Dialectical Behavior Therapy Skills Training for Professionals at Baylor University

I am proud to be presenting a one-day overview of DBT for mental health professionals and graduate students at Baylor University. This event will take place on Friday, November 1, 2019 from 9:00 am to 4:00 pm. Continuing education credits are available.

This learning opportunity will cover:

• the use of dialectical techniques to help manage behaviors related to both change and acceptance
• research to support the use of DBT for individuals who have difficulty regulating their emotions
• using DBT skills to target behaviors such as self-injury, suicidal thinking, and planning
• the four skills training modules: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation
• problem-solving for special clinical challenges

Lunch is included.

Interested in knowing more about me? You can learn more about my work by clicking here or you can check out my new book for families here.

For more information or to register, please visit Baylor University’s continuing education web site.

A Review of The Borderline Personality Disorder Workbook (2019) by Dr. Daniel Fox

Because effective and affordable treatment continues to be elusive for many people in the United States and other parts of the world, The Borderline Personality Disorder Workbook is an important and encouraging new book for anyone who is interested in a self-help approach to understanding borderline personality disorder (BPD) and recovery from the symptoms associated with the diagnosis.

Dr. Fox’s book is organized into five sections that spans over 250 pages. The first section is dedicated to educating the reader about BPD in a way that is both nonjudgmental and supportive. Dr. Fox uses a short narrative for understanding all nine DSM criteria in a nonclinical and understandable way. The reader can also conduct a short self-assessment to see where they fall in the spectrum of symptoms related to the diagnosis.

While many self-help books for individuals with BPD emphasize ideas from dialectical behavior therapy (DBT), this book also focuses on attachment theory, attachment styles, and defense mechanisms as a way of explaining many of the characteristics and behaviors related to BPD. For people who have been working with mental health professionals with a cognitive-behavioral approach, some of the ideas in this book may be new to many readers.

The Borderline Personality Disorder Workbook helps to focus the reader on actions that they can take to improve their lives. Some of the questions will be challenging for many readers. For instance, on page 53, Dr. Fox asks the reader, “Do you see benefits for staying where you are with the problems and issues you have related to BPD? What are the benefits?” Because the book includes a lot of questions and writing prompts that can’t be easily answered in space provided in the workbook, I’d encourage readers to keep a separate notebook or journal to record their observations and insights. Additional worksheets for some of the exercises, however, can be downloaded through the publisher’s web site for free.

It’s important to note that completing this book requires a lot of motivation. It might be most helpful for individuals with a diagnosis of BPD to use this workbook with the help of a compassionate and knowledgable therapist or a certified peer support specialist who can support the reader as they work toward their recovery goals.

In addition to the workbook, I also recommend that readers subscribe to Dr. Fox’s YouTube channel for more helpful resources and information about recovery from borderline personality disorder.

You can purchase Dr. Fox’s book on Amazon (US) by clicking or tapping this link. If you are in Canada, click or tap here to buy The Borderline Personality Disorder Workbook.

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Chocolate Coconut Avocado Pudding: A Mental Health Superfood for Borderline Personality Disorder

Can what we eat make a difference in how we feel?

Not all that long ago—and after some extensive reading and research—I began to connect the dots between nutrition and mental health. As a DBT therapist, I’ve watched many of my clients make a serious commitment to correcting significant (and often serious) nutritional deficiencies that have contributed to their emotional dysregulation. I now know that excellent, high-quality foods can make a positive difference when it comes to treating both depression and anxiety.

One of my favorite treats to make for myself and my husband is a lovely chocolate avocado pudding. This recipe is high in fiber, magnesium, vitamin C, vitamin B6, and polyphenols—micronutrients with antioxidant and anti-inflammatory benefits. It’s also a low-carb, keto-friendly dessert* that will help keep your blood glucose stable so that you can avoid the physical and emotional crash that often comes with eating foods higher in sugar. With just one serving, I promise that you’ll be full for hours.

Here’s how I make mine.

In a food processor, blend on high for two or three (2-3) minutes until thoroughly mixed:

• Two (2) ripe avocados
• 5.4 ounce can of coconut cream
• 1/4 cup of cacao powder
• (optional) a tiny bit of Stevia or Monk fruit to sweeten just a little

Chill in the fridge for one hour. This recipe makes two (2) servings.

You might want to top your pudding with extra nutritional goodness like:

• blueberries or raspberries
• local, organic honey
• chia or flax seeds
• Ceylon cinnamon
• unsweetened coconut flakes
• crushed pecans or Macadamia nuts
• homemade whipped cream
• Himalayan salt (just a pinch or two will complement the chocolate nicely)
• cacao nibs for some extra magnesium
• Lily’s chocolate chips (no sugar!)

If you’re looking for more information on the link between food and mood, I can recommend the book Nutrition Essentials for Mental Health by Leslie Korn, PhD. It’s a comprehensive bible of knowledge, information, and ideas for addressing many of the symptoms related to borderline personality disorder.

Please also check out my article Treating Borderline Personality Disorder Without Medications.

* You can also have this for breakfast!

Anxiety and Borderline Personality Disorder: Encouraging Statements for Panic Attacks

Anxiety, worry, fear, and catastrophic thinking are all common symptoms for individuals with a diagnosis of borderline personality disorder (BPD). Anxiety and panic attacks can be manifested through shallow and rapid breathing, crying, a racing heart, feelings of physical numbness in the hands or face, stomachaches, sudden headaches, and other symptoms. Some individuals think that they may be having a heart attack when they experience what feels like pain in their chest coupled with an inability to breathe normally. Anxiety can be truly terrifying for many people.

Other people become very quiet or are completely silent when they are panicked. People who are experiencing anxiety may shut down and might even dissociate—a way for individuals to emotionally protect themselves during emergencies (such as natural disasters or accidents) or during those moments when emotions and thoughts may become completely overwhelming. If you love someone with anxiety, you may find that it may be difficult to communicate with someone when they are having a panic attack. Your family member or friend may not be able to speak or follow directions for several minutes when anxiety is at its highest.

Sometimes people think that they need medications to help reduce their anxiety but the good news is that our emotions and emotional reactions don’t last forever. You may find that even intense anxiety may peak and then begin to diminish within a relatively short time span—often 10-15 minutes. A lot of people find comfort in knowing that anxiety may look and feel very different an hour from when their symptoms are at their worst. If we can be mindfully patient and compassionate with our anxiety, it will become more manageable.

Focusing on and reciting short statements can help us to survive extreme anxiety. See if you can say these short phrases as slowly as possible as a way to also help regulate your breathing. If you rush through these statements, they will not be helpful during a panic attack.

• Wise Mind. (You may know this one from dialectical behavior therapy—or DBT.)

• I am safe.

• I will survive this panic attack.

• I can love myself through this.

• I am not my anxiety.

• I can let go of fear.

• Breathe.

• Everyone worries.

• I am helping myself.

• Just this moment.

• It’s okay to not be okay.

You may have another word, phrase, or even a short prayer that helps you to survive extreme anxiety. Please use whatever strategy works best for you or bookmark this page so that you can find these ideas quickly when you need them.

Once the panic attack is over, you’ll want to be exceptionally kind to yourself and find a way for you to validate your pain. For instance, you could tell yourself, “I’m doing the best that I can on a tough day.” Or you might remind yourself that, “I’m learning different ways to cope with my anxiety.”

Sometimes people feel embarrassed or ashamed of their very normal emotional reactions—especially if they were given the message during childhood that it wasn’t safe or acceptable to express emotions. Believing that we “should” feel or react a particular way can keep us stuck in unwanted emotions much longer.

If you are finding that fear and worry is interfering with your relationships or if anxiety is keeping you from reaching your goals, I encourage you to work with a mental health professional who understands what it’s like to live with anxiety. A trained therapist can often teach you how to manage your anxiety within a short amount of time—all without addictive and potentially dangerous medications like benzodiazepines.

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Below I’ve listed some of my favorite books that I like to recommend about treating anxiety:

The Anti-Anxiety Food Solution

The DBT Skills Workbook for Anxiety

Mindfulness for Borderline Personality Disorder

What helps you the most when it comes to successfully coping with anxiety?

Interview with Shehrina Rooney—A New Book About Recovery from Borderline Personality Disorder

Yay! I love new books that I can recommend to my clients and their families. Please share this book with others. —Amanda L. Smith, LCSW

Tell us about Recovery Mum—your YouTube channel. How did you get started?

I was new in recovery from drug addiction and had just completed seven months as an inpatient at a 12 step rehab. When I left treatment I threw myself into 12 step meetings, doing at least one a day. Nine months after leaving treatment, my children who had been living with my Mum, came back to live with me. When I would tell them I needed to do a meeting I would be met with cries of “please stay at home with us Mummy! We like it when YOU get us to sleep”. I felt torn as I knew that my recovery was vital but I also knew the kids were too young to understand that. I started to think of all the other Mum’s out there that also struggled to attend meetings. That’s when I decided to set up Recovery Mum. I thought I would share my stories with people in the hope that it would help them. Initially I thought the channel would be more drug and alcohol recovery based, but in a short period of time I realised just how many people out there suffer with BPD. I honestly had no idea! I also realised that the same concept could work with people with BPD – one person in recovery helping another, just as fellowships such as AA and NA work. My channel now focuses on all the issues that I have personally struggled with, such as BPD, addiction, depression, post-partum depression, anxiety and an eating disorder. 

Who is The Big Book on Borderline Personality Disorder intended for? Whom did you have in mind as you were writing it?

When writing The Big Book on Borderline Personality Disorder, first and foremost at the front of my mind was those people who are still in the grips of this disorder. I wanted to not only help them understand the disorder and therefore themselves a bit better, but also to give them a message of hope. Going back 10 years ago, I never believed there was a way out of the hell that I was living in and for a long time I didn’t see the point in treatment as I thought it was pointless. I want others to know that there IS a way out.

Secondly I wanted to help loved ones of people with BPD understand this disorder. Outsiders only see our behaviours – they don’t know the thoughts and feelings we have that are driving these behaviours. That’s why I have included our thoughts and feelings as well as our behaviours in each chapter describing the BPD traits.

Was writing The Big Book on Borderline Personality Disorder personally challenging to write?

Believe it or not, I didn’t find it too challenging. I have spent the last few years talking about BPD on my YouTube channel so much that a lot of the information is just there, fresh in my mind. Obviously some days were better than others, where the words would just flow, followed by days of being stuck on one paragraph!

What was a typical day like for you when you were writing The Big Book on Borderline Personality Disorder?

A typical day would be me waking at 7am and rushing around to get the children ready for school. Once back home, I would open up the laptop and start writing. Lottie, my 1-year-old would be playing in the same room so I would try and alternate between writing and playing with her. Once Lottie went up for a nap I would film a video for my YouTube channel and then get back to writing until it was time to do the school run again. As soon as I walked back through the front door I would go straight into the kitchen to begin making dinner. It wasn’t until all 4 children were asleep after each having stories read to them that I could start writing again. I would try and write most evenings. Literally every spare moment I had needed to be spent writing! I completed the majority of the book in just over three months.

What has made the biggest difference for you in your recovery?

Having balance and a routine in my life! I never used to know whether I was coming or going. I was taught in rehab that if we make a daily plan and stick to the plan we won’t go off plan! This helps keeps us safe from relapse. Being spiritual has also been incredibly beneficial. The wonderful thing about spirituality is that there is no right or wrong way of doing it – you just do what feels right for you. For me that is keeping check of my behaviours and thinking of others – basically, be nice.

What do you wish everyone could know about borderline personality disorder?

That we can recover from it and go on to lead very happy lives.

What's the most important thing for family members to know about borderline personality disorder?

That we don’t choose to have this disorder and we don’t behave the way we do because we are nasty people – we are people that are suffering with overwhelming and intrusive thoughts and feelings that are so intense we feel them physically as well as mentally.

What advice would you give to your 18 year-old self?

I would tell myself that I have an inner strength I am not yet aware of. I would tell myself to not give up, no matter how bad things seem to be, there is light at the end of the tunnel – it’s just that I can’t see it yet, but it’s there.

What advice do you have for someone who has just been given the diagnosis of borderline personality disorder?

Don’t panic! This is NOT a life sentence! Recovery IS possible – and be careful when googling BPD as there is a lot of misinformation out there. I would say that if the information seems negative, stop reading it. There are a lot of people out there that have been hurt by someone with BPD and due to this hurt they can be really angry – often posting information that is very one-sided, inaccurate and damaging for someone in early recovery to read.

What is the most effective way for you to self-soothe when emotions are running high?

For me, going to the beach and watching the waves is so calming. I feel so small when looking out at the ocean and it really helps me connect to something bigger than me, a higher power.

When I start to feel my mood dropping I also self soothe by having a movie night on my own. I order Chinese food to be delivered, snuggle under a blanket on the sofa and watch a comedy that’ll make me laugh. I feel so relaxed afterwards.

What inspires you the most?

My Mum is my inspiration. She stood by me when so many others didn’t. My brother has been diagnosed with a progressive degenerative brain disease and he is slowly losing his motor skills, talking, walking, eating, etc. My Mum looks after him now and still finds time for her grandchildren, a children’s charity, work, friends and family – she is literally super woman.

What music is currently on your playlist?

I have such a variety of music that I listen to – everything from 60’s tunes by The Temptations, Ben E King and Aretha Franklin, to Ed Sheeran, Taylor Swift, Meatloaf, Eminem, Dappy, Madonna, Rihanna, Backstreet Boys,  Il Divo,  Rag n Bone Man, DJ Khaled and Justin Bieber! I’m listening to The Greatest Showman album a lot at the moment! I don’t have a favourite ‘type’ of music – it all depends on my mood.

Recovery from BPD really is possible. Congratulations, Shehrina! Check out her book by clicking here. If you are in the United Kingdom, click or tap here to purchase Shehrina’s book.

The Ethics of Treating Suicidal Clients

On Wednesday, August 15 I'll be giving a professional presentation on the ethical obligations and risks of treating clients who are suicidal. 

This event will take place from noon to 1:00 pm at NAMI Waco located at 4112 Memorial Drive in Waco, Texas. Licensed professionals will be able to earn one credit toward their professional development requirements. The cost is $15 and lunch will be provided.

Please RSVP to namievent@gmail.com. 

101 Coping Statements for Self-Injury and Self-Harming Behaviors

You may have lots of reasons to harm yourself. 

When you're ready to make a different decision (even if it's only for an hour or two) here are some positive coping statements that you can use to tell yourself to stay strong and stick to your goals.

1. I have others ways to cope with problems.
2. People get worried when I cut.
3. I don't want scars.
4. I can decide to treat myself with kindness.
5. I want to show respect for my body.
6. I can find ways to tolerate my emotional pain.
7. I can tolerate being upset without self-injury.
8. My emotions are always changing.
9. My urges are always changing.
10. My thoughts are always changing.
11. I can love myself until the urge passes.
12. I wouldn't want someone I love to hurt themselves.
13. Emotionally healthy people find ways to cope.
14. I may feel better an hour from now.
15. I feel ashamed after I burn myself.
16. I don't have to make a bad situation worse.
17. I like my skin.
18. I don't want to hide my body.
19. It's been X number of days since I last engaged in self-harm.
20. I choose life.
21. I don't need more trauma in my life.
22. People may think that I don't care about my recovery.
23. When I'm in Wise Mind, I know life will get better without cutting.
24. Burns are ugly.
25. I care about my future.
26. My body is sacred.
27. I can temporarily decide to be self-compassionate.
28. I can wait to see if I change my mind later.
29. I am worthy of recovery.
30. I don't want to delay my healing.
31. My family might think that I want to die.
32. People will judge me.
33. Life is already challenging and cutting makes my life harder.
34. I can self-validate my urges.
35. I can be a strong person.
36. Brave people don't harm themselves.
37. I am a not a victim.
38. I can use my DBT skills instead.
39. I believe in myself.
40. I can accept my urges but choose to do something else.
41. I want to inspire others.
42. Instead of cutting, I can listen to music.
43. I hate the guilt that comes from self-injury.
44. I can call my therapist or a warm line.
45. Holding ice until it melts helps me to feel pain without permanent injury.
46. I can choose to love myself.
47. There are too many cons and not enough pros.
48. Urge surfing can help.
49. I might need to go to the hospital if I really hurt myself.
50. Self-harm is embarrassing to talk about.
52. My boyfriend might think I can't handle life.
53. My girlfriend might get scared and break up with me.
54. Cutting and burning are messy.
55. I scar easily.
56. Cutting is gross.
57. My therapist will be disappointed.
58. Self-harm makes me hate myself.
59. I can handle the ups and downs in life.
60. I'll be proud of myself if I resist.
61. Self-injury is sad.
62. People will pity me.
63. I don't have band-aids. 
64. It will hurt tomorrow.
65. I have goals.
66. Self-love is an important value for me.
67. I'm working towards being a healthier person.
68. I am courageous and brave today.
69. I can reduce my suffering in other ways.
70. I don't want for others to think less of me.
71. My therapist might want to put me in the hospital.
72. I promised others I wouldn't cut.
73. I can take care of myself by letting others know I need help.
74. I hate being covered up while I wait for my body to heal.
75. I can accept my emotional pain.
76. I believe in my ability to overcome burning.
77. Long-sleeves are too hot.
78. Self-injury doesn't solve problems.
79. I'm not a slave to my emotions.
80. I don't deserve self-injury.
81. The smart, cool kids aren't cutting. 
82. I can image a life without self-harm.
83. I'm going to be okay.
84. My family might call 9-1-1.
85. I can journal instead of self-harming.
86. It's okay to find other ways to feel my emotions.
87. Things will get better when I get better.
88. I value happiness.
89. Cutting doesn't improve my relationships.
90. I'm smart enough to help myself in other ways.
91. Cats don't engage in self-harm.
92. Blood smells awful.
93. I am a strong and resourceful person.
94. I'll be proud of myself tomorrow.
95. Drawing or painting can help pass the time until my urges go down.
96. I want to be someone who doesn't cut.
97. I can soothe myself.
98. I can take myself to the movies instead.
99. Cutting isn't meaningful and meaning is important to me.
100. People might think I'm "crazy."
101. I take responsibility for my recovery.

Looking for a way out of your emotional pain? Dialectical behavior therapy may help. And check out these cute little self-harm prevention temporary tattoos.

Understanding Identity and Self-Awareness

Who are you? Who do others think you are?

These are sometimes difficult questions or ideas for individuals who are emotionally sensitive or who are coping with a mental health diagnosis.

Anyone is welcome to join us—including family members and friends—on Wednesday, January 10 at 8:00 pm Eastern/5:00 pm Pacific for a closer look at how we can understand ourselves, our values, our strengths, and our relationships better.

The investment for this live 90-minute webinar is just $19. However it's free for subscribers to My Dialectical Life. If you're a subscriber, email me for a special invitation.

The webinar will also be recorded for future listening. Simply log in and access the recording. It's that easy!

Please click here to register today.

How to Let Borderline Personality Disorder Ruin Your Life

It's important to recognize that individuals with a diagnosis of borderline personality disorder have a very good or even excellent prognosis. Most people not only get better but they remain healthier and happier for the rest of their lives.

However if you're someone who would like to stay miserable for decades, here are some tips for staying stuck as long as possible.

1. Invalidate yourself.

You can engage in invalidation by calling yourself names, telling yourself that you can't do something, imagining that you'll never get what you want, and by thinking that life will never improve. If you find that you're having neutral or even positive thoughts, firmly decide that recovery is for other people and that an evidence-based treatment such as dialectical behavior therapy is imperfect and just won't work for you.

2. Stay in bed.

If you're tempted to get out of bed at a reasonable time, imagine all the things that may happen if you leave your home. Tell friends that you are too sad or suicidal to get together with them. Tell your family members that you know nothing will ever change and that you'll always be a failure. Keep thinking that you can really only rely on the illusion of friendship you may get from Netflix and gaming from the safety of your bedroom.

3. Don't go to treatment.

You might think that treatment or therapy might help but just consider how imperfect therapists and treatment programs are. At some point, they are going to ask you to make a commitment to making tiny changes or they might even suggest that you work towards accepting yourself just the way you are. You already know that it's going to be challenging. Isn't it easier just to stay in bed?

4. Ignore your physical health.

Tell yourself that a poor diet, no regular sleep schedule, or a lack of exercise doesn't make any difference in how you feel emotionally. I mean, you're an adult. Why not eat whatever you want and sleep whenever you want? Exercise may just wear you out. If someone tells you that you might feel better if you go for a walk, ignore them and tell them that they don't understand what depression is like.

5. Be dismissive (or downright mean) to the people who care about you the most.

If someone tells you that they love you, scoff at or ridicule them. If someone tells you that they care, believe that there is something wrong with them. When other people want to hang out with you, never say yes because it will only encourage them to ask again. Remind yourself that if you keep burning your bridges, people really will leave you alone. Thankfully, being alone will reinforce your feelings of loneliness and make them even stronger. This will give you even more to complain about.

Staying stuck is a choice that you don't have to make. Today you can do something different.

Interested in learning more about how you can start helping yourself—or someone you love?

• DBT Self-Help
• Online BPD Family Course
• How to Recover from Borderline Personality Disorder

Borderline Documentary is Coming to Waco

Join me for an evening at downtown Waco's historic Hippodrome Theater where will view the documentary Borderline by filmmaker Rebbie Ratner, MFA.

This special event will take place on Wednesday, September 6 at 7:00 pm. The address for the Hippodrome is 724 Austin Avenue.

While the film is free to attendees, seating is limited. A suggested donation of a tax-deductible gift of $5.00 will benefit NAMI Waco. 

Please reserve your seat today by emailing Amanda L. Smith, LCSW at amanda@hopeforbpd.com. 

For more information, check out the film's web site.