Evidence Based Treatment of Borderline Personality Disorder

1. Evidence Based Treatment of Borderline Personality Disorder Jeff Riggenbach, PhD, LPC

2. Overview of Seminar • Introduction • Definitions • Outcome Research • Treatment Model • Case Studies

3. Personality Disorder Definitions DSM Definition: An enduring pattern of inner experience and behavior that deviates markedly from the individual’s culture, is pervasive and inflexible, has onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

4. Personality Disorder Definitions Shea’s “no nonsense” definition: An ongoing set of defense mechanisms that cause considerable distress for self and others.

5. Personality Disorder Definitions Family Member’s definitions: - “Manipulative” - “Mean” - “Sneaky” - Hurtful

6. Personality Disorder Definitions Clinical Definitions: Any referral preceded by an apology.

7. Personality Disorder Definitions Functional definition: “People who have unusual ways of asking for help”

8. Borderline Personality DisorderOutcome Studies - Dialectical Behavior Therapy - Cognitive-Behavioral Therapy - MBT/TFP - Schema-Focused Therapy

9. Borderline Personality Disorder The Treatment Model

10. CBT - Tenets Levels of Cognition Automatic Thoughts Conditional Assumptions Core Beliefs

11. Schema Definitions Term “Schema” originally coined by Piaget in 1926 – “structures that inte-grate meaning into events”

12. Schema Definitions Beck – “Cognitive structures that organize experience and behavior” Landau and Goldfried -- a mental filter that guides processing of information

13. Schema Definitions Core beliefs/Schemas Beck – “Cognitive structures that organize experience and behavior” Landau and Goldfried -- a mental filter that guides processing of information

14. Belief Modification Protocol • Identify the Maladaptive Belief • Identify Alternate Adaptive Belief • Rate Baseline Believability • Interventions • Rate Believability at Regular Intervals • Data Logs

15. SFT - Tenets Young – “Early Maladaptive Schema” 18 Schemas grouped into 5 schema domains Domain # 1: Disconnection & Rejection Abandonment Mistrust Defectiveness Emotional Deprivation Social Isolation

16. SFT - Tenets Young – “Early Maladaptive Schema” Domain # 2: Impaired autonomy and Performance Dependence Vulnerability Enmeshment Failure

17. SFT - Tenets Young – “Early Maladaptive Schema” Domain # 3: Impaired Limits Entitlement/Grandiosity Insufficient Self-Control

18. SFT - Tenets Young – “Early Maladaptive Schema” Domain # 4: Others Directedness Subjugation Self-Sacrifice Approval-Seeking

19. SFT - Tenets Young – “Early Maladaptive Schema” Domain # 5: Overvigilance Negativity/Pessimism Emotional Inhibition Unrelenting standards/hypercriticalism Punitiveness

20. Borderline Personality DisorderSchema Modification Treatment CASE STUDIES/INTERVENTIONS

21. Schema Modification Interventions - Collection of Historical Data - Behavioral Pattern Breaking - Data Logs - Internalization Exercises - Schema Mode Work

22. Borderline Personality DisorderSchema Modification Treatment Historical Data Logs

23. Borderline Personality DisorderSchema Modification Treatment Behavioral Pattern Breaking

24. Borderline Personality DisorderSchema Modification Treatment Ongoing Data Logs

25. Borderline Personality DisorderSchema Modification Treatment Internalization Exercises

26. Questions?Thank You!