Evidence Based Treatment of Borderline Personality Disorder

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Evidence Based Treatment of Borderline
Personality Disorder

• Jeff Riggenbach, PhD, LPC

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Overview of Seminar

• Introduction
• Definitions
• Outcome Research
• Treatment Model
• Case Studies

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Personality Disorder Definitions

• DSM Definition
• An enduring pattern of inner experience and
  behavior that deviates markedly from the
  individuals culture, is pervasive and
  inflexible, has onset in adolescence or early
  adulthood, is stable over time, and leads to
  distress or impairment.

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Personality Disorder Definitions

• Sheas no nonsense definition
• An ongoing set of defense mechanisms that
  cause considerable distress for self and others.

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Personality Disorder Definitions

• Family Members definitions
• - Manipulative
• - Mean
• - Sneaky
• - Hurtful

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Personality Disorder Definitions

• Clinical Definitions
• Any referral preceded by an apology.

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Personality Disorder Definitions

• Functional definition
• People who have unusual ways of asking for
  help

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Borderline Personality DisorderOutcome Studies

• - Dialectical Behavior Therapy
• - Cognitive-Behavioral Therapy
• - MBT/TFP
• - Schema-Focused Therapy

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Borderline Personality Disorder

• The Treatment Model

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CBT - Tenets
Levels of Cognition
Automatic Thoughts
Conditional Assumptions
Core Beliefs
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Schema Definitions

• Term Schema originally coined by Piaget in 1926
  structures that inte-grate meaning into
  events

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Schema Definitions

• Beck Cognitive structures that organize
  experience and behavior
• Landau and Goldfried -- a mental filter that
  guides processing of information

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Schema Definitions

• Core beliefs/Schemas
• Beck Cognitive structures that organize
  experience and behavior
• Landau and Goldfried -- a mental filter that
  guides processing of information

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Belief Modification Protocol

1. Identify the Maladaptive Belief
2. Identify Alternate Adaptive Belief
3. Rate Baseline Believability
4. Interventions
5. Rate Believability at Regular Intervals
6. Data Logs

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SFT - Tenets

• Young Early Maladaptive Schema
• 18 Schemas grouped into 5 schema domains
• Domain 1 Disconnection Rejection
• Abandonment
• Mistrust
• Defectiveness
• Emotional Deprivation
• Social Isolation

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SFT - Tenets

• Young Early Maladaptive Schema
• Domain 2 Impaired autonomy and
  Performance
• Dependence
• Vulnerability
• Enmeshment
• Failure

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SFT - Tenets

• Young Early Maladaptive Schema
• Domain 3 Impaired Limits
• Entitlement/Grandiosity
• Insufficient Self-Control

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SFT - Tenets

• Young Early Maladaptive Schema
• Domain 4 Others Directedness
• Subjugation
• Self-Sacrifice
• Approval-Seeking

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SFT - Tenets

• Young Early Maladaptive Schema
• Domain 5 Overvigilance
• Negativity/Pessimism
• Emotional Inhibition
• Unrelenting standards/hypercriticalism
• Punitiveness

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Borderline Personality DisorderSchema
Modification Treatment

• CASE STUDIES/INTERVENTIONS

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Schema Modification Interventions

• - Collection of Historical Data
• - Behavioral Pattern Breaking
• - Data Logs
• - Internalization Exercises
• - Schema Mode Work

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Borderline Personality DisorderSchema
Modification Treatment

• Historical Data Logs

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Borderline Personality DisorderSchema
Modification Treatment

• Behavioral Pattern Breaking

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Borderline Personality DisorderSchema
Modification Treatment

• Ongoing Data Logs

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Borderline Personality DisorderSchema
Modification Treatment

• Internalization Exercises

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Questions?Thank You!