A guide to Mindfulness for Health Professionals

This is a recent presentation I provided to physical health and pain rehab practitioners on the use of mindfulness in managing distress and chronic pain. It describes what Mindfulness is, how it works and provides practical, easy to use examples of mindfulness to use with clients. It also provides guidance on which exercises might be best for particular clients. Click on the link in the heading above to read further.

These people, who were neither insane nor mentally healthy, continued to puzzle psychiatrists for the next one hundred years. It was in this “borderland” that society and psychiatry came to place its criminals, alcoholics, suicidal people, emotionally unstable and behaviourally unpredictable people—to separate them off both from those with more clearly defined psychiatric illnesses at one border (those, for example, whose illness we have come to call schizophrenia and manic-depressive or “bipolar” disorder) and from “normal” people at the other border.

About a hundred years ago, a bright but very ill young woman found that if her doctor listened to her for hours while she told him about her inner experience and her memories, the symptoms that were making her life unbearable would gradually subside. The patient recovered and went on to become the first social worker in Germany.

Her doctor, Dr. Breuer, went on to become one of the teachers of Sigmund Freud, inventor of the “talking cure” — psychoanalysis. At first the students of Freud thought that the talking cure would help all mentally ill people except those who were seriously psychotic. But over the years they found themselves dealing with some patients who were in the same “borderland” described before: people who were not psychotic, but who did not respond to the talking cure in the way the therapists expected. Gradually, therapists began to define this “borderline” group not so much by their symptoms as by the special problems that were underneath the symptoms, and by the effects these people had upon others.

The symptoms of borderline patients are similar to those for which most people seek psychiatric help: depression, mood swings, the use and abuse of drugs, alcohol, or food as a means of trying to feel better; obsessions, phobias, feelings of emptiness and loneliness, inability to tolerate being alone.

In addition, these patients displayed great difficulties in controlling ragefulness; they were unusually impulsive, they fell in and out of love suddenly; they tended to idealize other people and then abruptly despise them. A consequence of all this was that they typically looked for help from a therapist and then suddenly quit in terrible disappointment and anger.

Underneath all these symptoms, therapists began to see in borderline people an inability to tolerate the levels of anxiety, frustration, rejection and loss that most people are able to put up with, an inability to soothe and comfort themselves when they become upset, and an inability to control the impulses toward the expression, through action, of love and hate that most people are able to hold in check. What seems to be of central importance in the symptoms and difficulties mentioned above is that the hallmark of the “borderline” personality is great difficulty in holding on to a stable, consistent sense of one’s self: “What am I?” these people ask. “My life is in chaos; sometimes I feel like I can do anything—other times I want to die because I feel so incompetent, helpless and loathsome. I’m a lot of different people instead of being just one person.”

The one word that best characterizes borderline personality is “instability.” Emotions are unstable, fluctuating wildly, often for no discernible reason. Thought processes are unstable—rational and clear at times, quite extreme and distorted at other times. Behaviour is unstable—often with periods of excellent conduct, high efficiency and trustworthiness alternating with outbreaks of regression to childlike states of helplessness and anger, suddenly quitting a job, withdrawing into isolation, failing.

Self control is unstable leading to impulsive behaviours and chaotic relationships. A person with borderline personality disorder may sacrifice themselves for others, only to reach their limit and suddenly fly into rageful reproaches, or they may curry favour through obedient submission only to rebel, out of the blue, in a tantrum.

Associated with this instability is terrible anxiety, guilt and self-loathing for which relief is sought at any cost—medicine, drugs, alcohol, overeating, suicide. Sadly, oddly, self-injury is discovered bymany borderline people to provide faster relief than anything else—cutting or burning themselves stops the anxiety temporarily.

The effect upon others of all this trouble is profound: family members never know what to expect from their volatile child, siblings, or spouse, except they know they can expect trouble: suicide threats and attempts, self-inflicted injuries, outbursts of rage and recrimination, impulsive marriages, divorces, pregnancies and abortions; repeated starting and stopping of jobs and school careers, and a pervasive sense, on the part of the family, of being unable to help.
And, of course, the effect of the illness upon the life of the patient is equally profound: jobs are lost, successes are spoiled, relationships shattered, families alienated. The end result is all too often the failure of a promising life, or a tragic suicide.

The above information was obtained from:
www.borderlinedisorders.com/public.php

The team involved in treatment may include your:
• Family doctor or primary care provider
• Psychiatrist
• Psychotherapist
• Pharmacist
• Family members
• Social workers

If you have mild symptoms that are well controlled, you may need treatment from only your family doctor, a psychiatrist or a therapist. If possible, find medical and mental health providers with experience in treating personality disorders.

Several treatments are available for personality disorders. They include:
• Psychotherapy
• Medications
• Hospitalization

Successful treatment depends on your active participation in your care.

Psychotherapy
Psychotherapy is the main way to treat personality disorders. Psychotherapy is a general term for the process of treating personality disorders by talking about your condition and related issues with a mental health provider. During psychotherapy, you learn about your condition and your mood, feelings, thoughts and behavior. Using the insight and knowledge you gain in psychotherapy, you can learn healthy ways to manage your symptoms.
Types of psychotherapy used to treat personality disorders may include:
• Cognitive behavioral therapy. This combines features of both cognitive and behavior therapies to help you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
• Dialectical behavior therapy. This is a type of cognitive behavioral therapy that teaches behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others.
• Psychodynamic psychotherapy. This therapy focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts to live a happier life.
• Psychoeducation. This therapy teaches you — and sometimes family and friends — about your illness, including treatments, coping strategies and problem-solving skills.
Psychotherapy may be provided in individual sessions, in group therapy or in sessions that include family or even friends. The type of psychotherapy that’s right for you depends on your individual situation.

Medications
There are no medications specifically approved to treat personality disorders. However, several types of psychiatric medications may help with various personality disorder symptoms.
• Antidepressant medications. Antidepressants may be useful if you have a depressed mood, anger, impulsivity, irritability or hopelessness, which may be associated with personality disorders.
• Mood-stabilizing medications. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression.
• Anti-anxiety medications. These may help if you have anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior.
• Antipsychotic medications. Also called neuroleptics, these may be helpful if your symptoms include losing touch with reality (psychosis) or in some cases if you have anxiety or anger problems.

Hospitalization and residential treatment programs
In some cases, a personality disorder may be so severe that you require psychiatric hospitalization. Psychiatric hospitalization is generally recommended only when you aren’t able to care for yourself properly or when you’re in immediate danger of harming yourself or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.

Participating in your own care
Try to be an active participant in your treatment. Working together, you and your doctor or therapist can decide which treatment options may be best for your situation, depending on your type of personality disorder, your symptoms and their severity, your personal preferences, insurance coverage, affordability, treatment side effects, and other factors.
In some cases, a personality disorder may be so severe that a doctor, loved one or guardian may need to guide your care until you’re well enough to participate in decision making.

References:
http://www.nlm.nih.gov/medlineplus/personalitydisorders.html

http://www.mayoclinic.com/print/personality-disorders/DS00562/METHOD=print&DSECTION=all

• Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
• Laboratory tests. These may include a complete blood count (CBC), a screening test for alcohol and drugs, and a check of your thyroid function.
• Psychological evaluation. A doctor or mental health provider talks to you about your thoughts, feelings, relationships and behaviour patterns. He or she asks about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you’ve had similar episodes in the past. You’ll also discuss any thoughts you may have of suicide, self-injury or harming others.They may also ask you to complete some questionnaires covering some of these aspects.

Pinpointing which personality disorder you have
It sometimes can be difficult to determine which particular personality disorder or personality disorders you have. For one thing, some personality disorders share similar symptoms. Also, a diagnosis is often based largely on how you describe your symptoms and behaviour, along with how your doctor interprets those symptoms and observes you behaving. Because of this, it can take some time and effort to get an accurate diagnosis. Be sure to stick with it, though, so that you can get appropriate treatment designed for your particular illness and situation.

Diagnostic criteria
The symptoms and clinical features for each personality disorder are detailed in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.
To be diagnosed with a particular personality disorder, you must meet the criteria for that disorder listed in the DSM. Each personality disorder has its own set of diagnostic criteria.

References:
http://www.nlm.nih.gov/medlineplus/personalitydisorders.html

http://www.mayoclinic.com/print/personality-disorders/DS00562/METHOD=print&DSECTION=all

References:
http://www.nlm.nih.gov/medlineplus/personalitydisorders.html
http://www.mayoclinic.com/print/personality-disorders/DS00562/METHOD=print&DSECTION=all

Personality disorders are long-term patterns of thoughts and behaviours that cause serious problems with relationships and work. People with personality disorders have difficulty dealing with everyday stresses and problems. They often have stormy relationships with other people. The exact cause of personality disorders is unknown. However, genes and childhood experiences may play a role.

Symptoms vary widely depending on the specific type of personality disorder. Treatment usually includes talk therapy and sometimes medicine.
A personality disorder is a type of mental illness in which you have trouble perceiving and relating to situations and to people — including yourself. There are many specific types of personality disorders.

In general, having a personality disorder means you have a rigid and unhealthy pattern of thinking and behaving no matter what the situation. This leads to significant problems and limitations in relationships, social encounters, work and school.

In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you, and you may blame others for the challenges you face.

Symptoms

General symptoms of a personality disorder
Personality disorder symptoms include:
• Frequent mood swings
• Stormy relationships
• Social isolation
• Angry outbursts
• Suspicion and mistrust of others
• Difficulty making friends
• A need for instant gratification
• Poor impulse control
• Alcohol or substance abuse

Specific types of personality disorders

The specific types of personality disorders are grouped into three clusters based on similar characteristics and symptoms. Many people with one diagnosed personality disorder also have signs and symptoms of at least one additional personality disorder.

Cluster A personality disorders
These are personality disorders characterized by odd, eccentric thinking or behavior and include:

Paranoid personality disorder
• Distrust and suspicion of others
• Believing that others are trying to harm you
• Emotional detachment
• Hostility

Schizoid personality disorder
• Lack of interest in social relationships
• Limited range of emotional expression
• Inability to pick up normal social cues
• Appearing dull or indifferent to others

Schizotypal personality disorder
• Peculiar dress, thinking, beliefs or behavior
• Perceptual alterations, such as those affecting touch
• Discomfort in close relationships
• Flat emotions or inappropriate emotional responses
• Indifference to others
• “Magical thinking” — believing you can influence people and events with your thoughts
• Believing that messages are hidden for you in public speeches or displays

Cluster B personality disorders
These are personality disorders characterized by dramatic, overly emotional thinking or behavior and include:

Antisocial (formerly called sociopathic) personality disorder
• Disregard for others
• Persistent lying or stealing
• Recurring difficulties with the law
• Repeatedly violating the rights of others
• Aggressive, often violent behavior
• Disregard for the safety of self or others

Borderline personality disorder
• Impulsive and risky behavior
• Volatile relationships
• Unstable mood
• Suicidal behavior
• Fear of being alone

Histrionic personality disorder
• Constantly seeking attention
• Excessively emotional
• Extreme sensitivity to others’ approval
• Unstable mood
• Excessive concern with physical appearance

Narcissistic personality disorder
Believing that you’re better than others
• Fantasizing about power, success and attractiveness
• Exaggerating your achievements or talents
• Expecting constant praise and admiration
• Failing to recognize other people’s emotions and feelings

Cluster C personality disorders
These are personality disorders characterized by anxious, fearful thinking or behavior and include:

Avoidant personality disorder
• Hypersensitivity to criticism or rejection
• Feeling inadequate
• Social isolation
• Extreme shyness in social situations
• Timidity

Dependent personality disorder
• Excessive dependence on others
• Submissiveness toward others
• A desire to be taken care of
• Tolerance of poor or abusive treatment
• Urgent need to start a new relationship when one has ended

Obsessive-compulsive personality disorder
• Preoccupation with orderliness and rules
• Extreme perfectionism
• Desire to be in control of situations
• Inability to discard broken or worthless objects
• Inflexibility
Obsessive-compulsive personality disorder isn’t the same as obsessive-compulsive disorder, a type of anxiety disorder.

When to see a doctor
If you have any signs or symptoms of a personality disorder, see your doctor, mental health provider or other health care professional. Untreated, personality disorders can cause significant problems in your life, and they may get worse without treatment.

Helping a loved one
If you have a loved one who you think may have symptoms of a personality disorder, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her.

If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help.

Causes
Personality is the combination of thoughts, emotions and behaviors that makes you unique. It’s the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of two factors:

Risk factors
Although the precise cause of personality disorders isn’t known, certain factors seem to increase the risk of developing or triggering personality disorders, including:

• A family history of personality disorders or other mental illness
• Low socioeconomic status
• Verbal, physical or sexual abuse during childhood
• Neglect during childhood
• An unstable or chaotic family life during childhood
• Being diagnosed with childhood conduct disorder
• Loss of parents through death or traumatic divorce during childhood

Personality disorders often begin in childhood and last through adulthood. There’s reluctance to diagnose personality disorders in a child, though, because the patterns of behavior and thinking could simply reflect adolescent experimentation or temporary developmental phases.

References:
http://www.nlm.nih.gov/medlineplus/personalitydisorders.html