or BPD, is a serious mental illness which is characterized by “unstable moods, behavior, and relationships.” BPD was first listed as a mental illness in 1980 in the Diagnostic and Statistical Manual for Mental Disorders, Third Edition. Since then, it has been estimated that approximately 1.6% of the U.S. population has been diagnosed with BPD. Interestingly, 75% of diagnosed patients tend to be women, but newer research suggests that there may be just as many men as women who suffer from BPD. Previously, according to the National Alliance on Mental Illness (NAMI), men with BPD may have been misdiagnosed as suffering from PTSD or depression.

Many individuals who suffer from BPD experience difficulty in regulating their emotions or thoughts or may be inclined towards impulsive or reckless behavior. They may also have difficulty maintaining stable relationships with other people because the fluctuate between idealization and devaluation. This behavior is also known as “splitting” since they seem to switch between one emotional extreme and another.

Treating Borderline Personality Disorder with Therapy

Unfortunately, the exact causes of BPD are still under debate, but many scientists agree that genetics and environmental factors play a huge influence. That being said, there are ways to address and treat BPD to make life a little easier for individuals struggling with the disorder. Mindfulness therapy can be a huge help because it can encourage slowing down and grounding oneself to become more self-aware and recognize how certain impulsive urges can potentially be harmful. Describing the sometimes overwhelming nature of BPD, Dr. Blaise Aguirre, assistant professor of psychiatry at Harvard Medical School states: “For people who struggle with impulsivity,  the often-dangerous consequence of impulsive behaviors, can, over time can lead to a sense that there is nothing to do, and that it is your destiny to have bad things happen to you. By definition, impulsivity is acting on an urge instead of thinking about the action and consequence.”

Thus, the key to overcoming the potentially dangerous impulsive urges that accompany BPD is through practicing mindfulness. Previously, we’ve addressed how mindfulness therapy can help overcome depression and anxiety, but it is also particularly useful for BPD. Dr. Blaise Aguirre explains the effectiveness of mindfulness therapy on BPD as follows: “The practice of mindfulness in targeting impulsivity is mostly about working with urges rather than reacting. The goal is to avoid acting on strong urges and to become familiar with what happens to your emotions and thoughts in these moments. Then, by knowing your mind, being able to slow down and choosing a different course of action.”

Because mindfulness therapy can be enormously helpful in combating the impulsivity of BPD, let’s look at 3 techniques one can employ help build a resistance to some of the symptoms:

1. Staying Still

For the most part, many of us can identify the impulsive behaviors which get us into trouble. As you develop an awareness of your thoughts and behavior, the realization may arise that in certain situations perhaps the best course of action is none at all. Dr. Aguirre advises that individuals with BPD identify a potentially self-destructive behavior that one is prone to doing when alone and make a commitment that the next time the urge arises to engage in that behavior the individual will instead practice not moving. The challenge here, then, is to essentially commit to resistance. Dr. Aguirre explains: “nothing lasts forever even when things feel like they will. For some people the urge will pass in a short while and for others, it could take quite a bit longer! As you sit or lie down, focus your attention on your breath, and notice the urges, labeling the urge as an urge.” He suggests that over time, intentionally doing nothing will result in reducing overall impulsivity.

2. Learning to Focus

There are times in life when we might be faced with certain situations which may trigger impulsive actions. For example, in situations when we feel emotionally provoked – such as when we receive an upsetting message from someone – might feel more inclined to react impulsively due to our innate emotional response. Acting upon these impulses can lead to instantaneous regret, just as we might regret sending an angry text message or snapping at someone versus telling them how we actually feel. The first step is to identify a situation when an impulsive behavior occurred, then, if and when this situation presents itself again, practice identifying the emotions at play which motivate the urge to act on a behavior which may provide short-term relief but long-term regret. Dr. Aguirre suggests: “ As you notice the intensity of the anger begin to heighten, and the urge to act becomes stronger, shift your attention to your toes.” Why toes? It’s a way of shifting one’s attention from the impulsive urges to something more sensational. While often neglected, feet, toes, and even posture can be a means of redirecting one’s attention from a harmful urge to a far more benign source.

3. Practicing Resistance

As we’ve already explored, an important part of using mindfulness to combat the impulsiveness of BPD is to practice resistance. This can be done in a number of ways, but another useful method of teaching oneself how to resist urges is to sit down and try to resist the urge to swallow. What does this mean? Swallowing saliva can be one of the most basic urges we have, which makes it a prime target for practicing urge resistance. Set a timer for one to two minutes and begin. As we resist this urge, we will begin to notice it intensify. Addressing this, Dr. Aguirre states: “You don’t have to give in to the urge. When the timer rings, swallow! What this practice teaches is that you might have an urge (in this case to swallow) but you don’t have act in the moment of the urge. You have the choice of controlling when, or if, you will act.” This resistance can then be applied to other instances of urges motivated by BPD.

By learning mindfulness and practicing these techniques, individuals struggling with BPD can learn to better take charge of their impulses and be in control of themselves, rather than allowing BPD to do so instead. The key is, as always, to practice, and self-control will follow.

To schedule an appointment with one our therapists, please contact our office directly @ 800-378-9354.
young girl holding up piece of paper that reads "Help" in front of her face.

How to Know if Your Teen is Self Harming

Unfortunately, it’s not uncommon for teens to engage in self-injurious behaviors. The teenage years are some of the most precarious in an individual’s lifetime. With surmounting concerns about peer acceptance, body image, and the expectations of others, teens often find themselves in a whirlpool of change and stress. This can lead to the development of some unhealthy coping mechanisms. In a 2011 news report released by ABC news, it was revealed that approximately 1 in 12 teens self-harm. However, not all self-sustained injuries are as immediately obvious. Not all injuries leave outward scars, some take the form of unhealthy behaviors which ultimately risk the individual’s safety and wellbeing. These can include eating disorders.

Self-Harm Among Teens

Dena Cabrera, psychologist and Clinical Director for the Rosewood Centers for Eating Disorders states that “Self-injury, or more formally Non-suicidal Self-injury (NSSI), is common in teenagers with anywhere from 8-61% of the population engaging in self-injurious behaviors. The 8% estimate is from community estimates, and the higher end of the spectrum is from patients seeking mental health services.” The average age of onset for the development of NSSIs is around 14 or 15. Initially, girls are more prone to self-injure than boys but the numbers becoming more equal in later adolescence.

But what exactly qualifies as an NSSI? NSSIs are formally defined as being the “direct and deliberate destruction of body tissue in the absence of any observable intent to die.” There are many possible reasons that can be attributed to the development of NSSIs but one of the most common motives is the regulation of emotions. Many teens may turn to self-harm if they are experiencing intense emotions which they have not learned to regulate in a more adaptive manner. According to Cabrera: “It is known when someone self-injures there are endogenous opiates that are released that can cause the person to feel better which is part of the reason that a young person continues the behavior despite other negative consequences.” Moreover, for some young people who have experienced trauma and have consequently dissociated or developed numbness self-harm might be their means of grounding themselves and remembering how to feel.

How to Tell if Your Teen is Self Harming

There are several warning signs which may indicate that a teenager has begun to self-harm. A common indicator is the increased presence of blood stains on clothing, towels, or tissues. There may also be frequent, unexplained wounds or an increase in “accidents.” Another potential indicator is that young people who self-harm typically do so in private, meaning that they develop an increased need for alone time beyond what is normal for a teenager and they seem to be irritable or hostile prior to their disappearance to someplace private – suggesting existing emotional distress.

If you suspect that your child may be self-harming, it is important to approach them in a calm, collected manner. Combating an inability to handle intense emotions with hostility isn’t going to create much progress. Cabrera advises concerned parents to “Ask your child about what you are noticing and try to take a curious and non-judgmental stance. Let them know that you realize that they must be experiencing significant pain if they are self-injuring, and that you are there for them and want to get them help.” Then, the next step would be to schedule an appointment with a mental health care professional. Perhaps not surprisingly, over 90% of teenagers that self-harm ultimately meet the criteria for one or more psychiatric diagnoses, including depression, conduct disorders, or anxiety disorders. But even more alarming is the fact that left unchecked, self-harm in teenagers and adolescents can potentially increase the risk of attempted and successful suicide.

Understanding the Treatment Options for Self-Harm

Treatment for teenagers suffering with NSSIs typically consists of the mental health practitioner developing a treatment plans with the teens and their parents which will address the problem of self-injury and any co-occurring disorders. Therapies such as dialectical behavioral therapy (DBT) and mentalization based treatment (MBT) are frequently used in such instances because they both offer a coherent model to help understand self-injurious behaviors. They also use active therapy and balance validation with change, which helps establish a balance between thoughts, feelings, and behaviors. In doing this, these treatments encourage agency amongst adolescents.

If your teen is self-harming in any way, the best thing to do is to seek immediate help. Doing so can not only save your child, but can also prevent them from continuing this harmful behavior.

Contact our office today to schedule an appointment with an adolescent therapist in Boca Raton.

The Truth About Eating Disorders

Eating disorders can be one of the most difficult mental health disorders to overcome. According to the National Association of Anorexia Nervosa and Associated Disorders, or ANADA, up to 30 million people, both men and women, suffer from an eating disorder (either anorexia, bulimia, or binge eating disorder) in the United States alone. Eating disorders have the highest mortality rates of any illness, and almost 50% of people with an eating disorder also meet the criteria for depression.

Currently, it is estimated that 10-15% of men suffer from anorexia or bulimia. Unfortunately, men are less likely to seek out treatment for their eating disorders due to the misconception that eating disorders are strictly “women’s diseases,” which can make admitting to having one seem emasculating. This misconception probably stems from the fact that eating disorders are more common amongst women which is likely due to the more overt perpetuation of female beauty standards through the media. In an alarming find, ANADA states that “47% of girls in 5th-12th grade reported wanting to lose weight because of magazine pictures.” and “69% of girls in 5th-12th grade reported that magazine pictures influenced their idea of a perfect body shape.” Perhaps even more alarming is the fact that children’s self esteem and self-image can be impacted by unrealistic beauty standards at an even earlier age. According to ANADA, “42% of 1st-3rd grade girls want to be thinner,” and “81% of 10 year olds are afraid of being fat.”

Concern with one’s weight does not necessarily correlate to a concern about health. Eating disorders are unhealthy and do not only threaten one’s mental and physical wellbeing but can also be fatal. Statistics regarding deaths related to eating disorders vary depending on source due to the fact that death can result from a number of issues related to the eating disorder (such as heart failure, organ failure, or suicide) but the ultimate cause of death reported will be one of those issues rather than the disorder that triggered them. That being said, presently, based on a variety of reports, it is believed that around 20% of individuals diagnosed with anorexia or a related disorder will die prematurely due to complications from their disorder.

It is Possible to Recover from an Eating Disorder

Despite the challenges along the way, however, it is entirely possible to recover from an eating disorder. There are a number of treatments available designed to help those who are struggling. As we embark on this New Year, we might find that we are suddenly surrounded by an abundance of New Year’s resolutions. The best resolution to make is a commitment to one’s own happiness and wellbeing, which means making a commitment to recover from unhealthy practices which may threaten that.

What exactly recovery means will differ from person to person, as every individual follows their own path. Dr. Judy Scheel, is the president of Cedar Associates Foundation, Inc. a non-profit organization which is dedicated to the prevention, research, and education of eating disorders.  Discussing the influence of culture on body image, Dr. Scheel states that “Growing up and living in a culture obsessed with body image makes it very difficult to challenge and change some of the beliefs inherited from our culture.” Because of the ways in which culture helps form our perception of ourselves, it can essentially provide the context for eating disorders. According to Dr. Scheel, this means that “Since culture provides the context for an eating disorder, recovery means facing the circumstances and issues in life (content) that contributed to the development of the eating disorder so that weathering the cultural ‘body image’ storm in the future is possible.”

That being said, we must remember first and foremost that recovery is not something that can be accomplished overnight: it is a process, regardless of what form it might take on an individual basis. Recovery is something that will unfold over time following a series of what Dr. Scheel calls “psychological awakenings”: these can include insights, revelations, and relational repairs which can ultimately lead to behavioral changes. This is also known as the “aha” moment, the point in time when ideas finally click in a manner that heightens our awareness of our own circumstances. These moments seldom occur in the same fashion for everyone.

The Problem with Perfection

In the case of eating disorders, full recovery is sometimes possible. Dr. Scheel defines a “complete” recovery as being when an individual resolves their eating behaviors and is no longer triggered by certain foods or scenarios to resume their disorder. However, these cases are not the most common outcome. But Dr. Scheel explains that “Other recovery scenarios are more likely, and these scenarios do not mean recovery is any less successful.  For example, some who recover may cease vomiting, but cannot keep any trigger foods in their house for the rest of their life. Others may cease vomiting but, under certain conditions or during emotionally charged situations, avoid foods that will likely trigger a binge-purge episode.”

While not the idealized outcome that we often see perpetuated through film and TV, these steps are no less significant or indicative of recovery. Too often we assume that recovery means simply “shutting down” an eating disorder or other problem. It’s not that simple. What recovery actually means is that we learn what we need in life to move forward and experience life to the fullest. Dr. Scheel lists a series of benchmarks for recovery including “having a healthy relationship with food, connecting with other people in healthy relationships, knowing your limitations, and honoring your feelings.” It is through demonstrating one, more, or eventually all of these benchmarks which means that one has recovered successfully. To expect perfection or set unrealistic expectations that one’s eating disorder will simply “disappear” does more harm than good.

Dr. Scheel explains that “Eating disorders represent, among many things, a belief that perfectionism is the only acceptable outcome in life. Recovery, then, represents the awareness that perfectionism is merely a protection against feelings of vulnerability.” In order to overcome, we must remember that just as it is important to integrate our positive and negative life experiences, so, too, we must learn to come to terms with the necessary compromises we need to make in order to make recovered life possible. To compromise is not to accept defeat. By realizing this we can begin to appreciate the steps we take and eventually realize the accomplishments we made. Through this, we can feel joy.

Asking For Help Can Be the First Step

If you or someone you know is suffering from an eating disorder, seeking help can help save a life. Moreover, it can make that life one that is happy, fulfilled, and serve as a reminder that life is indeed worth living.

woman running on road with sunshine in the background

How Exercise and Mental Health are Connected

I’m sure at some point in our lives we’ve all heard something along the lines of “a healthy body makes for a healthy mind.” While this might come across as simply a nice sentiment or common sense, the research supporting this claim is fascinating. In recent years, scientists have begun to reveal more and more on how exactly our minds and bodies work together to benefit each other. Earlier we examined how building our body’s muscle strengths can improve our brains strength as well. A study conducted on twins revealed that the twin with stronger leg muscles also had stronger cognitive abilities. The results from this study indicated that how we live and how we take care of our bodies can determine how we store information, since our bodies are, in essence, one large information system. To put it simply: we are our brains. But here may be more to the correlation between mind and body may be even more intricate than we previously realized. In fact,  as it turns out, regular bodily exercise can actually alter our physical chemistry which can result in better mental health. How? The answer lies in the microbes found in our stomachs.

Is The Key to a Healthy Mind Through Our Diet?

There have been a wide number of animal studies which have revealed a definite correlation between gastrointestinal pathology and certain psycho-neurological conditions including but not limited to: autism, anxiety, depression, and schizophrenia. In fact, since 2013, the National Institute on Mental Health has dedicated millions of dollars towards funding seven different studies attempting to examine what scientists refer to as the “Microbiome – Gut-Brain-Axis.” These studies confirm that our brains respond to microbial signals from our guts. In one instance, researchers from McMaster University in Hamilton, Ontario found that intestinal bacteria can play an important role in reducing anxiety and depression. Their findings were published in July 2015 in the scientific journal Nature Communications where they found that “MS-induced changes in host physiology lead to intestinal dysbiosis, which is a critical determinant of the abnormal behaviour that characterizes this model of early-life stress.”

In other words, the induced changes in the way the test subject’s physiology – their physical make-up –  caused an imbalance in intestinal bacteria. This, in turn, lead to abnormal behavior indicative of stress and anxiety. Another study, led by Elaine Hsiao, a biologist now working with UCLA, revealed that certain metabolites from gut microbes promote serotonin production in the cells which lined the colon. What does this mean? Well, one of the most common forms of antidepressants, SSRI (Selective Serotonin Reuptake Inhibitor), are purposely designed to target serotonin reuptake at the junction between neurons. Through this, they treat depression by reducing an imbalance in serotonin production that may cause it. Serotonin has been shown to improve the development of new brain cells which can alleviate depression since depression can in many cases effectively suppress this production. In essence, serotonin helps promote healing, which can ultimately lead to a sense of well being and happiness. It is interesting, then, that the majority of the body’s serotonin (around 90%)can be found in the human digestive tract, regulating gut movement.

The Relationship Between the Human Mind and Body

Currently, more research is needed to truly determine the extent of the relationship between our minds and bodies, particularly where chemicals such as serotonin are involved, since their roles are often multifaceted and complex. However, the growing body of evidence suggesting correlations between mind and matter is fascinating and can help us discover new ways to improve our overall health and wellbeing. That being said, there is surmounting evidence which suggests that exercise, especially in early-life, can alter the microbial community in our guts which can then promote good brain health and metabolic activity throughout the course of our lives.

While we don’t yet know the exact age range that our gut microbes are most susceptible to early-life changes in exercise, preliminary findings suggest that the earlier the better. After all, unhealthy habits developed while we’re young can be some of the most difficult to break later on, sedentarism included. Moving forward, scientists hope to find how the relationships in this microbial ecosystem impact brain function in a long-lasting way. By doing this, we can eventually hope to encourage gut-microbe plasticity in adults which can then help combat the high rates of anxiety and depression within that community. While further investigation is needed toward this goal, the future looks promising.

Learning How to Step Outside of Your Comfort Zone

I’m sure many of us are familiar with the concept of the comfort zone. The term is used to describe a number of behaviors, activities, and situations which enable us to feel safe and at ease with minimal to no experience of stress. Initially, this arrangement may seem ideal: after all, the promise of the absence of stress does seem like a win-win. But unfortunately, the comfort zone can actually be fairly restrictive.

Dr. Abigail Brenner, attending physician at the NYU-Bellevue Adult Mental Hygiene Clinic and Assistant Clinical Professor at New York University Medical School, describes the comfort zone thusly: “a psychological/emotional/ behavioral construct that defines the routine of our daily life. Being in one’s comfort zone implies familiarity, safety, and security. It describes the patterned world of our existence, keeps us relatively comfortable and calm, and helps us stay emotionally even, free from anxiety and worry to a great degree.” That being said, while creating a comfort zone is arguably a healthy adaptation for our day-to-day lives, so is stepping out of it.

If we don’t step out of our comfort zone, we may end up limiting ourselves and our experiences, which can ultimately hinder our quality of life. Think of it this way: if we spent all our lives inside of a box, we would miss out on the whole world outside our walls. When our comfort zone becomes our box that we refuse to leave, it becomes problematic rather than beneficial in any way. In many cases, our limitations are actually self-imposed and our fears irrational. For example, we might eat the same food everyday because it is familiar and therefore we assume it to be “safe”, but it’s irrational to believe that all other foods outside of our narrow selection are consequently “unsafe”. New experiences, both large and small, can be essential to living fulfilling lives. After all, it’s human nature to constantly grow and evolve.

Here are 3 reasons a therapist might give you for breaking out of the comfort zone and open up to new things, one step at a time.

1. Life is Waiting

Dr. Brenner states that “experiencing a little stress and anxiety now and then is a good thing… If all you ever do is strive to stay wrapped up in your little cocoon, keeping warm and cozy, you may be missing out on quite a lot—maybe no new experiences, no challenges, and no risks.” While perhaps scary at first, taking risks can be an important part of the transformative human experience, so long as we do so responsibly and use our common sense. Likewise, new experiences enable us to grow and transition in our lives, thereby helping us define who we are and bestowing meaning upon our existence. Our true lives exist beyond the bubble of our own personal thoughts and beliefs. In other words, true life includes the total summation of all of our experiences, not just the ones we are immediately comfortable with. Thus, we shouldn’t limit ourselves and look at the world from a narrow perspective. Broader horizons can give us a better idea of the scope of our potential.

2. Taking Risks Can Be Rewarding

Building on the previous point, it is not only healthy but essential to take risks from time to time. Taking risks is the only way we can allow ourselves to grow and progress personally, socially, and professionally. As Dr. Brenner explains: “Challenging yourself pushes you to dip into and utilize your personal store of untapped knowledge and resources. You have no idea what you’re made of unless and until you venture outside of your own familiar world.” In this way, all risks taken, regardless of outcome, lead to personal growth. Even when we make mistakes, we can take that newly acquired experience and knowledge and apply it to our future decision making. There is no such thing as failure if something can be gained from an experience, even if it’s not the first desired outcome.

3. Settling Keeps Us From Experiencing

By never allowing ourselves to experience new things, we might just end up settling for mediocrity. While it may sound harsh, the reality is that our comfort zones are pretty narrow and, as such, only account for a small selection of situations and experiences. But as it turns out the risks we take are cumulative. What this means is that each time we try something new, we are slowly opening ourselves to more and more new experiences as they arise, and, as a result, we are learning, expanding our skills and knowledge, and even expanding the size of our comfort zone by adding to what we know we can enjoy.

Stepping out of our comfort zones can seem daunting at first, but doing so can be important to our growth as individuals. To make things a little easier, we can start by making small changes. Dr. Brenner advises us to “Try to make small changes that take you out of the every day and familiar, yet are not too emotionally challenging.” This can be as simple as going to a new place or trying a new food. Regardless of what we do, the most important thing is to be open to new experiences.

If you would like to schedule a time to speak with one of our therapists about learning to step outside of your comfort zone, please call 800-378-9354.

A male and female interlocking hands in what appears to be a strong, happy relationship.

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