Workshop sessions are interactive opportunities to learn concrete skills for managing the difficulties that come with disruptive, dysregulated behaviors within the context of borderline personality disorder. Each workshop is tailored to a specific audience, and attendees are encouraged to participate in the workshop best aligning with their goals and needs.
Clinicians and Early Career Professionals
Borderline Personality Disorder: Implications for incarceration and reintegration
Audience: Clinicians & Early Career Professionals
Presenters: Shannon W Schrader, Yale School of Medicine, George Mason University; Kelly Moore, East Tennessee State University; June Tangney, George Mason University
Abstract: Rates of Borderline Personality Disorder (BPD) in correctional settings are remarkably high compared to community samples and even psychiatric samples. Despite this prevalence, little attention has been paid to BPD in jail and prison settings. The ability to accurately recognize BPD symptoms and effectively manage and treat individuals diagnosed with BPD during incarceration is necessary to best serve this population. Effective treatment strategies must also be modified in a way that is sensitive to the transient nature of jails as well as the limited staff and resources. Once released from jail, individuals can experience a wide array of barriers during reintegration (e.g., stigma, obtaining a job, interpersonal stability). There is a paucity of research on the experiences of individuals with BPD during this time of upheaval and adjustment. Very little is known about the struggles people with BPD face during the reintegration process. Common barriers to successful reintegration, methods of cultivating resilience despite such barriers, difficulties accessing necessary treatment and services, and what persons with BPD who are involved in the criminal legal system wish clinicians and correctional staff knew about these experiences (i.e., what is helpful, what is not helpful) will be discussed. This workshop considers implications both during incarceration and after release from jail.
Structure: The workshop will include a didactic and psychoeducational component in the form of a lecturette. We also plan to include open discussion from individuals with lived experience on things they wish jail staff, clinicians, and family knew about BPD; what has been helpful and unhelpful; and the struggles of reintegration back into the community after release from incarceration (e.g., types of services individuals need but may not have access to). Throughout the workshop, we will weave together empirical research findings with anecdotes and clinical examples.
Flagged for Disruptive Behavior: A Dialectical behavior therapy approach to working with veterans with Borderline Personality Disorder who have received disruptive behavior flags.
Audience: Clinicians & Early Career Professionals
Presenters: Rebecca Lusk, PsyD, ABPP - VA Ann Arbor Healthcare System, University of Michigan Department of Psychiatry; Hilary DeShong, PhD - Mississippi State University, Department of Psychology; Elizabeth Chapman, MSW - VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Abstract: The Veterans Health Administration (VHA) is the largest integrated public health system in the United States (Department of Veterans Affairs, 2021), and utilizes an extensive electronic medical record database. As part of efforts to improve identification of patients who may be at higher risk of making a suicide attempt or exhibiting unsafe behavior towards others, the VHA developed a chart flag system. One flag that providers can request on a patient’s chart is a “disruptive behavior flag,” which would then likely be viewable by all VHA providers for a 2 year period of time. This workshop will present research on how this flag system differentially impacts individuals with personality disorders, especially those with BPD. Though these flags can increase patient and provider safety, there is no structured or objective way to determine when to assign a flag, and clinicians receive no training in how to discuss flag use therapeutically with their patients. For a population that struggles with expressing anger and regulating emotions, this can be an especially invalidating system for patients with BPD. This workshop will present skills that can be utilized by clinicians to avoid needing a disruptive behavior flag, as well as discuss the receipt of a flag in a validating and helpful manner. In addition, attendees will be taught ways in which DBT skills can be taught to patients who are struggling with managing anger towards providers, as well as helping patients learn skills to advocate for themselves within often invalidating healthcare systems.
Structure: In this dynamic and interactive workshop, speakers will offer an introduction to the development of “disruptive behavior flags” within VA, and overview the research of individuals with BPD and “behavioral flags,” compared to other groups. Next, speakers will submit common pitfalls faced when considering whether to make a behavior report, and ways in which use of “flags” could be counter-productive to healthcare. Finally, speakers will provide case examples, host a compelling role-play to demonstrate effective communication with patients about “flags,” and how to use consultation with the patient to get them to advocate for themselves more effectively.
Deciphering when Shame is Disguised as Anger: Treatment Interfering Behaviors among Individuals with Borderline Personality Disorder
Audience: Early Career Professionals
Presenters: Olivia A. Goldman, Psy.D., Postdoctoral Resident, Trauma Recovery Program, James A. Haley Veterans’ Hospital; Heather N. Kacos, Psy.D., Licensed Psychologist, James A. Haley Veterans’ Hospital, South Hillsborough Outpatient Clinic, Assistant Professor, Morsani College of Medicine, University of South Florida; Jenny A. Bannister, Ph.D., Licensed Psychologist, Trauma Recovery Program, James A. Haley Veterans’ Hospital
Abstract: Borderline Personality Disorder (BPD) is often conceptualized as a shame based disorder. A meta-analysis found that individuals with BPD reported higher levels of shame compared to healthy controls. Shame has been found to be a less adaptive and more painful emotion when compared to a similar emotion such as guilt. Individuals with elevated PTSD symptoms report higher levels of shame, especially those who have experienced sexual and verbal abuse and neglect. Experiencing high levels of shame may lead to increased anger, externalizing behavior, and hostility. There is a distinct correlation between shame and poor self-esteem, aggression, and emotion regulation. Thus, anger is often the emotion that presents (secondary), despite shame being the primary experience. Shame may also contribute to cognitive reappraisal or suppression. Understanding how shame may present as anger, behavioral disruptions and treatment interfering behaviors is key in assisting individuals with BPD in maximizing their treatment benefits (i.e., improve interpersonal relationships, tolerate distress) and helping them to gain a better understanding of their functioning. This workshop will help attendees learn to decipher primary and secondary emotions, respond to shame-based aggression in vivo, and enhance skills training for their patients specifically in regards to managing shame.
Structure: This interactive workshop will provide empirically supported research on BPD, trauma, and shame/anger. It will be conducted in a PowerPoint format with the opportunity for attendees to ask questions or offer anecdotal experiences. Handouts will be provided and linked in the presentation. The facilitators will conduct role-plays to highlight how shame may present in body language as anger and can serve as a treatment interfering behavior. Further, providers will demonstrate how to deal with aggression in both individual and group formats. Attendees will practice these skills within break-out rooms to assist with application.
Improving Treatment for Disruptive Behaviors
Presenters: Peggilee Wupperman, Ph.D., John Jay College of Criminal Justice / Yale School of Medicine; Michah Sanguyu, B.A, John Jay College of Criminal Justice
Abstract: Clients with borderline personality disorder and disruptive behaviors often have trouble engaging in treatment, completing home-practice, and/or attending sessions. As a result, treatment outcomes may be disappointing, and drop-out rates are high. To address these issues, Mindfulness and Modification Therapy (MMT; Wupperman, 2019, Guilford) offers time- and cost-effective strategies for helping clients break free from disruptive behaviors. MMT integrates elements from Motivational Interviewing, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and other evidence-based approaches. Preliminary trials have shown large decreases in alcohol use, drug use, verbal aggression, physical aggression, and binge eating in self-referred and court-referred clients. Retention has been greater than 80% across studies. Case studies have shown decreases in trichotillomania, smoking, compulsive shopping, bulimic episodes, and other disruptive behaviors. MMT can be used as a stand-alone treatment or as a precursor to decrease problematic behaviors before moving to additional therapy. MMT strategies can also be incorporated into existing treatments. In this workshop, participants will master strategies that help improve motivation and engagement in clients presenting with BPD and disruptive behaviors. Participants will learn to (1) conceptualize and address disruptive behaviors in ways that decrease treatment obstacles, (2) customize treatment to fit diverse client needs, and (3) help clients begin moving toward lives that feel more meaningful and fulfilling. Implementation of strategies will be demonstrated through experiential exercises, discussions of case vignettes, and presentation of techniques. A guide for integrating the techniques within existing treatments will be presented along with sample handouts that can be modified to fit treatment goals.
Structure: The workshop will include multiple interactive components including: (1) at least two guided mindfulness exercises, (2) an exercise to help clinicians understand and more effectively communicate with clients with whom they feel frustrated or stuck, and (3) roleplays of techniques introduced in the workshop. The workshop will also include presentation of therapy techniques and case vignettes, although even those will include interactive discussions—with frequent invitation for participants to ask questions and share their own client experiences.
For Family Members & Those With Lived Experiences of BPD
Porcupine Love: Dealing with Dysregulated Behaviors in Long-term Intimate Relationships Where One Partner has BPD or its Symptoms
Audience: Family Members & Those With Lived Experience of BPD
Presenters: Cathleen Payne, an individual with lived experience, in her 36th year of marriage, and also the Secretary of National Education Alliance for Borderline Personality Disorder Board of Directors; Tina Moore, Program Manager, National Education Alliance for Borderline Personality Disorder
Abstract: People with BPD, and/or its hallmark symptom of emotion dysregulation, have trouble in their long-term, intimate relationships due to their highly sensitive emotions, the emotional pain they suffer on a daily basis, and the oft-ensuing “emotional storms” that can result when conflict arises. These people deserve to have love and long-term intimate relationships, just like all people do. Emotional dysregulation can lead to behaviors and/or harsh words that can damage relationships if left unrepaired.There is a dearth of resources available to help people with this condition and their partners, especially from the perspective of lived experience. This workshop will share some information, some personal and painful experiences, and an example of a type of repair that “life-long partners of 36 years-and-counting” have developed that often help us manage/negotiate the difficulties in the relationship that arise from one partner having this debilitating condition.
Structure: The person with BPD will share some slides, describe how this mental condition affects her, especially in times of conflict, and share the difficulties she has encountered in maintaining a long-term, intimate relationship with this condition. She will share some structures she and her husband-of-36-years have developed to help them, such as a “playbook for your partner” and “a 60-second repair” that others can develop on their own to adapt to their particular circumstances. There will also be at least two role-plays with the speaker and another demonstrating what the speaker and her spouse have tried that have helped them.
How to increase awareness to decrease regret: Utilizing a specific mindfulness tool to change disruptive behaviors
Audience: Those With Lived Experience of BPD
Presenters: Joanna L. Fava, PhD
Abstract: When I was working in corrections, a particular client was repeatedly getting his incarceration time extended because he would become aggressive with others on the unit and acquire new assault charges. This was creating much distress for him; intellectually he knew he needed to stop this behavior so he could get back home to his family. However, when his emotions would spike, he felt like he could not stop himself and would later feel tremendous regret and sadness over his impulsivity. We worked to increase his awareness around this behavior and identify his “key cue” (e.g., he noticed his ears would get hot from rage right before he would have the urge to hit someone.) One day while on the unit, I noticed words being exchanged between inmates and this client was right in the middle of the situation. I was sure he was about to do it again and push or hit the person across from him. He then shouted out, “My ears are hot!” and marched into his cell, asking the guard to shut his door. He felt intense pride instead of regret at his ability to catch the disruptive behavior and change his course of action in that moment, taking back his power. Attendees of this workshop will similarly be guided through the process of breaking down a disruptive behavior, identifying the cue that can signal one to STOP, and a replacement plan for how to respond instead.
Structure: An overview will be provided of how mindfulness to our vulnerability factors and to the moments that precede a disruptive behavior is the key to changing this behavior. Examples will be provided and attendees will be broken into groups and offered time to reflect on their own behaviors so they too can develop a plan for how to change it. This will be relevant for clinicians (as a way to help with behavior change in clients) as well as for people with lived experience (struggling to change certain behaviors that are sabotaging their goals).
When There is Fear in the Home
Audience: Family Members
Presenters: Marie-Paule de Valdivia, LCSW, Alli Kalpakci, PhD
Abstract: Fear is one of the most powerful emotions. It can create strong signals urging us to respond when we’re in emergencies. Fear orients us toward possible threats, whether they are perceived or real. Fear can prevent us from trying new things, growing as individuals, and reaching our goals, especially after being subjected to repetitive experiences. Eventually, the experience and associated behaviors become a habit. While we can’t avoid fear, we can learn to cope with it. Exploring the principles of exposure will be our starting ground to learning practical skills to deal with our fears. We will discuss safety, self-care, and emotion recognition. Using role-plays and skills, participants will learn to manage fears related to disruptive behaviors. The most courageous people are not courageous because they don't feel afraid; they are courageous because they are afraid AND they face their fears. The most important thing is to learn to cope with fear instead of letting it control you. Don’t let your fear paralyze you and prevent you from reaching your goals when you feel afraid. Fear is just an emotion—it’s a fleeting feeling that doesn’t have to hold you back anymore. Just like sadness or anger, you can learn to manage your fear. And when you do, you’ll feel proud of yourself, empowered, and fulfilled. The sky is the limit! This interactive presentation will enable participants to learn through stories and roleplays. Presenters will share information in a lecture format followed by questions for participants to reflect on and share. Using participant sharing via the chat and being called up on “stage”, the presenters will role-play with select participants.
DBT Strategies for Parents of Exquisitely Sensitive Children
Audience: Family Members
Presenters: Armida Fruzzetti, PhD; Briana Carbone, LICSW; A. Victoria Sheppard, PhD; Alison M. Yeager, PsyD
Abstract: Dialectical Behavior Therapy (DBT) has been modified to provide care for different clinical populations and different age groups. The biosocial model highlights the transaction between biological vulnerability to emotion dysregulation coupled with environmental invalidation (Linehan, 1983). DBT with adolescents has incorporated parents in skills groups and/or in family therapy to target areas of invalidation occurring in families. Research in this area (Miller & Rathus, 2006; Fruzzetti 2018) has indicated this improves adolescent outcomes. Since the 1960’s there has been significant emphasis placed on parent training (e.g., PCIT, PMT), to support treatment of latency aged children’s psychological and behavioral difficulties (Kazdin, 2005), however, these approaches do not help parents develop their own emotion regulation skills, nor do they target the transaction between children and their parents. The DBT transactional model suggests that parents and caregivers are critical in treatment when working with children under the age of 12 given their lack of agency or cognitive growth to independently evoke change within the family system. This workshop will focus on the critical role of parents and caretakers when working with younger children who experience emotional and behavioral dysregulation. The transactional model will be taught highlighting the transaction between invalidating environment and emotional dysregulation which may result in behavioral dysregulation in children. Through use of this model participants will learn skills that parents/caregivers can use for their own emotion regulation and how to validate an exquisitely sensitive child. Participants will leave this workshop with increased awareness of their role in the transactional model and strategies and options for responding in order to change their transactions. The first part of this one-hour workshop will be didactic in structure. Following this use of video or role play will be used to highlight options for responding. This role play will offer a sliding door frame with two outcomes modeled: in the first focus will address parents use of use emotion regulation skills in their interactions; the second will option will focus on parents validating their child in the interaction. It will close with an opportunity for question and answer.