On the last track we discussed three techniques for cultivating interpersonal relationships. The three techniques are Learning from Others, Remembering, and Engaging in Inner Work and Outer Play.
On this track... we will discuss cognitive distortions used by BPD clients. There are five cognitive distortions commonly seen in BPD clients. These five distortions are polarized thinking, personalization, control fallacies, catastrophizing, and emotional reasoning.
As you listen to this track, evaluate your BPD client for applicable cognitive distortions. Often times it is hard to see a change in BPD clients. To help increase your awareness of a change. you might rate your BPD client on a subjective scale from 1 to 10. One is low and rarely exhibits the distortion and 10 is high frequently exhibiting the distortion.
Five Cognitive Distortions
Mara, a BPD client of mine, exhibited each of the five cognitive distortions.
Distortion #1 - Polarized Thinking
For Mara, the first of the five cognitive distortions was polarized thinking, or seeing things in all-or-nothing, black and white terms or categories. Mara, age 41, displayed polarized thinking through overgeneralizations, global labeling, and filtering. Mara described polarized thinking when she stated, "It’s almost like my brain is one of those room darkening window shades. The good stuff, like light, just doesn’t get through." Think over your last session with your BPD client. How would you rate your client on a scale of one to ten?
Distortion #2 - Personalization
The second habit that Mara displayed was personalization. Mara assumed everything had to do with her. For example, the budget for a program Mara was to commission at work was cut. Mara stated, "Obviously, my boss is trying to send me a message about the quality of my work."
Also, Mara frequently asked questions like
1. "Are you mad at me?" or
2. "Did I do something wrong?"
Has your BPD client whom you are treating long term improved in the personalizing area or have they increased their use of this distortion? How would you rate your Mara regarding personalizing in your first session? How would you rate her now?
Distortion #3 - Control Fallacies
In addition to polarized thinking and personalization, the third cognitive distortion that Mara used was control fallacies.
Mara stated, "I feel like I am responsible all the time for everything. And it’s like I have no control. The other night I went out to dinner with my mother. I felt like I had to make her happy, so I stayed longer than I wanted to. I started feeling strange when it got real quiet, so I told her she was being stupid. Then she wouldn’t even talk to me! She stormed out of the restaurant. There I was, alone with my chocolate ice cream, feeling like I had lost control!"
Are you treating a BPD client like Mara who reinforces her own cognitive distortions? If so, perhaps the technique of Challenging the Critic described later in this track will provide some benefit.
Distortion #4 - Catastrophizing
The fourth cognitive distortion Mara displayed was catastrophizing. Sound familiar? By expecting the worst to happen in a given situation, BPD clients may engage in catastrophizing. Mara described the cognitive distortion of catastrophizing when she stated, "A couple weeks ago, my boyfriend was supposed to pick me up at 8 o’clock. At around ten after, I started worrying. I was sure he was either in an accident or cheating on me."
Has your BPD client related situations to you that reflect catastrophizing? Often evident in BPD characterized by paranoia, catastrophizing generally leads to false assumptions. On a scale of 1 to 10 how often and intense are your Mara’s episodes of catastrophizing?
Distortion #5 - Emotional Reasoning
In addition to polarized thinking, personalization, control fallacies, and catastrophizing, Mara’s fifth cognitive distortion was emotional reasoning. Are you treating a BPD client like Mara who assumes that things are the way that he or she feels about them? A signal Mara exhibited that indicated her use of emotional reasoning was a changing self concept based on temporary conditions such as mood and emotions.
Periodically, Mara would act on an emotion and then discover her feelings and impressions weren’t really based on the truth after all. Think of a specific situation in which your Mara applied emotional reasoning, you might consider using the Challenge the Critic technique in your next session.
Technique: Challenge the Critic
To help Mara dispute her own cognitive distortions, I asked her to try the Challenge the Critic technique.
--Step 1 - First, Mara listed which of the above cognitive distortions she believed affected her. For each one, Mara wrote a recent example of the distortion at work. For example, Mara wrote, "Dan is always late. He is trying to get a raise out of me by being late."
--Step 2 -Second, Mara challenged the distortion and rewrote the statement. Mara’s rewritten statement was "Dan came to a meeting late. I overgeneralized that he is always late."
Mara continued with her list until she began to develop affirmations that she could think about repeating whenever she found herself in a negative pattern of thinking. Here are eight examples Mara used to create her list. As you listen to these eight examples, consider how they might be used to your client.
I don’t always do anything, there are exceptions.
I don’t never do or not do anything, there are exceptions.
It’s not fair to make assumptions. I need to find out the facts first.
Everyone makes an isolated mistake or two.
Come to think of it, I could just as easily choose to see the glass half full instead of half empty.
Because I feel a certain way about something doesn’t make it absolutely true. Feeling and being are two different things.
It’s not always about me. People have their own reasons for doing what they do. I don’t have to take it personally all the time.
It’s not the end of the world. I’ll find a solution.
Do you agree that once BPD clients like Mara can begin to identify and challenge cognitive distortions, those clients can begin to internalize change? Think of your BPD client. How can you help him or her to avoid reinforcing negative perceptions? Would a colleague of yours who is treating a BPD client benefit from listening to this track?
On this track... we have discussed cognitive distortions used by BPD clients. There are five cognitive distortions commonly seen in BPD clients. These five distortions are polarized thinking, personalization, control fallacies, catastrophizing, and emotional reasoning.
On the next track we will discuss helping BPD clients rebuild self-esteem. Two aspects of self-esteem that we will examine are low self-esteem and setting boundaries. We will also review the self-esteem assessment and the ‘LEMON’ Enforcement technique.
Peer-Reviewed Journal Article References:
Niedtfeld, I., Renkewitz, F., Mädebach, A., Hillmann, K., Kleindienst, N., Schmahl, C., & Schulze, L. (2020). Enhanced memory for negative social information in borderline personality disorder. Journal of Abnormal Psychology, 129(5), 480–491.
Nisenbaum, R., Links, P. S., Eynan, R., & Heisel, M. J. (2010). Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: Multilevel analyses applied to experience sampling methodology. Journal of Abnormal Psychology, 119(2), 433–439.
Tomko, R. L., Lane, S. P., Pronove, L. M., Treloar, H. R., Brown, W. C., Solhan, M. B., Wood, P. K., & Trull, T. J. (2015). Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. Journal of Abnormal Psychology, 124(3), 740–753.
What are five cognitive distortions commonly seen in BPD clients?
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