BORDERLINE

PERSONALITY DISORDER
 DIAGNOSTIC AND STATISTICAL
MANUAL IV ( DSM ) CLASSIFICATION
▣ Multiaxial system – personality disorder on axis 2 ( along with
mental and pervasive development disorder)

▣ Cluster A ( odd / eccentric ) – paranoid , schizoid, schizotypal

▣ Cluster B ( Dramatic / self-important ) – Narcissistic,

Histrionic, Antisocial, Borderline

▣ Cluster C ( Anxious / fearful ) – Dependant ,

Aviodant,Obessional
 DSM – V BORDERLINE
PERSONALITY DISORDER
▣ Impairment in personality ( self and interpersonal )
functioning and the presence of pathological traits

▣ Impairment in self functioning

Identity : poorly develop , or unstable self- image ;
chronic feelings of emptiness; dissociative states under
stress

Self- direction : Instability in goals, aspirations, values, or

career plans
 DSM-V BORDERLINE
PERSONALITY DISORDER

▣ Impairments in interpersonal functioning :

Empathy : poor empathy with heightened sensitivity to
criticism
Intimacy : Intense , unstable , and conflicted close
relationships, marked by idealization and devaluation
and resultant over involvement and withdrawal
 DSM-V BORDERLINE
PERSONALITY DISORDER
▣ Negative Affectivity, characterized by :
Emotional liability : Unstable and frequent mood changes
; emotions that are easily aroused , intense , and/or out of
proportion to events and circumstances

Anxiousness : Fear of rejection by- and / or separation

from- significant others

Depressivity : Frequent feelings of misery ; feeling of

inferior self- worth; thoughts of suicide and suicidal
behavioral
 DSM-V BORDERLINE
PERSONALITY DISORDER
▣ Disinhibition , characterized by :
Impulsivity : Sudden action with poor foresight;
self-harming behavior under emotional distress.

Risk taking : Blasé engagement in potentially self-damaging

activities

Antagonism, characterized by persistent hostility

▣ Stable and consistent
▣ Not normative for age and socio culture background
▣ Not secondary to physiological effects / general medical
condition
ICD-10 ( F60.3) EMOTIONALLY
UNSTABLE ( BORDERLINE )
PERSONALITY DISORDER
▣ Marked tendency to act impulsively without consideration
of consequences, together with affective instability

▣ Impulsive type :
Emotional instability and lack of impulse control outbursts
of violence or threatening, behavior
 CONTD…..
▣ Borderline type :
Self-image ,aim , and internal preferences ( including sexual) are
often unclear or disturbed.

Chronic feelings of emptiness.

Liability to become involved in intense and unstable relationships

may cause repeated emotional crises
 Perspectives on borderline

▣ A level of personality organization ( kernberg)

▣ A tendency to experience temporary psychotic states (

NEUROSIS – PSYCHOSIS )

▣ A form of affective disorder ( Akiskal )

▣ A type of impulse control disorder

▣ A variant of post-traumatic stress disorder

 BPD – pathogenic learning

▣ Parenting attitudes – child feels unwanted ; child learns

seduction/exploitation / deception

▣ Inconsistent / harsh methods of parental control

▣ Dysfunctional family communication style

▣ Family discord

▣ TRAUMA – sexual, emotional, physical

 BPD - biological perspective

▣ Cyclothymic temperament

▣ High emotional reactivity in child and

mother may predispose to intense interaction

▣ Serotonin in CNS is linked to impulsive

aggression , self harm and suicide
 BPD – Psychodynamic perspective

▣ Stern defined ‘a borderline group of neurosis’,

could start analysis ; later resistance and
breakdown

▣ Knight : “ Normal ego functions ( secondary-

process thinking , realistic planning , adaptation to
environment, maintaining stable object relations
and defenses against primitive impulses) are
weekend” while “ superficial functioning and
social relations may be intact “
BPD – Psychodynamic perspective

▣ Kernberg postulated levels of personality organization

▣ Normal development results in integrated concept of

self and other ( EGO IDENTITY ) and a mature ability
to withstand stress ( EGO STRENGTH ).

▣ It implies predominant use of MATURE defense

mechanisms
 BORDERLINE TRAIT ( Kernberg)

▣ Identity diffusion
▣ Primitive and intense emotional displays
▣ Impulse control problems
 BPD – Object relation theory
▣ Difficulty in integrating identification system
of opposing ( inconsistent ) quality.

▣ Confusing message of possessiveness vs

threatened abandonment = ambivalence
between assertiveness and abandonment.

▣ Failure of object constancy = failed

internalization and representation of a holding
– soothing caregiver.
 BPD - Interpersonal perspective

▣ Need for intense , unconditional nurturing

▣ Fear of abandonment trigger swings between helpless

paralysis and rageful vengeance; may “ pre-empt” by
breaking relationship first .

▣ Ambivalence between emptiness idealized and

engulfment

▣ The other person is alternately idealized and devalued-

chaos becomes the norm
 BPD - Cognitive perspective

▣ Stream of consciousness is easily

overwhelmed by emotion , and in turn
influences actions ( PTSD links )

▣ Black and white , dichotomous thinking

Psychological assessment for patients
with BPD
▣ Is psychological assessment required?
▣ How ?
▣ Where?
▣ On whom?
▣ When ?
 Perequisities
▣ Rapport
▣ Confidentiality
▣ Comprehension of language
▣ Reliable source
▣ Privacy
▣ Psychologist factors
▣ Other factors?
▣ ANXIETY
▣ STAI
▣ HAS
▣ DEPERSSION
▣ BDI
▣ HDRS
 SIB/DSH

▣ Beck’s suicidal ideation scale – beck

▣ 19 items

▣ Intentionally , lethality, frequency

 INTELLIGENCE

▣ WAIS--- WAPIS-PR
 PERSONALITY DISORDER

▣ IPDE- International personality disorder examination

▣ ICD 10 criteria by WHO

▣ Translated to Dutch , French, German, Hindi, Japanese,

Swahili and Tamil

▣ Symptoms to be stable and present for along duration –

ICD-10.5yrss
 6 AREA :
▣ Work
▣ Self
▣ Interpersonal relationship
▣ Affect
▣ Reality testing
▣ Impulse control
 CRITERION
▣ About 18 year
▣ Not appropriate for people with severe depression, or substantial
cognitive impairment
▣ Self rated
▣ Family member to augment data
▣ Clinician should be familiar with ICD-10
▣ Takes about 1 hours to administer
 SCORING
▣ 0- absent or normal
▣ 1- exaggerated
▣ 2- criterion level/ pathological
▣ NA- not applicable
▣ ? Reserved for occasions when subjects despite encouragement
refuse to answer a question or state that they are unable to do so.
 SCORING – CONTD..

▣ Duration: Behavior should be present at least for 5yrs.

▣ Positive score is given when the behavior has not occurred at all
during past 1yrs
▣ Except for certain items which need to have occurred at least once
during past 5 yrs
 DURATION PROBES :

▣ How long have you been like that ?

▣ How long has that been going on ?
▣ How long have you been that way ?
▣ When did that start?
▣ How old were you when that began?
▣ At what age did that start ?
▣ Have you been that way for a long time ?
 FREQUENCY
▣ Important to distinguish scores of “0,1,2”

▣ Frequency probes :

How often are you like that ?

How often does that happen?
How often do you behave like that ?
 SCORING
▣ 0- if requirement are not met
▣ 1 or 2- if requirement is met and is not prior to age 25 years
▣ ?
▣ NA
▣ X- if the subject meets all requirements but has displayed the
behavior during past 1 years
 SCREENING QUESTIONNAIRE-
SCORING
▣ Impulsive : 19, 30, 37, 53, 56

▣ Borderline : 4,9,13,25F, 40

▣ Histrionic : 5, 17, 26, 28, 35F, 44

 SCORING
▣ Emotionally unstable ( Borderline )

▣ Emotionally unstable ( Impulsive )

▣ Histrionic

▣ Handout 2 – detailed review of IPDE

 EMOTIONALLY UNSTABLE PD –
F 60.3
▣ F60.3 Impulsive type
▣ At least 3 of the following must be present , one
of which must be (2)
1. Marked tendency to act unexpectedly and without
consideration of the consequences 58
2. Marked tendency to quarrelsome behavior and to
conflicts with others, especially when impulsive
acts are thwarted or criticised30
3. Liability to outbursts of anger or violence, with
inability to control the resulting behavioral
explosions 43
4. Difficulty in maintaining any course of action that
offers no immediate reward 11
5. Unstable and capricious mood 50
 BORDERLINE TYPE F60.31
▣ At least 3 of the symptoms mentioned in impulsive type must be
present with at least 2 of the following in addition :

Disturbances in and uncertainty about self image , aims, and

internal preferences ( including sexual) 5,6,7,25,56

Liability to become involved intense and unstable relationships ,

often leading to emotional crises 26
 F60.31
Excessive efforts to avoid abandonment 48

Recurrent threats or acts of self harm 59

Chronic feelings of emptiness 45

 HISTRIONIC PERSONALITY
DISORDER F60.4
▣ At least 4 of the following must be present

1. Self dramatization , theatrically or exaggerated

expression of emotions 40
2. Suggestibility( individual is easily influenced by other
or by circumstances) 12
3. Shallow and labile affectivity 49
4. Continual seeking for excitement and activities in
which the individual is central of attention 16,41
5. Inappropriate seductiveness in appearance or behavior
54
6. Over concern with physical attractiveness 17
Orientation to dialectical
behavior therapy ( DBT)
 DBT HISTORY
▣ Developed by Marsha Linehan in the late 1980’s and early
1990’s

▣ Originally created for suicidal and actively self- harming

patients with a history of multiple psychiatric hospitalizations
who met the criteria for borderline personality disorder(
BPD)
 CONTD..
▣ Core belief of DBT is cause and the maintenance of bpd is rooted
in biological disorder combined with environmental disorder

▣ Fundamental biological disorder is in the emotion regulation

system

▣ Due to generate , intrauterine factors before birth, traumatic events

in early developmental etc.
 CONTD..

▣ The environmental disorder is any set of circumstances

that pervasively punish, traumatize or neglect this
emotional vulnerability specifically or the individual’s
emotional self generally

▣ Termed the invalidating environment

 EMOTIONAL DIFFICULTY
▣ Emotional vulnerability : Sensitivity to emotional
stimuli, emotional intensity and slow return to
emotional baseline.

▣ “High sensitivity” refer to the tendency to pick up

emotional cues, especially negative cues, react
quickly, and have a low threshold for emotional
reaction

▣ “Emotional intensity” refer to extreme reaction to

emotional stimuli ,which frequently disrupt cognitive
processing and the ability to self soothe
▣ “ Slow return to baseline” refer to reaction being long lasting
which in turn leads to narrowing of attention towards mood
congruent aspects of the environment , biased memory , and biased
interpretations, all of which contribute to maintaining the original
mood state and a heightened state of arousal

▣ EMOTIONAL DIFFICULTY

2. Deficits in skills needed to regulate

 CRITICAL FUNCTION OF DBT
▣ Enhance and maintain the client’s motivational change
▣ Enhance the client’s capabilities
▣ Encourage the generalization of the client’s newly acquired
capabilities
▣ Enhance the therapist’s motivation to continue therapy
▣ Structure the environment so that treatment can take place
 1. MOTIVATION ENHANCEMENT
▣ Focus on marking sure that clinical progress is
reinforced ( rather than punished ), that maladaptive
behavior is not reinforced , and on reducing other
factors ( such as emotions and beliefs ) that inhabit
or interfere with clinical progress.

▣ Intensive individual therapy

▣ CBT based

1. Reducing suicidal and other life threatening

behaviors
 CONTD..

2. Reducing therapy interfering behaviors ( including

noncompliance and dropping out of treatment)

3. Reducing serve quality of life interfering behaviors (

including axis I disorder , such as depression )

4. Increasing skillful coping behavior including distress

tolerance , emotion regulation , interpersonal
effectiveness and mindfulness.

Enhancing self-respect and mastery.

 CONTD..
6. Reduction traumatic emotional experiencing , including
post- traumatic stress response ( for example , continuing
reaction to childhood trauma )

7. Reduction problem in lying and

8. Resolving a sense of incompleteness.

 2. CAPABILITY ENHANCEMENT

▣ Focus on increasing behavioral and self regulation

▣ Psycho-educational skills training in five areas :

mindfulness ( to improve control of attention and the
mind ), interpersonal skills and conflicts management
, emotional regulation, distress tolerance ,self
management.

▣ Medications
3. ENHANCING GENERALIZATION

▣ Ensure generalization of new behavior to the natural

environment.

▣ Through phone consultation.

 4. ENHANCING THERAPIST
CAPACITY AND MOTIVATION
▣ Weekly team consultation meetings of all DBT therapists

▣ Goal is provide consultation and support for therapists in

their attempts to apply DBT.
 4 COMPONENTS
▣ Individual : Therapist and patient discuss treatment target.

▣ SIB is priority , therapy interfering issues and QOL interfering

issues.

▣ Group : 4 Skill modules

▣ Phone coaching

▣ Consultation group to ensure therapist motivation skills

 INCORPORATES :

▣ Individual and group therapy

▣ Group supervision and support for the therapists treating

the clients.
 SIGNIFICANCE OF INDIVIDUAL
AND GROUP THERAPY

▣ Individual component necessary to keep suicidal urges or

uncontrolled emotional issues from disrupting group
sessions.

▣ Group session teach the skills unique to DBT, and also

provide practice with regulation emotion and behavior in
a social context.
 TREATMENT STRATEGIES

▣ Dialectical strategies : Balancing acceptance and change

in all interactions, always searching for a synthesis and
looking to shift the frame of problem that resist solution.

▣ Core strategies : Validation and problem solving

 VALIDATION
▣ Validation consist f a set of strategies emphasizing acceptance and
validation of the patient by listening empathetically, reflecting
accurately , articulating that which is experienced but not
necessarily said, clarifying those disordered behavior that are due
to disordered biology or past learning historry, and because they fit
current facts or are effective for the patients long term goals

▣ Essence of validation is seeing and responding to the patient as a

person of equal status and value
 ▣ Means telling someone that what they feel, think ,
believe, and experience is : Real logical understandable

In DBT, we are learning to validation other because:

1. …It helps our relationships go better
2. ..It calms intense situations so that we can problem solve

We learn to self-validate because :

1. …It quiets defensive / fearful emotions so we can problem
solve
2. …It allows us to let go of the pain and exhaustion that
constant
3. Self- justification and self-doubt requires.
▣ Validation does NOT mean that you AGREE or
APPROVE of behavior.

▣ In fact, validation is non-judgmental

Describe- non-judgmental state the facts of the situation

State the unstated- note the presence of feelings, beliefs ,

etc. that have not been voiced : “You seem to feel angry,
but also hurt by what that person said to you”

Find what is true/ valid about the experience and note

this. Without feeling that you have to agree or approve of
the experience , find a piece of it that makes perfect sense
and validate this.
 PROBLEM SOLVING

▣ Problem solving strategies are designed assess the

specific problem of the individual, figure out what factors
are controlling or maintaining the problem behaviors, and
then systematically applying behavior therapy
interventions.
 OTHER FACTORS

▣ Environment – structuring the environment

▣ Family sessions

▣ Case consultations

▣ Dialectical means that 2 ideas can both be true at the

same time
▣ There is always more than one true way to see a situation
and more than one true opinion , idea , thought , or dream

▣ Two thing that seem like (or are) opposites can both be
true

▣ All people have something unique , different, and worthy

to teach us

▣ A life worth living has both comfortable and

uncomfortable aspects ( happiness and sadness, anger and
peace, hope and discouragement , fear and ease, etc).

▣ All points of view have both true and false within them.
 EXAMPLES

▣ You are right and the other person is right.

▣ You are doing the best that you can and you need to try
harder, do better, and be more motivated to change

▣ You can take care of yourself and you need help and
support from other
BEING DIALECTICAL MEANS :
▣ Letting go of self- righteous indignation
▣ Letting go of “Black and white”, “ all or nothing” ways of seeing a
▣ Situation
▣ Looking for what a left out of out of your understanding of a
situation
▣ Findings a way to validate the other person’s point of view
▣ Expanding your way of seeing things
▣ Getting “unstuck” from standoff and conflicts
▣ Being more flexible and approachable
▣ Avoiding assumptions and blaming
▣ Hand out – Dialectic homework sheet
 DBT’S FOUR MODULES:

▣ Mindfulness

▣ Interpersonal effectiveness

▣ Emotion regulation

▣ Distress tolerance
 1. MINDFULNESS
▣ Considered a foundation for the other skills taught in DBT

▣ Helps individual accept and tolerate the powerful emotions they

may feel when challening their habits or exposing themselves to
upsetting situations
 WHAT IS NOT MINDFULNESS

▣ Falling to notes subtle or not-so-subtle feelings of

physical discomfort, pain, tension etc.
▣ Forgetting someone’s name as soon as you hear it
▣ Listening to someone with one ear while doing something
else at the same time
▣ Getting so focused on goals that I lose touch with what I
am doing right now
▣ Being preoccupied with the future or the past
▣ Eating without being aware of eating

▣ Having periods of time with difficulty remembering

details of what happened – running on autopilot

▣ Reacting emotionally in certain ways- feeling like an

emotion just “came out of nowhere”

▣ Daydreaming or thinking of other things when doing

chores.
STATE OF MIND

Reasonable Emotion
mind Wise mind mind
 “WHAT” SKILLS
▣ What skills teach participants to non-judgmentally observe their
inner and outer environments

▣ To describe their experience and observation without using

judgmental statement or opinions

▣ Skills to participate fully in the moment with focused attention

attention, rather than moving distractedly through life.
 OBSERVE
▣ Be curious about what you feel

▣ Just notice how you feel, without trying to make feelings stronger,
or weaker, go away, or last longer

▣ See how long your feeling lasts, and if it changes

▣ Notice how feelings flow in and out of your body like waves

▣ What comes through your senses? Touch,smell,sight,sound,taste

▣ Be like a non-stick pan , letting things slide off of your body and
your emotions
 DESCRIBE
▣ Use word to describe your experience

Use “fact” words call a thought “ just a thought”, call a feeling

“just a feeling”
Use words that everyone would agree with
Don’t paint a colourful picture with words or magnify situation
with words. Try to avoid emotional words.
Try to let go of your emotions about being “right” or about
someone else being “wrong” while searching for words to describe
Handout
 PARTICIPATE

▣ Get “lost” in an activity

▣ Let’s go of your sense of time while you are doing

something

▣ Allow yourself to be natural in the situation

▣ Practice your skills until they become a part of you

 “HOW” SKILLS
▣ How skills teach clients to act non- judgmentally , and
focus the mind on one thing at a time

▣ Using these skills, clients learn to move more effectively

through all of life, and not be as swayed by their
emotional states.
 NON JUDGMENTAL STANCE
▣ SEE, BUT DON’T EVALUATE. Take a non-judgmental stance.
Just the facts

▣ Focus on the “what”, not the “good” or “ bad”, the “terrible”, the
“should not”

▣ UNGLUE YOUR OPINION from the facts, from the who, what,
when and where

▣ ACCEPT each moment, each event as a blanket spread out on the

lawn accepts both the rain and the sun, each leaf that falls upon it
▣ ACKNOWLEDGE the helpful, the wholesome, but don’t
judge it. Acknowledge the harmful, the unwholesome, but
don’t judge it.

▣ When you find yourself judging, DON’T JUDGE YOUR

JUDGING.

▣ One mindfully in the moment

DO ONE THING AT A TIME. Do each thing with all of

your attention
LET GO OF DISTRACTIONS
CONCENTRATE YOUR MIND
 EFFECTIVELY
▣ FOCUS ON WHAT WORKS. Do what needs to be done in each
situation in order to meet your larger goals. Stay away from
thoughts of “right”, “wrong”, “should”, “should not”, “fair”, and
“unfair”

▣ PLAY BY THE RULES. Act as skilfully as you can meeting the

needs of the situation you are in, not the situation you are in not
the situation you wish you were in.

▣ LETS GO of vengeance , useless anger, and righteousness that

hurts you and doesn’t work
 2. DISTRESS TOLERANCE

Emphasis is learning to bear pain skilfully

Clients learn skills for accepting , finding meaning

within, and tolerating distress.
The goal is to become capable of calmly recognizing
negative situation and their impact, rather than
becoming overwhelmed or hiding from them.

Allow individual to make wise decision about

whether and to take action , rather than falling into
intense , desperate, or destructive emotional accept
reaction
 ACCEPT
▣ Helps to dis tract oneself temporarily from unpleasant emotions.

▣ Activities- Engage in a positive activity that you enjoy

▣ Contribute-Help out others or your community

▣ Comparisons-Compare yourself either to people who are less

fortunate, or to yourself when you were in a less fortunate situation

▣ Emotions ( other) – Cause yourself to feel something different by

provoking your sense of humor or happiness
▣ Push away- Put your situation on the back- burner for a while

▣ Put something else temporarily first in your mind

▣ Thoughts(other)- force your mind to think about something else

▣ Sensations(other)- Do something that has an intense feeling other

than what you are feelings , like a cold shower or a spicy candy
 “RADICAL ACCEPTANCE”.
LINEHAN
▣ Means that clients must stop
fighting reality, and must accept
their current situations exactly as
they are.

▣ Does not indicate surrendering to

negative situations, but rather
accepting all reality as it is so that
clients can choose the most
effective and competent ways to
deal with it
 IMPROVE
▣ Improve the moment
▣ Imagine ( better times, better things , success)
▣ Meaning( find one useful thing about the situation for you )
▣ Prayer ( find some quiet place inside of you)
▣ Relaxation(quiet your body)
▣ One thing at a time ( just this moment)
▣ Vacation( go someplace in your mind, or take a time out)
▣ Encouragement ( tell yourself it will be ok)
 THINKING OF PROS AND CONS
▣ Make a list of the pros and cons of tolerating the distress-coping
by using skills

▣ Make another list of the pros and cons not tolerating the distress –
that is , of coping by hurting yourself, abusing alcohol or drugs, or
doing something else impulsive

▣ Focus on long- term goals, the lights at the end of the tunnel.
Remember times when pain has ended
 IDENTIFY YOUR STYLE
▣ Think back over recent interaction in your five most
significant relationship. Place a check next to the statements
that reflect your typical behavior

1. I go along with something , event if I don’t like it

2. I push people to do what’s right , even if there’s an upset
3. I try to be pleasant and easy going , no matter what people do
or say
4. I give people a piece of my mind when they deserve it
5. I always try to be sensitive to what other people need and feel,
even if my own needs get lost in the process
6. I know what I want and insist on it , even if it means having to
get angry
7. When there’s a conflict, I trend to give in and let things go
the other person’s way
8. When people don’t do what appropriate or reasonable, don’t
let them get away with it
9. I’ll pull away from a relationship rather than say anything
that could be upsetting
10. I leave people alone , let them be whatever they are
11. If people ignore my needs or insist on things that don’t
work for me, I get more and more upset till they pay attention
 SCORING
▣ If you tended to make odd number, your predominant
style is passive
▣ If you checked even numbers, you may have a tendency
to an aggressive problem – solving style
▣ I want- They want
▣ Write outcome of I want versus. They want
▣ I want- I should
▣ Help you be more effective in your dealing with people
▣ Improve your ability to get your needs met
▣ Help you negotiate conflicts without damaging a
relationship
▣ Strengthen your self- respect by giving you alternative to
old, damaging patterns of anger or withdrawal
INTERPERSONAL EFFECTIVENESS
▣ Composite of social –skills training ( MCKay, Davis, and
fanning,1983), assertiveness training ( Alberti and Emmons,
1990;Bower and Bower,1991) and listening skills ( Baker 1990;
Roger,1951) which have been combined by Linehan(1993a) for
dialectical behavior therapy

▣ Negotiation skills
 GETTING THE “THING” I WNAT

▣ When it’s your legitimate right

▣ Getting another to do something for you
▣ Refusing an unwanted or unreasonable request
▣ Resolving on interpersonal conflict
▣ Getting your opinion or point of view taken
seriously
 QUESTION
1. What is the “thing” that I want from this interaction?

2. What do I have to do to get the results? What will

work?
 RELATIONSHIP EFFECTIVENESS
▣ Getting and keeping a good relationship

Acting in such a way that the other person keeps

liking and respecting you
Balancing immediate goals with the good of the
long-term relation
Remembering why the relationship is important to
you now and in the future

▣ QUESTIONS

1. How do I want the other person to feel about me

after the interaction?
2. What do I have to do get ( keep) this relationship?
 SELF-RESPECT
EFFECTIVENESS
▣ Keeping or improving self – respect and liking for
yourself

Respecting your own values and belief : acting in a way

that makes you feel moral
Acting in a way that makes you feel capable effective
 QUESTION

1. How do I want to feel about myself after the

interaction is over?
2. What do I have to do to feel that way about
myself? What will work?
 FACTORS REDUCING IP
EFFECTIVENESS
▣ Lack of skills

▣ Myths-handout

▣ Emotion mind

▣ Indecisiveness-asking everything vs not asking at all; saying Yes

vs saying No environment

▣ Hand out – self encouragement

 GUIDELINES FOR SHARING
EMOTIONS:
1. State your views as your own feelings and thoughts , not
as absolute truths
2. When expressing negative emotions or concern, also
include any positive feeling you have about the person or
situation
3. Make your statement as specific as possible , both in term
of specific emotions and thoughts
4. Speak in “paragraph”, That is express one main idea with
some elaboration and then allow the other person to
respond. Speaking for a long time without a break makes
it hard for someone to listen
5. Express your feeling and thoughts with tact and timing so
that the person can listen to what you are saying without
becoming defensive
▣ Ways to respond while the other person is speaking

1. Show that you understand the person’s statement and accept

his or her right to have those thoughts and feelings.
Demonstrate this acceptance through you tone of voice, facial
expressions and posture

2. Try to put yourself in the other person’s place and look at

the situation from his or her perspectives in order to determine
how the other person feels and thinks about the issues
 SKILLS FOR RESPONDING:
▣
Ways to respond after the other person finishes speaking:
1. After the person finishes , summarizes and restate their most
important feelings , desires, conflicts and thoughts

2. While in the listener role , do not:

a) Ask question , expect for clarification

b) Express your own viewpoint or opinion
c) Interpret or change the meaning of person’s statement
d) Offer solutions or attempts to solve a problem if one
exists
e) Make judgments or evaluate what the person has said
 3. EMOTIONAL REGULATION
▣ Identifying and labelling emotions
▣ Identify obstacles to changing emotion
▣ Reducing vulnerability to acting out
▣ Engaging in distress tolerance
▣ Chain analyses of difficult situation, to better understand what
triggers their emotions, how they experience those feeling in the
mind and body, and how they might choose more productive
outcomes in the future
 WHY LEARN SKILL
▣ To quieten body

▣ To quieten behavior

▣ To find wise mind easily

▣ To be more effective in meeting goals

▣ To improve self respect

▣ Write out names of emotions

▣ Write description / common words of emotion

▣ Hand out
 HEALTHY PERSPECTIVES ON
EMOTION
▣ Handout
Emotion are neither good or bad , right or wrong
Emotion don’t test forever
When a strong emotion comes, you do not have to act on
your feeling
Emotion are not facts
You cannot get rid of emotions because they serve
important survival function
 EMOTION
8 basic emotion
Anger
Sorrow
Joy
Fear
Disgust
Guilt/shame
Interest
Suprise
 SECONDARY EMOTION

An emotional reaction to an emotion

Usually learnt
Feeling shame when you get angry
Feeling angry when you have a shame response (
e.g; hurt, feeling)
Feeling fear when you get angry ( may be you’ve
been punished for anger)
 USE OF EMOTION
▣ 3 jobs of emotions

▣ Communication

▣ Motivation- ACT now- stay motivated

▣ Validation

▣ HAND OUT
 STRONG
▣ Sleep as much as you need- not too much, not too little
▣ Take medications your doctor prescribes, When sick take care of
yourself
▣ Resist using street drugs or alcohol
▣ Once a day ,do something that gives you a feeling of being in
control, mastering your world
▣ Nutrition- Eat a balanced diet, don’t over or under eat. Don’t make
decision about food based upon your emotional state at the time.
Keep your blood sugar
▣ Get exercise- Try to do 20 minutes a day. Research show that
exercise helps people improve their mood
 STEPS TO INCREASE POSITIVE
EXPERIENCE
▣ Short term : Do pleasant things that are possible now

▣ Long term

▣ HANDOUT
▣ Accumulate positives
▣ Attend to relationships
▣ Avoid avoidance behaviors
▣ Focus on positive events
▣ Refocus
▣ Distract
▣ Mindfulness practice of present emotion
▣ Ways to change emotion – hand out
▣ Ways to handle emotions skilfully- hand out
▣ ACCEPT---SELF SOOTHE--- IMPROVE

▣ HAND OUT – Pleasant events list

▣ HAND OUT – Mindfulness about current emotion
▣ HAND OUT – Handing negative emotions
INTERPERSONAL EFFECTIVENESS
▣ Assertiveness skills

Ask for what one needs,

saying No
Coping with interpersonal conflict

HANDOUT
▣ HANDOUT – Skills for tolerating painful emotions right
away.

▣ HANDOUT – Use 5 senses to self soothe

▣ HANDOUT – Improve the moment

▣ HANDOUT – Grid to check pros and cons

 TAKE HOME MESSAGE

▣ Key points
▣ What I found most helpful
▣ What did not makes sense
▣ How would I do the therapy differently
▣ Future suggestions for workshops
THANK YOU