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4 Steps to Break the Anxiety Cycle

4 Steps to Break the Anxiety Cycle

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"Get a sofa bed." This unassuming project has been patiently biding its time in the murky depths of my Non-Urgent-Things-To-Do list. After having the girls, there's no extra room in our apartment to welcome the occasional guest.

In a classic two-birds-one-stone maneuver, I thought I would do a little online browsing for sofa beds (Yay! The satisfaction of progress!) while also procrastinating writing this blog post (Yay! The sweet sweet relief of avoidance!). Excellent. But then, in a paradoxical victory of sorts, looking at sofa bed videos brought me right back to writing this post.

More thrilling sofa bed updates in a moment. First, a little primer about fear vs. anxiety.

Fear vs. Anxiety

Fear is the emotional state that arises in response to an immediate perceived threat. It's basically nature's alarm to help you survive when your safety is threatened. Your body and brain change gears to give you the means to fight, flee, freeze, or take cover. To help you take protective action, your mind becomes more able to detect and focus on sources of danger (Barlow, 2002).

Anxiety is the emotional state that arises in response to an anticipated threat. You may feel apprehension, worry, and muscle tension. The experience of anxiety may be less intense compared to a state of acute fear, but it might be much longer lasting. This depends, in part, on what stories your mind is telling you (Forsyth and Eifert, 2007).

While fear is oriented towards the present moment ("The house is on FIRE!"), anxiety is focused on an imagined future (1) ("What if I make a mistake and the house catches on fire?!"). Used adaptively, anxiety can help motivate us to plan appropriately for the future and take action.

However, the creative human mind can also come up with brilliantly compelling stories about potential threats that are so distant or so beyond our realm of control that there’s nothing we can really do to take action right now. Like a deer in headlights, we can fixate on those disturbing stories and forget about any adaptive problem-solving. We can even get stuck in a maladaptive cycle of anxiety that feeds into itself without resolution.

The Anxiety Cycle: Mind-Body Looping

Clinical psychologist and meditation teacher Tara Brach describes stuck anxiety as a cycle of mind-body looping (Brach, 2013). Let's say the mind focuses on the perception that something might go wrong (e.g., “What if I write this blog post and it's stupid and irrelevant?”). If we get tangled up and carried away by that threatening thought, it generates physical sensations in the body as well (e.g., a slight tension and quivering in my stomach; my heart beat quickens a bit and my breathing is slightly more shallow).

In turn, the mind picks up these physical signals. The body’s felt-sense of fear tricks the mind into confirming that the potential threats are true stories (“Of course there’s some real danger here! Why else would I feel like this?”). With the mind on high alert for threats, we detect and focus even more on anxious thoughts...and the cycle continues.

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If the looping becomes habitual we might feel chronically anxious. Fixated on an imagined future we start missing out on anything enjoyable, useful, or interesting that’s available to us right here, right now in the present moment. So how do we break the cycle?

Experiential acceptance vs. experiential avoidance

There’s a kind of futon-type sofa bed I was checking out. If you want to open it up into a bed, you have to do something a little counter-intuitive. Just pulling outwards to try to pry it open won’t work. It just locks in place. You actually have to push the backrest inward, towards the seat first. This activates some kind of release mechanism and voila! The sofa opens up and you’ve just created some bonus space to rest.

Understandably, we want to avoid what we perceive as the aversive, unpleasant experience of anxiety. We want to NOT feel what we are feeling and we instinctively pull away from it. But this experiential avoidance doesn't actually get us away from the anxiety. If anything, it seems to lock the anxiety into place! So what if we try turning inward, towards the anxiety instead?

RAIN: A mindful 4-step practice

You can see for yourself what it’s like to turn towards your anxiety, lean in, and stay present using Dr. Tara Brach’s (2013) 4-step RAIN practice:

1) Recognize what is happening

Close your eyes and bring to mind something that arouses anxiety. To build confidence as you begin to practice these steps, start by choosing something that is only mildly or moderately anxiety provoking.

Become mindful of your anxious or worried thoughts and notice the different forms they take: planning, rehearsing, trying to figure something out, a voice or some sort of mental commentary or judgment, or some visual images. Once you've identified your worry thoughts, whisper "fear thinking."

2) Allow the experience to be there, just as it is

Instead of avoiding or struggling against your inner experience, experiment with just letting it be. You might even experiment with saying “yes” or “I consent” as if you are giving yourself permission to fully experience and mindfully explore whatever is there.

3) Investigate with interest and care

Drop into your body, bringing your awareness below the neck with curiosity, openness, and kindness. Where does the worry and anxiety show up in your body right now? Bring your awareness to wherever you feel the anxiety most strongly in your body and notice the physical sensations: any pressure, tightness, ache, heat, movement, or other sensations?

It takes a lot of courage and willingness to stay present with unpleasant sensations. You can support yourself through this exploration with slow, gentle breaths.

4- Nurture with self-compassion

What does the anxious part of yourself most need to hear to feel comforted at this time? You can explore the ways you might deliver a message of kindness and care to the vulnerable part of you. Using a gentle tone of voice, you might offer some words like “it’s ok, I’m with you” or “that’s then and this is now”. You can also offer a caring physical gesture of some sort, like softly placing your hand on your heart.

After completing the four RAIN steps, use your senses to ground yourself in the here and now. Feel your feet on the floor or feel any other points of contact where your body is physically supported in this moment. See the light, shapes, and colours around you. Hear the sounds and let them flow through you. Take some time to notice what has changed in your body and your mind.

Each time you practice these steps, you’ll be further de-conditioning the tendency to get stuck in a useless anxiety cycle. Unlike the “false refuge” of distraction or rumination, we can lean in and open up a “true refuge” (Brach, 2013)—an inner space that’s always available to us… even in the midst of suffering and discomfort. Even when special guests like anxiety show up.


Maryann Joseph is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.



References

Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

Forsyth, J. P. & Eifert, G. H. (2007). The Mindfulness and Acceptance Workbook for Anxiety: A guide to breaking free from anxiety, phobias, and worry using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications.

Brach, T. (2013). True refuge: Finding peace and freedom in your own awakened heart. New York: Bantam Books.

T. Steimer (2002). The biology of fear- and anxiety-related behaviors. Dialogues in Clinical Neuroscience, 4(3), 231-249.


Notes

1) Although this is an important conceptual difference, there may be a great deal of overlap in the body’s physical response: the basic fear-based brain and behavioural mechanisms that evolved to protect us from imminent danger may be re-used to some extent for the fancier task of protecting us from distant or virtual threats (Steimer, 2002).

Understanding Borderline Personality Disorder: Part 2—BPD Treatment and How to Use It

Understanding Borderline Personality Disorder: Part 2—BPD Treatment and How to Use It

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In part I, I wrote about receiving a BPD diagnosis. A diagnosis opens the door to treatments that fit. This is an important first step, but what’s next? What do we know about treatments and how can they be helpful?

What we know about working with BPD

At its heart, BPD is pattern of strained relationships. This means that people with BPD have difficulty with relationships within themselves, with others, and with the world. At the root of these problems is a troubled relationship with emotions. People with BPD experience their feelings as more intense, urgent, and often unbearable. It is common for these individuals to experience a lot of distress, and come to mental health professionals feeling desperate for some relief.

As mentioned in Part 1, the intensity of the distress can have an impact on the relationship with health care professionals, leaving the parties involved feeling frustrated and helpless. As a result, and in an attempt to reduce the suffering, the person seeking help may end up being prescribed lots of different medications—many with unpleasant side effects. Although in some cases, certain medications might help with some of the symptoms, we have more recently learned that the best approach for treating BPD is not pharmacological, but rather involves effective psychotherapy (Paris, 2017).

In the 1990s, Marsha Linehan developed a treatment specifically to help individuals with BPD understand and change their relationship with themselves and the emotions they experience as mixed and intense. She called it Dialectical Behaviour Therapy (DBT), to highlight the importance of the “dialectical”, or “the plaid” which refers to working with opposite forces. For example, this can mean accepting one’s emotions and experiences as valid, while simultaneously working to change behaviours that have negative consequences (to read more about the “Plaid” and DBT, check out Michelle’s Blog post). With robust research support, DBT has gained significant recognition. It is effective, accessible, and popular, which has led many health care professionals and people seeking therapy to equate BPD treatment with DBT.

Although DBT has virtually become synonymous with BPD treatment, it is not the only psychological treatment available and appropriate for BPD. Many other approaches to therapy use other lenses to address BPD difficulties and have been shown to be effective. Mentalization-based therapy (MBT) is a particularly good fit because it aims to help people understand their internal experiences in order to change their relationships with themselves, with others, and the world. Similarly, approaches that focus on emotions (e.g., Emotion-Focused Therapy-EFT) or relationships (e.g., Transference-Focused Psychotherapy-TFP) have also garnered research support as effective in addressing the challenges that arise with BPD (Paris, 2017).

While there are lots of 3-letter treatment options, each with its own angle, there is not much evidence to suggest that one unique type of therapy addressing personality-related difficulties is actually superior than others for BPD (Livesley, Dimaggio & Clarkin, 2015). Among many researchers and clinicians specializing in BPD, there is some consensus that the best approach is to offer therapy that integrates relevant ideas from all approaches (Livesley, 2017; Nelson et al., 2017). When it comes to therapies addressing personality disorders, no one “brand name” does better than others (Paris, 2017). This is good news, because it means most therapy approaches for BPD work, and integrating more than one is even better.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

What’s important in BPD treatment

Knowing that integrating relevant ideas from different approaches is what seems to work best, how do we know which ideas to integrate?

First, since an intense experience of emotions is often what drives a lot of the difficulties, working to identify, understand and manage emotions is critical. Managing emotions might mean learning to take a step back, observe, and experience—survive the emotion without reacting. This process also helps reduce impulsivity by creating a space to be purposeful rather than immediately acting on urge. I like to think of it as having conversations with emotions. With time, these conversations shift the relationship with one’s internal experience and reduce the chaos.

Another piece of the puzzle is shifting one’s relationship with other people. This may involve learning about other people’s emotions and intentions, and about the subtleties of relationships more broadly. It often involves understanding physical, personal, and emotional boundaries (For more on boundaries, check out this blog post) as well as what makes a relationship sustainable.

There are other elements that we know contribute to progress in therapy for BPD regardless of the content of therapy or approach. This list includes having a consistent and predictable structure (e.g., regular, weekly therapy sessions), building motivation for change, and working toward self-reflection (Livesley, 2017).

Beyond all these factors, if you are looking for therapy that works, good fit with a therapist and investment in the journey itself are crucial to making therapy work. What does this therapeutic effort look like and what does this all mean about being in therapy when you have BPD?

How to be in therapy when you have BPD

  1. Give the process a chance. Lots of big feelings might come up as you begin, challenge yourself to get started even when it’s a substantial effort that feels uncomfortable at first.

  2. Once you’ve found a fit, stick to it and be consistent in order to build momentum. At the beginning, go weekly—even when you don’t feel like it, or if you have some other reason not to go. Therapy is a big investment of time, money, and emotional energy. If you allow yourself to build momentum and persevere, you will make it a valuable (and cost-effective) experience of personal growth.

  3. Tolerate difficult emotions as they come up: Showing yourself you can survive intense and difficult emotions is an important part of the process.

  4. Trust your gut, yet still challenge yourself. Ask yourself what your emotion is telling you, and whether rolling with the discomfort could possibly be beneficial to you. For example, it might look like facing your fear, giving a person a chance even if you’re angry, or getting out of bed even though you’re sad.

  5. Focus less on the what and more on the how. Listen to the words of your stories and take a step back to understand the big picture in what’s going on. Use this often in your therapy.

  6. Open up to talking about your emotions in therapy, especially when they have to do with your therapist. Tell them if you’re scared to talk about something, if you’ve felt sad or hurt after they said something, if you’re angry with them, etc. Lots of old and new feelings can come up in the therapeutic relationship. It’s your opportunity to work out the messy parts with someone who is qualified to help you.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Livesley, W. J., Dimaggio, G., & Clarkin, J. F. (Eds.). (2015). Integrated treatment for personality disorder: A modular approach. Guilford Publications.

Livesley, W. J. (2017). Integrated modular treatment for borderline personality disorder: A practical guide to combining effective treatment methods. Cambridge University Press.

Nelson, D. L., Beutler, L. E., & Castonguay, L. G. (2012). Psychotherapy integration in the treatment of personality disorders: A commentary. Journal of personality disorders, 26(1), 7-16.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.



对精神疾病的偏见阻止了亚洲移民寻求帮助 – 怎样才能克服障碍并寻求他们所需要的帮助呢?

对精神疾病的偏见阻止了亚洲移民寻求帮助 – 怎样才能克服障碍并寻求他们所需要的帮助呢?

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试想一下,要是我们生活在那样一个世界,每个人都可以公开而无顾虑地谈论他们的心理治疗过程,就像他们谈论看牙医或理疗一样(那该多好啊!)。虽然心理治疗在某些文化中非常常见,但这些在亚洲移民社区是闻所未闻的,对他们来说,讨论心理健康是很忌讳的,他们回避治聊,寻求帮助那是需要巨大的勇气的!严重的障碍不仅与精神疾病有关,而且因为精神疾病使人感到羞愧和负罪感,使得亚洲移民不愿意寻求帮助。此外,文化方面的挑战,例如“家丑不外扬”或“丑事不出门”的观念(以防止外人发现自己的心理健康问题),害怕受到社区的排斥,寻求帮助被视为一个人的“弱点”,对隐私的担忧,以及失去“面子”或给家人带来耻辱的可能性,可以进一步阻止他们承认/认可他们正在经历心理健康问题 (Chen, Kazanjian, & Wong, 2009; Thomson et al., 2018; CBC/Radio Canada; 2018)。

说起他们的原籍国,他们的主要支持网络由亲密的家庭成员,朋友和同事构成。移民到新的国度,原籍国的支持网络可望而不可及,这可能大大增加他们出现精神健康问题的可能性。本来在新的国度寻找新的支持来源就很困难,更何况许多人却不愿意获取帮助。已经有科研证据表明,亚洲种族的加拿大人最不愿意在他们的社区中使用心理健康服务 (Durbin et al., 2015; Li & Browne, 2009; Tiwani & Wang, 2008)。

由于可能存在语言障碍,强烈的羞耻感,内疚感和他们文化价值观中根深蒂固的抵触感,寻诊心理医生通常对亚洲移民族群来说,实在是不得已而为之。在他们看来,接受专业帮助通常被视为禁忌,经历心理健康问题的人,害怕被贴上“疯狂”或“不正常”的标签,因而常常有人讳疾忌医,或者擅停前期的心理治疗。那些亚裔移民,一旦寻诊心理医生,病情症状就要比其它族裔的加拿大人要严重的多, 因而治疗起来更加困难 (Fang, 2010)。此外,亚洲移民可能会把心理疾病病症误认为是身体疾病,那是他们更为重视、关注身体疾病,而忽视心理健康(或可能是因为羞耻而回避)。更为糟糕的是,由于媒体或文化观念的原因,亚洲族群可能存在许多误区,他们不知道临床心理学家所做的治疗,以及他/她可以提供的心理治疗服务。对于许多亚洲移民来说,心理学是西方人崇尚的东西,治疗的价值和效用是源自西方个人主义文化,都是以改善个人生活为重点的。这可能与集体主义文化价值形成鲜明对比,后者是更典型的亚洲文化,其中关注自我改善可能被视为自私,甚至使人感觉内疚。

最后,与加拿大相比,他们原籍国心理医生所起的作用可能大相径庭。在有些国家,心理学专业年轻, 且行业规范化管理也不是太好。来自这些国家的移民可能经历过不同的,也许是不怎么有效的心理治疗,这些会误导他们,使他们不理解接受心理服务的益处。其实,在加拿大,临床心理学家必须获得其省级监管委员会的许可(例如,魁北克的Order  of Psychologists),并且必须具备严格的学术资质和临床资质才有资格获得。如果您正在寻找符合您需求的心理治疗师,请访问魁北克 Order of Psychologists of Quebec / Ordre des Psychologues du Québec (O.P.Q.)的官方网站寻找你中意的临床心理治疗师: http://www.ordrepsy.qc.ca/.

那么,作为健康职业从业者,为了帮助移民们克服障碍,帮其所需,我们应该做些什么呢?

1)规范如何从加拿大心理服务寻求帮助,并鼓励他们在省级监管委员会内寻找心理治疗师(例如,魁北克Order of Psychologists)

2)鼓励他们克服障碍,看待心理问题就像心理得了“感冒”一样。鼓励他们寻求帮助,而不是让症状拖延,直到问题变成心理“发烧”(更严重的症状)

3)鼓励移民人群寻求社区支持 – 例如,在当地社区和文化中心,用他们的语言提供支持服务

4)协助他们利用社区和在线资源来教育他们,如何处置那些与移民和心理健康有关的问题。

5)解决人们避而不谈的,移民经常面临的种族歧视,种族隔离的问题

6)遇到不同文化背景的患者时,要有文化敏感性。 好奇并愿意了解患者的问题,并尝试了解他们的文化背景

7)提供有关身、心健康之间密切关联的心理教育

8)利用文化咨询服务,例如:https://www.mcgill.ca/tcpsych/clinical/ccs


Zhen Xu is a Ph.D. candidate in clinical psychology at McGill University and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram, or like us on Facebook.


参考资料

CBC/Radio Canada. (2018, March 1). 'The unspoken ones': How race and culture complicate Asian-Canadians' access to mental health care [News Release]. Retrieved from https://www.cbc.ca/radio/thecurrent/facing-race-the-current-s-town-hall-event-in-vancouver-1.4558134/the-unspoken-ones-how-race-and-culture-complicate-asian-canadians-access-to-mental-health-care-1.4558354.

Chen, A. W., Kazanjian, A., & Wong, H. (2009). Why do Chinese Canadians not consult mental health services: health status, language or culture?. Transcultural psychiatry, 46(4), 623-641.

Durbin, A., Moineddin, R., Lin, E., Steele, L. S., & Glazier, R. H. (2015). Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. BMC health services research, 15(1), 336.

Fang, L. (2010). Mental health service utilization by Chinese immigrants: Barriers and opportunities. Canadian Issues, 70.

Li, H. Z., & Browne, A. J. (2009). Defining mental illness and accessing mental health services: Perspectives of Asian Canadians. Canadian Journal of Community Mental Health, 19(1), 143-159.

Thomson, M. S., Chaze, F., George, U., & Guruge, S. (2015). Improving immigrant populations’ access to mental health services in Canada: a review of barriers and recommendations. Journal of immigrant and minority health, 17(6), 1895-1905.

Tiwari, S. K., & Wang, J. (2008). Ethnic differences in mental health service use among White, Chinese, South Asian and South East Asian populations living in Canada. Social psychiatry and psychiatric epidemiology, 43(11), 866.

Stigma of mental illness preventing Asian immigrants in seeking help – what it takes to overcome the stigma and find the help they need

Stigma of mental illness preventing Asian immigrants in seeking help – what it takes to overcome the stigma and find the help they need

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Imagine living in a world in which everyone feels free to talk about their therapy sessions openly without judgement, as they do about dentist or physiotherapy appointments. Although psychotherapy is a common practice in some cultures, this scenario is unheard of in the Asian immigrant community in which discussions of mental health are hushed, therapy is shunned, and seeking help takes tremendous courage. Not only is heavy stigma associated with mental illnesses, feeling shame and guilt for having a mental health issue also makes Asian immigrants reluctant to get help. Additional cultural challenges, such as the desire to “keep it in the family” or “not washing dirty linens in public” (to prevent outsiders from discovering one’s mental health issues), fear of being ostracized by their communities, seeking help as being seen as a “weakness”, concerns of confidentiality, and the possibility of losing “face” or bringing shame to their families can further prevent them from even acknowledging/admitting that they are experiencing mental health problems (Chen, Kazanjian, & Wong, 2009; Thomson et al., 2018; CBC/Radio Canada; 2018).

Back in their countries of origin, their main supportive networks may consist of close family members, friends, and co-workers. Immigration to a new country can significantly reduce the accessibility of social support networks in their home countries, which can greatly increase their vulnerability to mental health problems. It can be difficult to find new sources of support in a foreign country, yet many are still resistant to getting help. It has been shown that Canadians of Asian ethnicities are the least likely to utilize mental health services in their communities (Durbin et al., 2015; Li & Browne, 2009; Tiwani & Wang, 2008).

Due to possible linguistic barriers, strong feelings of shame, guilt and denial deeply rooted in cultural values, visiting a psychologist is usually seen as a last resort in Asian immigrant communities. Receiving professional help is often seen as taboo and people who experience mental health problems live in fear of being labeled as “crazy” or “insane”. Refusing to seek help or dropping out prematurely during psychological treatment is common. Symptoms of those who make it to the psychologist’s office are often more severe and more difficult to treat than Canadians of other origins (Fang, 2010). In addition, Asian immigrants may mistake psychosomatic symptoms for physical illness due to the importance and attention they give to physical health, yet they lack awareness of, or perhaps avoid, issues related to mental health.

Furthermore, there may be numerous misconceptions in the Asian community of what a clinical psychologist does and the services that he/she can offer, possibly due to media and/or cultural beliefs. For many Asian immigrants, psychology comes across as a western subject matter, with treatment values and perspectives developed in western individualistic cultures that focus on improving the life of the individual. This may be in direct contrast to collectivistic cultural values, which are more typical of Asian cultures, in which focusing on self-improvement may be viewed as selfish and even induce guilt.

Finally, the role of psychologists can be drastically different in their home countries compared to that in Canada. In some countries where the profession of psychology is young and not as well regulated, immigrants may have experienced different and perhaps ineffective psychological treatment, which misconstrues the potential benefits of psychological services. In Canada, psychologists must be licensed with their provincial regulation boards (e.g., Order of Psychologists in Quebec) and must have strict academic and clinical credentials to be eligible to do so. If you are looking for a psychologist who fits your patient’s needs, visit the official website of the Order of Psychologists of Quebec to find a suitable match: http://www.ordrepsy.qc.ca/.

So what can we do as health practitioners to help immigrants overcome stigma and find the help that they need?

1) Normalize seeking help from psychological services in Canada and encourage them to look for a psychologist within their provincial regulation board (e.g., the Order of Psychologists of Quebec)

2) Reduce the stigma by encouraging them to think of psychological problems as getting a “cold” psychologically. Encourage them to seek help instead of letting symptoms drag on until the issue becomes a psychological “fever” (more severe)

3) Encourage immigrant populations to seek out community support – e.g., at their local community and cultural centres that offer support services in their language of preference

4) Assist them in utilizing community and online resources to educate themselves about issues related to immigration and mental health.

5) Address “the elephant in the room” – racism and discrimination issues that immigrants often face

6) Practice cultural sensitivity when seeing clients of a different cultural background. Be curious and willing to learn about your clients’ issues and try to understand their cultural context

7) Provide psychoeducation regarding the close association between one’s physical and mental health

8) Utilize cultural consultation services such as: https://www.mcgill.ca/tcpsych/clinical/ccs


Zhen Xu is a Ph.D. candidate in clinical psychology at McGill University and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram, or like us on Facebook.


References

CBC/Radio Canada. (2018, March 1). 'The unspoken ones': How race and culture complicate Asian-Canadians' access to mental health care [News Release]. Retrieved from https://www.cbc.ca/radio/thecurrent/facing-race-the-current-s-town-hall-event-in-vancouver-1.4558134/the-unspoken-ones-how-race-and-culture-complicate-asian-canadians-access-to-mental-health-care-1.4558354.

Chen, A. W., Kazanjian, A., & Wong, H. (2009). Why do Chinese Canadians not consult mental health services: health status, language or culture?. Transcultural psychiatry, 46(4), 623-641.

Durbin, A., Moineddin, R., Lin, E., Steele, L. S., & Glazier, R. H. (2015). Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. BMC health services research, 15(1), 336.

Fang, L. (2010). Mental health service utilization by Chinese immigrants: Barriers and opportunities. Canadian Issues, 70.

Li, H. Z., & Browne, A. J. (2009). Defining mental illness and accessing mental health services: Perspectives of Asian Canadians. Canadian Journal of Community Mental Health, 19(1), 143-159.

Thomson, M. S., Chaze, F., George, U., & Guruge, S. (2015). Improving immigrant populations’ access to mental health services in Canada: a review of barriers and recommendations. Journal of immigrant and minority health, 17(6), 1895-1905.

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 Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In my July Blog post, I referred to what happens when certain personality traits are too high or too low, causing life difficulties. Borderline Personality Disorder (BPD) is one psychological diagnosis or label that mental health care professionals and clinicians use to describe a specific pattern of problems. Typically, this pattern involves intense, chaotic relationships with both the self and others. Even though some of the traits involved are amplified versions of normal personality traits, many people with BPD will experience problems that are serious, and that most people never experience (Paris, 2017). Although there are some commonalities and a general pattern, individuals with BPD do not all have the same problems or experiences.

Let’s think of Jessica for example. She was recently diagnosed with BPD. She’s always felt something was “off”. She suspected early in life that she wasn’t feeling the way others around her felt: her emotions have always been so intense, it was as though she was walking around with no skin. She’s noticed she reacts impulsively to these intense feelings, which change from one moment to another. One moment she can be thrilled, the next, filled with sadness or rage. Along with these strong emotions is also an emptiness inside that she’s not sure how to describe to others.

Sometimes she feels her life is not real and asks herself “what’s the point?”. She often thinks of suicide, wondering if it’s the only way to stop her suffering. She’s even attempted to end her life a few times by taking pills, with mixed feelings when hospitalized and treated for these overdoses. She questions who she is, often feeling like a bad person who isn’t worthy of love. When she gets into a relationship, she’s afraid the person will leave and looks for ways to prevent this, or to have her partner reassure her that they won’t. Eventually, the ups and downs and efforts to avoid being broken up with cause a lot of stress in the relationship and it ends.

Jessica has received many diagnoses by health professionals in the past, including Generalized Anxiety, Depression, Attention Deficit and Hyperactivity Disorder, and Bipolar Disorder. She has tried therapy numerous times and felt frustrated because nothing seemed to “stick”. Recently, a new psychiatrist she was seeing diagnosed her with BPD.

Receiving a BPD diagnosis

It’s important to remember that a diagnosis, especially one of BPD, is not an identity: it describes a cluster of problems in someone’s life—what’s not working for them. Receiving the BPD diagnosis can be the key to getting the right help. When Jessica first got diagnosed, she went home and looked it up online. She was angered to find that much of what she was reading suggested there is something wrong with her personality and that she would be “difficult to treat”. She felt ashamed and angry with her psychiatrist, who she had no intention to return to see. She felt as though another health professional had let her down.

Despite this, she also felt some relief that she could make sense of what’s been going on, and eventually decided she would go for another visit to ask a few questions. Although she was hesitant, she told her psychiatrist how angry she was and was surprised that this led to a conversation during which she felt understood and even hopeful about the future.

Jessica learned that this diagnosis would allow her to get more specialized help, and together she and her psychiatrist came up with a plan. With treatment that fits (and some patience), Jessica can go from being diagnosed with BPD to no longer meeting any of the criteria and leading a more satisfying life. It’s also important to remember that when the label no longer describes someone’s current problems, it no longer applies.

Unfortunately, because of stigma around BPD, many people are reluctant to accept or disclose their diagnosis, which can get in the way of receiving appropriate help.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

Why the stigma?

Compared to other disorders, BPD is a fairly new diagnosis, with treatments having only been developed in recent decades. There are times individuals with BPD feel like their experience is unbearable. Their symptoms often reflect the intensity of their distress; When Jessica went to see the psychiatrist, she had cut herself badly and said she wanted to give up on life. Although her psychiatrist identified her diagnosis, some health care professionals may not recognize BPD or know how to help, leaving all parties feeling frustrated. In fact, people with BPD are often not diagnosed or treated at all. Sometimes, they are offered treatments that do not fit their problems. Since intense emotions are part of the experience, speaking about what’s most painful with a health care professional, who is often a stranger, can be quite challenging.

It is not surprising that there would be friction between someone consulting for a situation that feels urgent and impossible, and a health care professional who isn’t sure how to help. Sometimes, the clinician may themselves react unfavourably when feeling unsure or helpless. As you can imagine, these reactions would not be well-received by someone in distress who already feels let down.

In fact, it is likely that someone seeking help for these symptoms has already had many frustrating experiences in the health care system. As a result, they might express anger (even rage) or withdraw from treatment, which in turn might lead to the clinician distancing themselves even more. This can become a continuous self-fulfilling cycle and can help explain some of the frustrations that people with BPD as well as clinicians face (Aviram, Brodsky & Stanley, 2006). Unfortunately, cycles like this one perpetuate the stigma and contribute to a reluctance toward both pursuing treatment (on the part of those seeking help) and providing treatment (on the part of clinicians).

Maybe you relate with parts of (or all of) Jessica’s experience, and you’ve experienced these frustrations yourself. If you’ve been feeling helpless, hopeless, and chaotic on the inside (and maybe outside too), or like no diagnosis has made sense so far: Remember there is the right kind of help out there—help you can use to help yourself.

What to do if you think you might have BPD and want to consult:

1- Take a deep breath. Remember these are words to describe problems you are experiencing, and that having these words means you can communicate to get the help you need.

2- Look for someone who is qualified to assess and work with personality in therapy, or ask for a referral to someone who does. You can look online, or ask your GP or most health care professionals.

3- Be prepared to speak with someone by taking note of what’s most important to share about what you are experiencing.

4- When meeting a health care professional, observe whether you are feeling intense emotions, and challenge yourself to be open—to stick around and share your experience as best as you can, even if lots of uncomfortable emotions rise to the surface. Ask yourself: how can I help this person help me? Sharing your difficulties and what you are looking to work on are some ways to collaborate.

5- Give the person time to get to know you and figure out how to help. They may not know right away.

Don’t give up on getting the help you’re looking for. Sometimes, it takes meeting with a few different professionals before you feel you’re on the right track.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard review of psychiatry, 14(5), 249-256.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.