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Section 7
Track #7 - Teaching Your BPD Client to Reduce Impulse & Paranoia

Question 7 | Test | Table of Contents | Borderline
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On the last track, we discussed the various types of blaming trigger thoughts in BPD clients. Some of these thoughts are  black and white thinking; mind reading; and labeling.

As you already know, stress can increase certain symptoms in BPD clients such as paranoia, fear, and most especially anger. 

On this track, we will examine the effects of stress on BPD clients who react in anger.  Also, we will include techniques for reducing stress, "Scanning the Body" and "Stop and Breathe".

#1 Effects of Stress - Impulse and Paranoia
First, we will present the effects of stress on BPD clients other than anger. An increased susceptibility to impulses is one effect. Because a BPD client is already in a heightened state of anxiety, their reasoning core is not as functional as it would be in less stressful circumstances.  These impulses can range from harmless shopping ventures to life changes. Next, stressed BPD clients become more paranoid. A client’s sense of danger and harm becomes such that any act could be interpreted as a threat. 

Kelly was a 21 year old client who was about to get married. While preparing for her wedding, Kelly found it difficult to meet all the demands of a bride. She stated, "I had always wanted a large wedding, but this was too much. Over 250 guests and the price tag was getting close to thirty thousand dollars. I was so scared." Instead of talking to her fiancé about the stress and pressures of the wedding, Kelly impulsively called the wedding off. 

She stated, "It felt like everyone was testing me, that everyone was waiting for me to slip up."  As you can see, faced with such stressful situation, Kelly felt that the only way to handle the circumstances was to react radically.  In addition, instead of recognizing her fear as stress, Kelly interpreted it as a test. Even though Kelly did not react angrily, these same effects of stress can often result in angry outbursts if not addressed.

Technique: Scanning the Body
Although it may sound silly to say that some people don’t know they are stressed out, this is often the case with BPD clients. Often, I have found that these clients have just not taken the time to realize what their body is trying to tell them. To help clients like Kelly recognize their stress signs before they have an angry episode, I asked her to try "Scanning the Body" exercise. 

I gave Kelly a list of the following steps to take when she began to feel paranoid and trapped by a situation.

  1. Begin by paying attention to your feet and legs.  Start by wiggling your toes, then rotating your feet and relaxing them.  Not any tension in your calves and let go of this tension.
  2. Now focus on your lower torso.  Become aware of any tension or pain in your lower back.  Relax as fully as you can.  Notice if you have tension in your hips, pelvic area, or buttocks.  Relax these areas.
  3. Move your focus to your diaphragm and stomach.  Take a couple of deep breaths, breathing slowly in and out.  Feel yourself relaxing, more and more deeply.  Notice any tension that you are experiencing in this area.
  4. Become aware of your lungs and chest cavity.  Search for tension in this part of your body.  Take a couple of slow, deep breaths and relax.
  5. Next, pay attention to your shoulders neck and throat.  Swallow a couple of times and notice any tension or soreness in your throat and neck.  Roll your head around clockwise a few times.  Now reverse and roll your head the other way.  Shrug your shoulders and become aware of any tension in this area and then relax.
  6. Begin at the top of your head and scan for tension.  Look for pain in your forehead.  Perhaps there is a band of pain around the top of your head.  Maybe there is pain or tension behind your eyes.  Notice any tightness in your jaw.  Check for locking or grinding of teeth and taut lips.  Be aware of your ears.  Go back over you head and relax each part.
  7. Now go back and scan your entire body for any remaining tension.  Allow yourself to relax more and more deeply.

I have found this technique helpful in slowing down a BPD client’s escalating stress.  Think of your Kelly.  Could he or she benefit from the "Scanning the Body" exercise?

#2 Effects of Stress - Anger
Second, we will discuss the effect of stress on a BPD client’s anger. As we discussed earlier on in this track, BPD clients often experience susceptibility to impulses. When this occurs, the client is also more susceptible to angry outbursts. Their learned defense mechanism has used anger before as a coping strategy and, when he or she feels threatened, will use it again. Trey was a 25 year old client who was prone to angry actions. 

Trey described the following period in his life, "Well, I had just gotten fired from my job, and of course, as usual, I didn’t know what I was going to do with my future.  I was confused and angry and I needed to take it out on somebody.  Of course, the closest person was my mom.  Whenever she asked me the simplest question, I would bite back, and bite back hard. It’s not so much what I said, but how I said it. I shouted and growled and would say sarcastic things. I’d challenge her every step of the way." 

As you can see, the situations leading up to Trey’s angry outbursts were incidents that created unbearable pressures. 

Technique: Stop and Breathe
To help Trey release his stress in a less aggressive manner, I asked him to try relaxation techniques. The technique I asked Trey to try was called the "Stop and Breathe" exercise. I gave him the following simple steps to take when he began to feel overwhelmed by his thoughts and stress.

  1. When you begin to feel like the outside world is against you and you have to take it out on somebody, go into an empty room and tell yourself out loud and firmly, "Stop."
  2. Now shift your attention to your breathing.  Take slow, deep breaths into your belly.  Put a hand on your abdomen to make sure you’re breathing properly.
  3. Begin to count your breaths, counting each time you exhale up to four.  Each time you reach four, start over again.
  4. Empty your mind and stay focused on your breathing.  Continue this exercise until you feel relaxed.

By resorting to this simple and easy exercise rather than reacting angrily, Trey could more easily control the need to react angrily towards his mother.

On this track, we discussed the effects of stress on BPD clients who react in anger.  Also, we included two techniques for reducing stress,  "Scanning the Body" and "Stop and Breathe".

On the next track, we will examine steps to help BPD clients prevent angry outbursts as a result of stress and underlying causes. These steps are  identifying the problems; clarifying goals; and coping strategies.

Peer-Reviewed Journal Article References:
Mauchnik, J., Ebner-Priemer, U. W., Bohus, M., & Schmahl, C. (2010). Classical conditioning in borderline personality disorder with and without posttraumatic stress disorder. Zeitschrift für Psychologie/Journal of Psychology, 218(2), 80–88.

van Dijke, A., Ford, J. D., van der Hart, O., van Son, M., van der Heijden, P., & Buhring, M. (2012). Complex posttraumatic stress disorder in patients with borderline personality disorder and somatoform disorders. Psychological Trauma: Theory, Research, Practice, and Policy, 4(2), 162–168.

Woodward, H. E., Taft, C. T., Gordon, R. A., & Meis, L. A. (2010). "Clinician bias in the diagnosis of posttraumatic stress disorder and borderline personality disorder": Correction to Woodward et al. (2009). Psychological Trauma: Theory, Research, Practice, and Policy, 2(2), 96.

What are two techniques for reducing stress in the BPD client? To select and enter your answer go to Test.

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