Treatment Plan Ideas for Borderline Personality Disorder

Borderline personality disorder (or BPD) can be challenging (but certainly not impossible) to treat.

As an intensively-trained DBT therapist who specializes in BPD and self-harming behaviors, I want for individuals and their families to know that BPD is highly-treatable, and that most people will see significant improvement using evidence-based treatments for this disorder.

Below I’ve organized some treatment plan goals organized by DSM-5 criteria. This approach may be helpful for some but I also want to acknowledge that alternative models for diagnosing and understanding BPD (or traits of BPD) exist. An example can be found on pages 766-767 of the DSM-5.

While this list was created for mental health professionals, peer support providers, and graduate students in mind, individuals who are taking a self-help approach are strongly encouraged to use these ideas to create their own personalized treatment plan. Readers will note that many of the treatment plan ideas may also be applicable for individuals with a diagnosis of PTSD, depression, anxiety, and even ADHD.

Finally, this is an incomplete and imperfect list. Your expertise and clinical wisdom will help fill in the many gaps that are inherent in any proposed treatment plan.

Note: Please also check out my article How to Recover from Borderline Personality Disorder.

Fear of abandonment

☐ Work toward building healthy relationships

☐ Learn about creating healthier relationships by reading books like The High-Conflict Couple and The Relationship Cure

☐ Spend time connecting with friends and family members for at least one hour each week

☐ Become involved in community activities (volunteer at an animal shelter, join a theater group, get involved in a community chorus, use MeetUp to find groups)

☐ Engage in religious services or activities

☐ Attend local support and self-help groups

☐ Identify cognitive distortions in relationships

☐ Consider the role of forgiving or receiving forgiveness in renewing important relationships

☐ Learn about attachment styles and theory by reading Attached: The New Science of Adult Attachment and How It Can Help You Find and Keep Love, The Highly Sensitive Person in Love, and The Attachment Theory Workbook

☐ Use DBT skills like GIVE, FAST, check the facts, and mindfulness of others

Unstable and Intense Relationships

☐ Identify core relationship values

☐ Learn about creating healthier relationships by reading books like The High-Conflict Couple and The Relationship Cure

☐ Practice validating others

☐ Practice self-validation and self-acceptance

☐ Commit to safety in unsafe relationships

☐ Be proactive in reaching out to people who are important

☐ Identify cognitive distortions in relationships

☐ Use DBT skills like mindfulness of others, GIVE, FAST, and DEAR MAN

Identity Disturbance or Unstable Sense of Self

☐ Identify core values

☐ Create list of personal and professional strengths

☐ Read inspiring recovery stories

☐ Practice self-validation and self-acceptance

☐ Practice self-forgiveness

☐ Create a personal mission statement

☐ Establish short-term and long-term goals

☐ Use DBT skills like accumulating positives, problem solving, and mastery

Impulsive Behaviors

☐ Practice self-validation and self-acceptance

☐ Learn how to self-soothe

☐ Use crisis resources

☐ Create a relapse prevention plan

☐ Reach out to a sponsor, friend, or therapist before engaging in impulsive behaviors

☐ Use mindfulness and distress tolerance (pros and cons) skills from DBT

Suicidal Behavior, Suicidal Threats, or Self-Harming Behaviors

☐ Practice self-validation and self-acceptance

☐ Learn how to self-soothe

☐ Make a list of reasons to stay alive

☐ Create safety plan

☐ Keep a gratitude list to help increase desired emotions

☐ Use coping statements when urges to self-harm are high

☐ Use crisis resources

☐ Read How I Stayed Alive When My Brain Was Trying to Kill Me

☐ Read Yes to Life: In Spite of Everything

☐ Use mindfulness and distress tolerance skills from DBT

☐ Address self-injury with a separate treatment plan

Emotional Instability

☐ Practice self-validation and self-acceptance

☐ Learn how to self-soothe

☐ Reach out to support persons during a crisis

☐ Practice naming and describing emotions

☐ Learn how to reduce shame, guilt, and embarrassment

☐ Journal as a way to track and understand emotions

☐ Accept emotions instead of avoiding or pushing them away

☐ Use distress tolerance and emotion regulation skills from DBT

Emptiness or Boredom

☐ Read inspiring stories about people who have overcome obstacles

☐ Learn how to self-soothe

☐ Use tools to help manage time and schedules

☐ Volunteer at least once a week

☐ Practice behavioral activation

☐ Engage in religious services or activities

☐ Read (or listen to) Viktor Frankl’s Man’s Search for Meaning

☐ Create art, write, or play music to alleviate boredom

☐ Use mindfulness and distress tolerance skills from DBT

Intense or Inappropriate Anger

☐ Practice self-validation and self-acceptance

☐ Learn how to self-soothe

☐ Find ways to practice relaxation and reduce stress

☐ Improve sleep hygiene with ideas from CBT for insomnia

☐ Run, walk, swim, climb stairs, or jump rope to release anger

☐ Respond with curiosity. Ask, “What is underneath the anger?”

☐ Use mindfulness, opposite action, radical acceptance, and distress tolerance skills from DBT

Paranoia or Dissociative Symptoms

☐ Practice grounding exercises

☐ Learn how to self-soothe

☐ Increase present moment awareness

☐ Use ideas from somatic experiencing to address trauma and reduce dissociative symptoms

☐ Read Coping with Trauma-Related Dissociation

☐ Use mindfulness, check the facts, and distress tolerance skills from DBT

General Well-Being

☐ Exercise four to six times a week for a minimum of 20 minutes

☐ Pay attention to nutrition and diet

☐ Practice sleep hygiene

☐ Refrain from using drugs or alcohol to manage emotions

☐ HALT: When emotionally dysregulated, ask, “Am I hungry, angry, lonely, or tired?”

☐ Attend support or recovery groups

☐ Consider the role of mentors and coaches to enhance treatment

☐ Read articles and books about BPD and related symptoms (depression, anxiety, and trauma)

☐ Keep all therapy/treatment appointments

Additional Considerations for the Therapist

☐ Help provide a framework to define mental health for the client and family members

☐ Use tools such as the Ways of Coping Checklist (pdf) to focus on strengths

☐ Take advantage of opportunities for additional consultation and supervision

☐ Provide resources to family members

☐ Use caution when making assumptions about what the client can (or cannot) do

☐ Rule out medical causes for emotional dysregulation

☐ Assess for excessive shame within the therapeutic relationship (“I am bad for needing help.”)

☐ Remain hopeful

32 Ideas for Using the FAST Skills from Dialectical Behavior Therapy

The FAST skills were developed by psychologist Marsha M. Linehan in the 1980s as a part of dialectical behavior therapy (DBT).

The FAST skills remind us that we can increase our self-respect by:

F = being fair to ourselves as well as others
A = not apologizing or not over-apologizing
S = sticking to our values and beliefs
T = telling the truth

The other Interpersonal Effectiveness skills in DBT are GIVE (to help us improve our relationships with others) and DEAR MAN (a skill to help us get more of what we want or need).

If you are looking for ways to practice the FAST skill, consider the wisdom of:

• Giving ourselves permission to be in healthy and safe relationships

• Saying no when we need to say no

• Saying yes when we don’t often say yes

• Asking for a second opinion

• Expressing concerns without being aggressive or mean

• Giving ourselves the time to have personal space before making a big decision

• Allowing ourselves the opportunity to make mistakes

• Stating preferences for movies, restaurants, and activities when we’re with friends or family members

• Telling someone what we think while being kind and compassionate

• Advocating for a cause or organization that is important to us

• Letting others know how we want to be treated

• Asking someone to listen to us for five minutes without interrupting

• Prioritizing treatment or therapy

• Forgiving ourselves

• Not apologizing for getting the rest we need to be our best

• Thinking about how we can reach our goals

• Being honest with ourselves about things we could improve

• Creating and sticking to a safety plan

• Not apologizing for crying

• Letting go of self-judgment

• Deciding that we are “good enough”

• Taking care of ourselves by making our beds in the morning

• Living within a budget we establish

• Earning a living wage at a job we enjoy

• Not apologizing for needing help

• Asking ourselves, “What are my values in this relationship?”

• Thinking about how often we apologize

• Attending church or religious services

• Letting go of being demanding or controlling in relationships

• Treating others in a way that we also want to be treated

• Not apologizing for our thoughts or emotions

• Asking for additional help before there’s a crisis or emergency

Remember: There’s no perfect or right way to use these skills. What works best for you? How are the FAST skills helping you to create a life worth living?

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For additional information about DBT, check out:

DBT Self-Help

Ideas for Using DEAR MAN

101 Ideas for Self-Soothing

What Does it Mean to Be Dialectical?

A Conversation with Elizabeth Stuntz, LCSW about Coping with Cancer (2021)

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Tell us about your background and the catalyst for writing this book.
I am a Zen student and psychoanalyst with a family therapy background, heavily influenced by DBT. As a cancer survivor who lost my mother and grandmother and too many friends to cancer, I have had a long term interest in awareness of and services for the social and emotional aspects of the disease. After being encouraged by my Zen teacher, Marsha Linehan, to be open to all experiences and perspectives, I recognized the value of the DBT framework for people living with cancer.

Now, Linehan and I have developed a program of coping skills based on DBT. Our work is informed by the wisdom of Zen, now validated by neuroscience and psychoanalytic thinking. We wanted to try to fill a gap highlighted by Institute of Medicine that constructive ways to deal with the social and emotional sides of cancer were not keeping pace with the amazing progress in medical treatments.

We felt it was important for patients and their loved ones to know that their reactions are understandable. And, that there are also ways to mange fear, anxiety, sadness or anger that may be more intense than is in their interest. We share strategies to make wise decisions and be hopeful without being in denial. We include tools for patients to let loved ones, colleagues and medical providers know what they want and need without compromising a relationship or their self regard. Lastly we present ways to live meaningfully even in the darkest days.

What do therapists and medical professionals need to know about the emotional toll of a cancer diagnosis and treatment?
Patients can doubt themselves. They may question whether they are coping the way they "should." Are they too overwhelmed? Are they facing facts? Should they be more positive? Less stressed? More in control? Less angry?

They may have a roller coaster of emotions. They may be frightened, anxious, sad or angry about an unknown future. It is not uncommon to have ideas about their health, relationships or themselves that are not based on facts. Some worry whether the need to rely on others will change the relationship. Are they viewed differently now? Seen as needy, helpless or a burden? Everyone responds uniquely. Some feel alone. Others may be the one to distance - perhaps defensively or in reaction to feeling smothered, pitied or discounted.

It is important for loved ones, therapists and medical professionals to validate the understandable anxiety, fear, sadness or anger that can come with cancer. It is helpful when those in the patient's life also know ways to help balance those reactions when they are more intense than is useful.

Using Strategies from DBT to Cope with Cancer

How can dialectical thinking help people who have been diagnosed with cancer endure the unknowns and balance uncertainty with hope.
The D of DBT stands for dialectics. Two things that seem to be opposite can both be true. Dialectics makes it clear that it is possible to think feel or act in more than just one way. What is the relevance for cancer? When we are upset, it is easy to reduce life and our view about ourselves to one way or the other, black OR white, good OR bad. Things are either a total disaster OR no big deal. We are in control of what is happening OR powerless.

Life with cancer is actually more complex. In many cases, a cancer patient is neither simply completely healthy NOR dying immediately. A larger balanced perspective includes ideas that can seem to be at odds. For example, it is possible to feel weak AND act strong. We can be unhappy about cancer AND still be happy about parts of our life. The key to coping is taking a balanced view that includes BOTH views. Indeed, we can feel frustrated by the limits of our control over cancer AND recognize that it's possible to learn effective ways to deal with what is happening.

I like to compare coping to going back and forth on a seesaw. Paying attention to the continual movement between seemingly opposite sides helps to maintain a more balanced perspective. Acknowledging the ebb and flow between sides helps make this balance act work. While we start on one end of the seesaw, we need to notice the other extreme so we can push off and not remain stuck. Yet, like a on a seesaw, no one really stays in that balanced place all the time. In dark times, it is easier to deal with hopeless feelings when we remind ourselves that light still exists, even at moments we can't see it.

What is your favorite skill?
Wise mind is particularly useful for people living with cancer. People have more faith in them selves when they recognize and trust their own intuitive wisdom. They realize the balance of their emotions and logic, bringing together left-brain rational thinking and right brain emotions, helps them trust their own sense of what is and is not in their interest. They feel more capable of making the difficult decisions they can face.

Do you believe that DBT can help anyone facing a medical challenge?
DBT can be very helpful to anyone facing a medical challenge or dealing with unknowns in general, including this COVID pandemic. Any situation where we feel uncertain or out of control may leave us unsure how to manage feeling more anxious, sad or angrier than is in our interest. Yet, coping is less about the particular stress and more about how we respond to it.

Like dealing with the unknowns of cancer, other medical conditions or this pandemic may leave us feeling frightened, helpless about our health or more isolated. The strategies to balance uncertainty with hope can be particularly useful.

Effective coping in challenging times like cancer, other medical conditions or COVID involves five steps, facing the circumstances and then balancing the four parts of our response.

1. Accepting the reality of the danger is an essential first step. We can't manage problems we haven't recognized. For example, right now the reality for us all is that COVID is dangerous and spiking

2. Pausing to recognize and identify our emotional response. The neuroscience expression is "name it to tame it.”

3. Broaden our perspective by balancing distressing thoughts with ideas that may seem at odds.

4. Use our body to promote calm. Longer exhales can slow down the rapid heart rate that comes with anxiety. Scanning the body and relaxing tight muscles can ease tension.

5. Take actions to balance the painful parts of life with actions that evoke opposite feelings. Laughter is some of the best medicine for sad times or COVID blues. Connections on Zoom, reorganizing at home or learning new skills can offset feeling isolated or less in control. Finding safe ways to support others may minimize a sense of helplessness and loss.

I am not simply saying just look on the bright side, as being distressed about cancer or a pandemic is understandable. Yet, a balanced view that considers both sides of the situation and our reactions may ease our anxiety and strengthen our resilience, as we trust that we can cope.

A broader view of a medical crisis like cancer or a pandemic presents both an immense challenge and a unique opportunity to remember what and who are most important to us.

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Congratulations, Liz! You can purchase Coping with Cancer: DBT Skills to Help You Manage Your Emotions and Balance Uncertainty with Hope here.

An Interview with Maggie Mullen, LCSW About The Dialectical Behavior Therapy Skills Workbook for Psychosis (2021)

Tell us about you and your interest in DBT.
I’m a licensed clinical social worker, trainer, and author based in Oakland, California where I live with my spouse and two cats. I specialize in culturally responsive care for psychotic spectrum disorders, trauma and PTSD, and the LBGTQ+ community. I’m also the Training Director for a Post-Master’s Fellowship program where I take a lot of pride in developing and mentoring the next generation of social workers.

I learned about DBT about 13 years ago when working to help people transition out of institutions and back into the community. What drew me to DBT was its development by someone who herself struggled with severe emotion dysregulation problems. Dr. Marsha Linehan, the creator of DBT, shared that when she was hospitalized as a young adult while struggling with suicide and self-harm, she made a pledge that if she got better, she would devote her life to helping others get out of this same hell. The lived experience that drove Dr. Linehan to develop DBT really spoke to me because I believe it’s critical to have treatments developed by and for the communities they serve.

Why DBT for psychosis? What's most important for therapists and clients to know?
People with Psychotic Spectrum Disorders (such as Schizophrenia or Schizoaffective Disorder) face significant barriers to accessing quality mental health treatment. More so than almost any other group, people experiencing psychosis are consistently overlooked by the mental health field as well as by society in general. As an example, when you look at the majority of psychotherapy research, you’ll find there’s almost always a rule out for psychosis. This has resulted in an almost exclusive emphasis on psychiatric medication to treat psychosis and overall avoidance of using psychotherapy or skill building to help people experiencing psychosis.

Recently a treatment called Cognitive Behavioral Therapy for Psychosis (CBTp) with a strong evidence base for helping people with psychosis has become more commonly used. I was trained in CBTp which I love and use regularly, but I felt like it lacked the types of concrete tools DBT offers to people when they’re emotionally overwhelmed. People with psychosis often get caught in a vicious cycle where their strong emotions make it more likely their psychotic symptoms will worsen. And then their symptoms tend to cause their emotions to escalate even more. For example, you might feel really ashamed after getting reprimanded at work. As a result of this increase in emotions, your psychotic symptoms are more likely to get worse, such as hearing distressing voices saying critical things to you. In turn, hearing these critical voices are probably going to make you feel afraid or sad and you’re then more likely to isolate yourself from others. This cycle just continues until we find a way to break it which is where DBT skills come in.

One way to think of DBT skills are as tools you can use to take back control of your life from your emotions. They can help you be more mindful, improve your communication skills, and get through a hard moment without doing something to make it worse. DBT skills do a really great job of helping reduce suicidal thoughts, self-harm behavior, PTSD, and drug use, all of which are very common amongst people experiencing psychosis. DBT is ultimately about helping people build a life worth living. That’s a powerful concept. Rather than simply doing suicide prevention with the goal of keeping you alive, DBT is about giving you a reason to fight for your life, a reason to do the work and stay motivated. I love that about DBT.

I started a DBT skills group for people experiencing psychosis in 2014 in an effort to make these skills available in a more accessible and concrete way. Offering simplified DBT skills to people dealing with psychosis helps them deal more effectively with emotional overwhelm, suicidal thoughts, drug use, and work to build a life worth living. I typically use it as an addition to CBTp and/or medication management.

Why should clients experiencing psychosis remain hopeful?
Recovery is absolutely possible! I’ve worked with hundreds of people experiencing psychosis over the last decade and have seen many of my clients go on to build careers, graduate college, live independently, have children and meaningful relationships, and generally build the lives that they want. The path isn’t always easy though. I really believe that the key ingredients for recovery are taking good care of your mental health and building a strong support network you can call on when you need it.

Self-care is unique for every person and can take the form of taking medication regularly, getting enough sleep, reducing drug use, engaging in therapy, doing activities that bring you joy, or using coping skills like from DBT to manage your emotions and stress. Your support network is where community-care comes in, meaning the people you call on for support when you need it so you don’t have to shoulder the burden alone. Creating a support network means building solid relationships with family, friends, colleagues, and/or mental health professionals.

Psychosis is similar to other chronic medical conditions where ongoing daily maintenance work is required to keep yourself healthy. While things may look different in your life now then you originally envisioned them, that doesn’t mean you can’t still have a life that’s worth living. The fact that you’re even reading this is already a positive step in the recovery journey!

What do you wish family members knew about the treatment of psychosis?
Helping your loved one who is struggling with psychosis can be tough. When I work with families of people with psychosis, they often talk about feeling powerless over their loved one’s struggle. In addition, they commonly talk about being burned out and how caregiving is impacting their own mental and physical health. Feeling overwhelmed when you’re caring for someone else is unfortunately very common.

A lot of times what I see contributing to family member’s burnout is when they consistently push past their own limits. While it makes total sense to want to be there 100% of the time for your loved one who is struggling, it’s going to inevitably take a toll on you. Caring for yourself is critical as a caregiver and DBT skills can also be really helpful for you. They can help you stay in the moment rather than ruminating on worries about the future, be more patient with your loved one when they’re suffering, and learn to set healthy limits to protect your own mental health. Remember that recovery is a marathon, not a sprint, so the more you and your loved one both utilize self-care as well as your support network, the better off you’ll both be on this journey.

In your book, you talk about a wellness plan. What's a wellness plan?
A wellness plan is a tool to help anticipate your mental health needs and identify the people who can support you in getting these needs met. Similar to an emergency preparedness plan for a natural disaster, your wellness plan outlines what to expect when your symptoms get worse and how to intervene to prevent a crisis.

When creating a wellness plan, you first think through changes in your mental health that suggest worsening symptoms could come if you don’t intervene, such as changes in your thinking, behavior, or mood. For example, you might notice early warning signs such as sleeping significantly less, frequent suspicious thoughts, or hearing bothersome or distracting voices. Next you identify what’s helpful when you notice these changes such as working to reduce your stress, using self-soothing skills, calling a crisis hotline, or getting a medication adjustment. Lastly, you consider who from your support system you’d like help from to ensure you take care of your mental health needs. After creating your wellness plan, I recommend giving a copy to the people in your support network.

A wellness plan is an example of the DBT skill called coping ahead. Coping ahead involves creating a plan of how you’ll deal with a situation you’re worried about so you can feel better prepared and therefore less anxious about the future. A wellness plan has you prepare for the worst-case scenario of another mental health episode which can increase your peace of mind that you have a plan in place if it were to happen.

What is your favorite DBT skill to use?
One of my all time favorite DBT skills is alternate rebellion. Growing up, I was constantly rebelling against the traditional expectations around gender and sexuality that the place I grew up put on me. Sometimes the way I would rebel though would come with consequences that I didn’t really think through such as getting a tattoo which I’m left with the rest of my life. The skill of alternate rebellion acknowledges that we all need to rebel sometimes, whether against an institution, your family, conformity, boredom, or something else entirely. The idea is to find something relatively harmless that still feels like you’re breaking the rules but doesn’t come with negative consequences for you.

Now that I’m an adult, I still have that same rebellious spirit, but I’ve learned to rebel in ways that are more in line with my long-term goals. For example, when I get frustrated with the limitations of the mental healthcare system, I participate in protests, sign petitions, and advocate for my clients. Alternate rebellion reminds us that rebellion can be really fun, and there are plenty of ways to do it safely.

What are you currently reading?
I’m reading Homecoming by Yaa Gyasi which explores the stories of two sisters in Ghana and their descendants through eight generations, winding through the legacy of slavery as well as the history of African and African-American resilience.

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Congratulations, Maggie!

You can find The DBT Skills Workbook for Psychosis: Manage Your Emotions, Reduce Symptoms, and Get Back to Your Life by clicking here.

For additional information about DBT, check out:

DBT Self-Help

Should People with BPD Use Ayahuasca?

101 Ideas for Self-Soothing

What Does it Mean to Be Dialectical?

14 Ways to Validate Without Ever Saying a Word

All of us need validation. We can validate ourselves and we can also validate others to help improve our relationships.

Validation means that we are acknowledging another person’s experience, thoughts, emotions, values, or goals.

When we validate others, we are communicating, “You are important to me” We often feel loved and understood when others validate us.

In healthy relationships, there’s lots of back-and-forth validation between people. Validation is not a one-way street so it’s important that we find ways to validate each other. It’s not fair when one person is working overtime to validate a spouse, partner, or friend.

While we can verbally validate others, we can also practice validating without ever saying a word. This is also known as nonverbal validation.

Today you could validate a family member or a friend by:

• Giving a small gift
• Making someone you love breakfast in bed
• Mailing them a postcard or a greeting card with a sweet note
• Texting them a funny meme or gif
• Holding someone’s hand
• Completing a household chore
• Running an errand for your family member
• Listening (and not giving advice)
• Giving someone a tissue when they are sniffling
• Getting someone a sweater when they are cold
• Surprising a friend with their favorite coffee
• Being gentle
• Leaving a sticky note on their mirror with an encouraging word
• Just being quietly present

Here’s my relationship challenge for you: Find one way to validate a friend or family member each day. This validation can be verbal or non-verbal. You can also ask yourself, “What does my family member or partner really appreciate?” or “How does my child want to be validated?”

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If you are looking for additional information on creating more meaningful communication, please check out the following resources.

• The BPD Wellness Planner for Families by Amanda L. Smith

• The Power of Validation by Karyn Hall and Melissa Cook

• Genuine Validation: Compassionate Communication That Transforms Difficult Relationships at Home and Work by Corrine Stoewsand

• Nonviolent Communication by Marshall Rosenberg

Mental Health Smoothie for Borderline Personality Disorder

Is it possible to treat the symptoms related to borderline personality disorder (or BPD) naturally and without medications?

We have so much evidence that increased daily intake of fruits and veggies not only help us feel better physically but they may help us to become more emotionally healthy.

In this particular study in the journal Nutrients (2020), a meta-analysis of almost 61 published articles on a potential food-mood connection concluded that:

The most prominent results indicated that high total intake of fruits and vegetables, and some of their specific subgroups including berries, citrus, and green leafy vegetables, may promote higher levels of optimism and self-efficacy, as well as reduce the level of psychological distress, ambiguity, and cancer fatalism, and protect against depressive symptoms.

This is important information for our emotional well-being.

One of my favorite ways to get more fruits and vegetables into my diet is by enjoying a smoothie several times a week.

This is an easy recipe that will appeal to many people who are trying smoothies for the first time.

Blueberry Almond Smoothie

1 cup frozen blueberries
1 frozen or fresh banana
1/2 avocado
1 tablespoon of flaxseed
1 cup of almond milk
1/2 cup water

If you are feeling ambitious, you can make your own almond milk by following this recipe.

Blend with two or three cups of ice anywhere from 30 seconds to one minute depending on the power of your blender. This makes a pretty thick smoothie. Add extra water if needed.

This recipe has approximately 350 calories and has over 100% of the daily requirement Vitamin E, 50% of the daily requirement Vitamin A, 63% of the daily requirement Vitamin B6, 30% of the daily requirement of Vitamin C, and 40% of the daily requirement of magnesium.

If you’d like an additional boost of Vitamin K, Vitamin A, and magnesium, you can add a cup of fresh spinach to your smoothie. (You can’t taste the spinach—I promise.)

Of course, you don’t need to have a diagnosis of borderline personality disorder in order to benefit from this smoothie. We know that increased fruit and vegetable consumption can help people who have been diagnosed with depression, anxiety, bipolar disorder, and even schizophrenia. Please check out this article for more information.

I’d love to learn more about your favorite smoothie ingredients. Write to me today and let me know what kinds of foods are helping you to be your very best. My email address is amanda@hopeforbpd.com.

One more thing: Take a moment and check out my recipe for Chocolate Avocado Pudding.

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Other articles that may be beneficial to read:

Evolution of Well-Being and Happiness After Increases in Consumption of Fruits and Vegetables (2016)

Antidepressant Foods: An Evidence-Based Nutrient Profiling System for Depression (2018)

Nutritional Psychiatry: Towards Improving Mental Health by What You Eat (2019)

Is Exercise a Treatment for BPD? (2020)

Should People with Borderline Personality Disorder Drink Alcohol?

For many adults, drinking alcohol is an important part of celebrations, family gatherings, and enjoying delicious food but is it a good idea for someone with a mental health diagnosis to drink on occasion?

There are many pros and cons to drinking alcohol.

Pros
• Alcohol may enhance the flavor of many foods
• Alcohol often helps people to relax and be more sociable
• Alcohol may help some people regulate their emotions for a short period of time
• Alcohol can provide a temporary distraction from painful emotions or thoughts

Cons
• There is no safe level of alcohol consumption for women who are pregnant or who may be pregnant
• Alcohol may interfere with the effectiveness of medications
• Alcohol combined with some psychiatric medications (such as benzodiazepines) may be potentially lethal
• Symptoms related to emotional dysregulation may become worse with alcohol use
• Alcohol may be correlated with increased urges to self-harm or die by suicide
• Regular or prolonged alcohol use may interfere with important academic, vocational, or relational goals
• Alcohol use may lead to impulsive behaviors
• Binge drinking may lead to physical health problems including memory loss

Of course, drinking may or may not be problematic for you.

Ask yourself:

• Am I at my healthiest when I’m drinking?
• Does alcohol decrease my ability to regulate my emotions?
• Is alcohol helping me to reach my goals?
• Do I hide my drinking from those who love me?
• Do I feel guilt or shame after drinking?
• Are other people worried about my alcohol use?

As a DBT therapist, I encourage my clients who use alcohol regularly to consider a 30-day vacation from using any alcohol or to think about the role of mindful drinking in their lives. Many of my clients find that when they take a break from using alcohol that they are better able to manage many of the symptoms related to borderline personality disorder. Taking an extended break from alcohol may also help increase an individual’s self-worth.

If you are an individual learning skills from DBT to help yourself, you might think about the benefits of using the following skills to help decrease your alcohol use:

• Wise Mind
• ACCEPTS
• IMPROVE
• Self-soothing
• Pros and Cons
• PLEASE
• Coping Ahead
• Opposite Action

What might help you to reach your goals? Remember: Recovery is possible.

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If you’re looking for additional information about borderline personality disorder or dialectical behavior therapy, check out these resources and ideas:

DBT Self-Help

BPD Crisis Resources and Help

DBT-inspired Art Journaling Prompts

What Does it Mean to Be Dialectical?

The Role of Validation in Creating Healthier Families

You already know that validation can be one of the most effective ways that you can close the communication gap with your loved one.

It’s important for family members and friends to know that validation isn't just something you say ("I can see that you really feel strongly about this.") or text, but also something you do. For instance, we validate each other when we give hugs, put our phones down and make eye contact, or when we hand someone a tissue when they're crying, or a blanket when they are feeling cold. 

This is especially true if your family member's love language is acts of service.

External validation is validation that comes from other people. This might include the validation we receive from parents, spouses, friends, strangers on the internet, and work colleagues. Internal validation comes from within. It may be that small voices that tells us, "You're okay. This is tough but you'll make it through this."

The problem, however, with needing that external validation is that it may not always be accessible. Sometimes people simply don't know what to say or do. Other times people don't know when their family member is desiring validation. Even the best validators in your family may miss the mark at times. It's unrealistic to think that we can be perfectly validating at any given moment.

A lot of people desire that external validation but we want to recognize that the ability to validate our experiences, emotions, thoughts, values, and urges is also important. 

The healthiest individuals I work with can often tell themselves things like:

* Emotions are just emotions, and thoughts are just thoughts.

* I can solve this problem myself and ask for help if I need it.

* I can have my values and still love others with different values at the same time.

* I can do hard things.

* Sometimes people are just upset about other things, but they aren't necessarily mad at me.

* It's okay to want a hug right now.

Of course, self-validation is a learned skill and not something that comes easily for most people with a diagnosis of borderline personality disorder. All of us get better at self-validation when we consistently embrace moments when we can self-validate. That may be obvious to you but may not be quite so apparent to your loved one.

When you validate your family member, you model an essential life skill for them. The fact is that most people will need for you to do this for them before they can do it on their own.

Will you be that person in your loved one's life today? 

If you love someone with borderline personality disorder, please check out my 12-week course for families.

Borderline Personality Disorder Recovery: Are Your Beliefs Holding You Back?

Do your thoughts ever get in the way of being the person you want to become? For many people with BPD, limiting beliefs and a bias toward negativity may be something important that prevents them from healing and reaching their goals.

For instance, do (or your family member) you ever think:

• It’s not safe for me to recover.

• I cannot get what I need to recover.

• I don’t have the support to recover.

• I am undeserving of recovery.

• I’m not ready to recover.

• I’m unable to recover.

• I cannot recover.

• I don’t want to recover.

• I will be alone if I recover.

Thinking, “Why bother?” or “I’ll only fail again,” prevents people from stepping out of their comfort zone and taking the steps that will lead them to healthier lives and better relationships. These next steps might include an evidence-based therapies like dialectical behavior therapy or mentalization-based treatment. Even a self-help approach like NAMI Connection’s model of weekly support and education or Recovery International may be helpful. A self-compassion practice is also something that may be helpful in changing limiting or defeating beliefs.

How Family Members Can Help

Family members and friends can help by letting their loved one know that they believe in them and their ability to heal. Recovery work can be long and family members will benefit from being patient. The individual’s support system should be encouraged to celebrate small successes along the way while recognizing that motivation to complete the work may continue to rise and fall due to the non-linear process of recovery. A pause in the work does not mean that the person has failed.

One of my favorite bits of wisdom about recovery from borderline personality disorder comes from Marsha Linehan, PhD—the creator of dialectical behavior therapy. I love sharing this quote is from her book, Cognitive-Behavioral Treatment for Borderline Personality Disorder.

Improvement will not result from simply visiting a therapist and gaining insight, taking a medication, receiving consistent nurturing, finding the perfect relationship, or resigning ourselves to the grace of God. Most importantly, the therapist cannot play the role of savior. While it may be true that the person cannot change on their own, and needs help, the lion's share of the work must be done by the person with the problem.

Countless people all over the world have found both hope and healing from borderline personality disorder. People with borderline personality disorder can learn to help themselves. Please don’t assume that you (or your family member) are the exception.

Recovery is possible.

If you love someone with borderline personality disorder, please check out my 12-week course for families.

Five Mindfulness Apps (to Help You When You're Learning DBT)

Mindfulness practice is one of the core components to dialectical behavior therapy (or DBT). In fact, DBT wouldn’t be as effective as it is without it. That’s how important mindfulness is when it comes to helping people to manage both their thoughts and emotions.

For most people, learning how to be mindful will take a lot of practice. While you don’t need to devote hours each day or week to practicing these skills, two minutes here and five minutes there every day there should be enough time to help you notice a difference in a month or two. Consistency is the key to when it comes to noticing the benefits of mindfulness.

One of the reasons why I love recommending mindfulness apps is because they give us a place to start that is fairly easy to access.

Here are five app ideas to help you establish a daily mindfulness practice. My hope is that you’ll find one that encourages you to take your mindfulness game to the next level.

Calm
Getting a good nights' rest, relaxation, and meditation can all go a long way towards alleviating symptoms of both depression and anxiety. The Calm app is one of the more popular mindfulness apps out there. Their guided meditations are great for users of all levels, from brand new beginners to seasoned meditators. The app lets you pick how much time you want to devote to app usage every day. When you deal with anxiety, a good night's rest is one of the first things to get problematic. The app gives you a long list of daily meditations you can use every day. One special feature that Calm offers its users includes its sleep stories and nature stories. Yes, you can listen to bedtime stories before you go to sleep, just like when you were a kid. These two features can help you get a restful slumber night after night.

You can find Calm here.

MindShift
MindShift helps teens and young adults gain basic skills to manage their anxiety symptoms. This free app can help reduce mild symptoms of the following anxiety disorders:

• Generalized anxiety disorder
• Social anxiety
• Panic attacks
• Phobias

This app can also manage worry, performance anxiety issues, perfectionist tendencies, and test anxiety. The skills that you can learn on this app can get applied to emotional, physical, behavioral, or cognitive versions of anxiety. It provides you with more balanced ways of thinking about life situations that scare you.

The app does a great job of offering long lists of coping strategies that depend on the type of anxiety you have. The strategies and information that you get are really simple and clear. Mental imagery, breathing exercises, and mindfulness strategies can be accessed in both text and audio format. You can use the "Quick Tips" feature to help you with anxiety in the moment. On the app, you can even "favorite" the anxiety fighting methods that you liked the best. MindShift won't help you if you want to track your anxiety symptoms over time. You will also have a hard time with the app if you're overwhelmed with the presentation by a lot of choices.

You can find the MindShift app here.

Sanvello
Sanvello teaches anxiety-fighting methods such as deep breathing, the identification of cognitive distortions, behavioral exercises, and the use of more positive thinking patterns. As an app, users find great benefits from using it between sessions with their treatment provider. Sanvello does a good job of personalizing the cause of your anxiety through voice recordings. It also introduces cognitive-behavioral therapy (CBT) methods as well as reinforcing different app exercises between therapy sessions.

Check out Sanvello here.

WorryWatch
If you deal with anticipatory anxiety, constant worry, and generalized anxiety disorder, WorryWatch will give you good self-monitoring exercises as well as the documenting of your worrisome moments through a menu featured in the app. You'll also get a tool that categorizes your moments of worry through different factors. You will also be prompted by the app to think about whether the moment of worry in question was really as bad as you originally stated.

The app was created by a developer who has generalized anxiety disorder. While the app can't replace therapy completely, it can serve as a supplement to treatment. Don't download WorryWatch if you have trouble working with graphical data. More users might get more benefits from the app if there was a tutorial that taught people how to use WorryWatch's main features. However, the app does do a wonderful job of giving you the visual evidence of the frequency, intensity, and the duration of your cognitive distortions.

Click here to learn more about WorryWatch.

Nature Sounds Relax and Sleep
Some of the bigger symptoms of anxiety include ruminating and racing thoughts. But you can breathe deeply, slow down, and clear away all of your thoughts with the sights and sounds of nature. Nature Sounds Relax and Sleep features both of these things. From rain and thunder to bird sounds and crackling fires, there really is something for every type of user with anxiety and sleep issues. You can set the app's timer to "listen" while you slowly drift off to sleep. You also have the opportunity to set one of the app's nature tracks as your morning alarm. This way you can start your day with a slightly more charming track than that incessant beeping that comes with most clocks and phones.

Click here to download this app on Apple.

Remember: No app, free or paid, can replace the help and assistance of a trained mental health professional. If you have questions about using your DBT mindfulness skills, it’s okay to ask for help.

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If you’re looking for additional information about DBT, check out these resources and ideas:

DBT Self-Help

A Review of Marsha Linehan’s Memoir: Building a Life Worth Living

DBT-inspired Art Journaling Prompts

Mindfulness with Music