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Author Topic: TREATMENT: Cures and remission?  (Read 6616 times)
Mollyd
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It's a strange game when the only move .... is not


« on: May 15, 2006, 05:32:36 PM »

I see BPD as an enduring condition, kind of like addiction is, where one can live in recovery, but at this time in our world, cannot be cured.  

Molls.
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« Reply #1 on: May 15, 2006, 11:24:11 PM »

I like Molly's post.  I have alcoholism and I treat it on a daily basis, either here, a 12 step program and a men's group I am in.  No matter how good I appear, it waits for me to screw up.  It is cunning, baffling, powerful and patient.  My point, like Molly's, is that I will always have it.  How that appears to people around me depends entirely how hard I work on myself.  

I am hoping that my SO's BP will respond in the same way.  We'll see.
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« Reply #2 on: July 20, 2008, 05:23:46 PM »

For those in a position to comment, how long did it take for the person with BPD to noticeably improve once they had actually committed themselves to improvement and treatment?

www.BPD.about.com/od/faqs/f/PrognosisFAQ.htm

Excerpt
Question:

What is the Borderline Personality Prognosis.  I have been diagnosed with BPD. Does this mean I will have it for the rest of my life?

Answer:  Most likely, no, you will not have BPD for the rest of your life. At one time, experts did believe that BPD was a life sentence; they thought that BPD was not likely to respond to treatment and that BPD was always chronic and lifelong.

Now, we know that this is a complete myth. Research has shown that almost half of people who are diagnosed with BPD will not meet the criteria for diagnosis just two years later. Ten years later, eighty-eight percent of people who were once diagnosed with BPD no longer meet criteria for a diagnosis.

In addition, there are now a number of treatments that have been proven to be effective for reducing the symptoms of BPD. So, with treatment, the disorder may remit much more quickly.

Source: Amarine, MC, Frankenburg, FR, Hensen, J, Reich, DB, and Silk, KR. "Predictions of the 10-year course of borderline personality disorder." American Journal of Psychiatry, 163:827-832, 2006.

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« Reply #3 on: August 05, 2008, 11:58:36 AM »

The treatments are focused on the behavior - but I'm not sure I would say "only".  You and I often moderate our behavior when our instinctual thinking is different.

For example, last year someone said something on the boards that really upset me. My instinct was to respond to it - but instead I closed my laptop and went to lunch with a friend.  When I came back, I discussed privately and with a third party what had upset me and why and we talked through it - I purged it.  I then let it go.  In the coming weeks I came to understand what triggered me.

That is a behavioral change.  This is how they work a person with borderline personality.

From what I've read, people with BPD are weak  in terms of "executive control", which is our ability to pull back and moderate our behavior consistent with our long term goals.  In the case of above, my long term goal - the respect of my friends - is why I took "executive control" over my gut reaction.

So it's a long process of learning behavioral modification.  Treatment may start with medication to calm the mood swings and help deal with the trauma that caused the person to seek treatment.  You might notice immediate improvement... but the real test is how they handle stressful or triggering situations over time... and thats sort of a "failure, re-evaluate, more work, and improve" process.

Maybe its like learning to ski.  Nothing is intuitive.  Some takes lessons for life and never go very far.  Some become excellent skiers -usually because the really wanted it and worked at it.

Its probably more about motivation than time.

Anyway, some thoughts...

Skippy
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WABT

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« Reply #4 on: August 05, 2008, 12:22:54 PM »

From what I've read, people with BPD are weak  in terms of "executive control"

Yes, I've seen that too.  I read something mentioning that people with BPD have a reduction in activity of the prefrontal cortex - the center for executive control.  

Certainly makes sense, in light of the capriciousness of their behaviors.  It also is consistent with the whole idea of them being a "child trapped in an adult's body."  Children do not have the same structural and functional capabilities within the frontal lobes as an adult.  
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« Reply #5 on: August 05, 2008, 12:34:25 PM »

Here is an editorial on STEPPS, a 20 week program that can be used in additional to DBT or other behavioral therapies. DBT programs are often a year (once a week).   Usually there is some general talk therapy too... no question that this is expensive and intensive process.

This editorial reports 40% of patients with borderline personality disorder remit (remission) after 2 years, with 88% no longer meeting Diagnostic Interview for Borderlines—Revised or DSM-III-R criteria after 10 years



Editorial

Augmenting Psychotherapy for Borderline Personality Disorder: The STEPPS Program

Kenneth R. Silk, M.D.


The diagnosis of borderline personality disorder conjures up thoughts of helplessness and hopelessness. The helplessness and hopelessness reside not only in the patient but often in the treatment providers as well. A widespread belief that continues to exist among mental health professionals is that treatment does very little for borderline personality disorder patients. Yet they are very difficult to disengage from treatment. Therapists shy away from informing the patient that she has the diagnosis because to pronounce the diagnosis not only would be equivalent to a type of "death sentence" (as we used to be afraid of telling patients that they had cancer or schizophrenia), but it would also cause fear of the rage that the therapist is certain to encounter from the affectively dyscontrolled patient.

Much has changed in the last 10–15 years, but unfortunately too many therapists still feel that borderline personality disorder is untreatable and is a lifelong drain on the energy of the therapist, the psychopharmacologist, and the entire mental health system. While it is true that people with borderline personality disorder utilize mental health resources to a far greater extent than their 1%–2% prevalence would suggest (1), the idea that these patients never change or improve needs revision.

Substantial research now sheds light on many of these mythical assumptions. There is strong evidence from the McLean Study of Adult Development that 40% of patients with borderline personality disorder remit after 2 years, with 88% no longer meeting Diagnostic Interview for Borderlines—Revised or DSM-III-R criteria after 10 years (2). The temporal stability (or lack of it) in a borderline personality disorder diagnosis has also been examined in the Collaborative Longitudinal Personality Disorders Study, and findings suggest that about one-half of those who meet borderline personality disorder on intake no longer meet DSM-IV criteria 24 months later (3).

Even more surprising and myth-debunking is the number of well-designed controlled studies in support of effective treatment for borderline personality disorder patients. These studies, for the most part, are randomized controlled trials of therapies that range from cognitive behavior, such as dialectical behavioral therapy (4) and other more straightforward cognitive behavioral therapies (5), to psychodynamic and psychoanalytically based therapies, which include mentalization-based therapy (6) and transference-focused psychotherapy (7), to the blend of cognitive and dynamic therapies in schema-focused therapy (8 ). And not surprisingly, as therapies that appear to be effective emerge, there are now articles urging that patients be informed of their borderline personality disorder diagnosis (9). It is interesting that most of these interventions are in the nonpharmacologic arena, while psychopharmacologic treatment of borderline personality disorder remains unclear, uncertain, and in general unimpressive.

The article by Blum et al. in this issue of the Journal is another step along the path of developing and testing more useful and reasonably successful psychotherapeutic interventions for borderline personality disorder. What is intriguing about the study by Blum et al. is that this nonpharmacologic intervention called Systems Training for Emotional Predictability and Problem Solving (STEPPS) is essentially an augmentation of or adjunct to treatment that is already occurring for the borderline personality disorder patient. It combines 20 weekly sessions of cognitive behavior and skills training elements with a systems component or approach that involves family members, significant others, and health care professionals with whom the patient interacts regularly. The randomized controlled trial study design measured STEPPS plus treatment as usual (N=65) or treatment as usual alone (N=59) every 4 weeks through the 20 weeks of treatment. The study found that the STEPPS intervention affords greater improvement in the affective, cognitive, interpersonal, and impulsive domains of borderline personality disorder; greater improvement in mood and impulsivity; decreasing negative affect; and greater overall global improvement when compared with treatment as usual without STEPPS. STEPPS is brief, adjunctive, and easy to use by a wide range of mental health professionals.

While the STEPPS intervention did not lead to significant between-group differences for suicide attempts, self-harm, or other measures of crises, the importance of the intervention should not be diminished. There are a number of treatments for borderline personality disorder that do decrease suicidal attempts or self-destructive behavior, but some of those that improve suicide do not necessarily improve depression any more significantly than the control intervention (4, 5, 7). It would appear sensible to use STEPPS as an adjunct, particularly to an intervention in which effectiveness is limited in areas where STEPPS has been shown to have beneficial impact. Perhaps as we study the impact of specific and different psychotherapeutic interventions, we may be able to combine or sequence various interventions to get a greater degree of the effectiveness of psychotherapy. For example, in the case of dialectical behavioral therapy, where impact on depressed mood is not impressive, the strategy of augmenting the treatment with STEPPS might provide more extensive overall benefit.

In addition, STEPPS has what the authors label as a "systems" component. By systems, the authors expect that there is involvement of a friend or relative who is willing to learn about borderline personality disorder and who participates in psychoeducational sessions to help him or her respond better to some of the dysfunctional and certainly confusing and affect-provoking behaviors displayed by the patient. There is a need for more interventions that involve the systems that surround the patient with borderline personality disorder, since it is often the people who interact with the patient who remain perplexed and stymied in knowing how to respond to their patient, friend, or relative with the disorder. STEPPS then provides another systems-based treatment available to families and significant others, along with interventions such as the Family Connections Program of the National Education Alliance for Borderline Personality Disorder (www.neaBPD.com). In addition, the patient is expected to be in ongoing therapy and have a mental health professional available to STEPPS in the event of a crisis.

The STEPPS study is a well-designed effectiveness study and was carried out in a thoughtful way, although with a high dropout rate, which is unfortunately not uncommon in such studies. In addition to the randomization, the study is also naturalistic in that outside psychotherapeutic and psychopharmacologic treatments were not controlled other than the requirement of having an outside therapist. It is to the researchers’ credit that they were able to combine the best elements of a randomized controlled trial with this naturalistic aspect of ongoing "outside" treatment.

In an editorial in the June 2007 issue of the Journal, Glen O. Gabbard, M.D. (10), referring to a point made by Daniel X. Freedman many years ago, suggested that we should be cautious not to pit one therapy against another in an attempt to find the very best. What is so helpful about having STEPPS in our therapeutic black bag is that it complements other therapies and need not replace or compete with them. To paraphrase what Marsha Linehan said in her keynote address to the International Society for the Improvement and Teaching of Dialectical Behavior Therapy in Philadelphia in the Fall of 2007, we should derive great satisfaction in knowing that there are a number of different types of interventions that appear effective for borderline personality disorder. The greater the number of available effective interventions, the better the chance that a patient may be able to improve to a degree where she feels that life is once again, if it ever was, worth living. Then we will have more evidence to erase the myth that borderline personality disorder is untreatable and that the diagnosis relegates the patient to a life of helplessness and hopelessness.


Dr. Silk, University of Michigan Health System, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109-5769; ksilk@umich.edu (e-mail). Editorial accepted for publication January 2008 (doi:10.1176/appi.ajp.2008.08010102).

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« Reply #6 on: January 15, 2009, 07:22:18 PM »

As the subject asks... Ex has recently told me that her therapist told her that she was probably BPD years ago, during a series of suicide attempts, but she is not now.  In all the reading I have done, have not heard of this.  I understand that sometimes symptoms can lessen with age, but the whole illness disappear?  And, FWIW, I know that listening to the ex tell me what her therapist said can be "misleading"...  Thanks in advance for any help.

Red
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« Reply #7 on: January 15, 2009, 07:43:09 PM »

Everything I read suggests they "BPD suffers" learn to "cope" just like the rest of us...but they have to really work at it.

I read more and more that medication and Dialectic  treatment has shown good success rate.
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« Reply #8 on: January 17, 2009, 09:23:55 AM »

I think that some show many of the BPD traits but not really have BPD...  They may have substance abuse problems, learning deficiencies, mood disorders, or simply be emotionally immature.  

I think that people who have less severe cases (like high functioning), good family systems, and no co-morbidities - are more likely to respond to treatment.

About symptoms lessening with age...  many of those who treat those with BPD feel that is true, but that hasn't been the experience of people here, but it may be a biased sample here.
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« Reply #9 on: January 26, 2009, 01:13:12 PM »

I have read anecdotal accounts of BPD behaviors mellowing or dissipating with age.  That said, having read the stories on these boards of people who have been married for 20/30/40 years to a BPD-sufferer, I'm not sure how accurate those accounts are.  It seems to me that the disorder never really disappears.  It's effects can simply be ameliorated through treatment/personal work and the development of healthy coping skills.
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« Reply #10 on: February 20, 2009, 04:13:45 PM »

Do BPD people ever get better?

Is this something they can just wake up from and begin behaving humanely?  With or without treatment?

Or does medication just make them slightly more tolerable without getting rid of the abhorent behaviors?

Will they always be untrustworthy, chaos causing people?
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« Reply #11 on: February 20, 2009, 04:35:21 PM »

Many people with BPD can recover.  There are some studies that show that as many as 80+% can recover to the point that they are not longer diagnosable with BPD traits.  The key is that the person with BPD needs to be very committed to recovery.  We have had some people here who are experiencing great joy with their recovered/recovering BPD partners.

They can't just wake up and begin behaving humanely.. it takes commitment, treatment, and often medications in the early stages of recovery.

Medication can help with some of the symptoms of BPD, but it isn't a cureall.  Appropriate therapy, usually Dialectical Behavioral Therapy, is the gold standard in treatment.

"Untrustworthiness" is not a diagnostic trait of BPD, but many here have reported untrustworthy BPD loved ones.  Sometimes tbe person may be more antisocial p.d. instead of BPD...  It's often hard to tell the difference as some of the patterns of behavior can cross.
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« Reply #12 on: February 20, 2009, 06:16:36 PM »

The statement you will hear echoed over and over when you ask this question is yes, they can, but THEY must be committed to it

As Joanna said:

Excerpt
The key is that the person with BPD needs to be very committed to recovery.

Note - "the person with BPD" - not the spouse of the BPD, the parent of the BPD or the child of the BPD.  We can be committed to assisting them through recovery, but they must recognize they have a problem and do something about it.

And sometimes, they can SEEM recovered, but when a big stressor in life hits they fall off the wagon (which is what my story has been lately with my uBPDh.)  Of course - I guess I expected that to happen someday when I told him about the success of Dialectical Behavior Therapy but that it was pretty intense and he laughed and said "yeah right - like I'm going to do something really intense."  Hmmm - note the lack of committment there?

This is one reason why you will find alot of emphasis put on working on ourselves here on the board.  Ultimately, that is something we have so much more control over.
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« Reply #13 on: February 20, 2009, 09:58:10 PM »

So this would explain why 6 years of Zoloft didn't "cure" my mother, but made her tolerable?  And why when she discontinued her Zoloft she became just as bad - if not worse - than before...because she never addressed the problem, just medicated the symptoms?

But none of that means she can't get better one day - just that it will be a long, hard journey to change 68 years of behavior?  And only then if she ever decides to?
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Girl Friday

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« Reply #14 on: February 22, 2009, 05:39:23 PM »

As a BPD suffer I can say this,

BPD is something you are. You can medicate some symptoms (my meds have saved me and made me able to deal with therapy) Dialectic Behavioral therapy teaches you vital skills to living with this disorder!

These together can offer you a way to manage BPD and live a normal life but it never leaves. It's something you have to accept and learn to live with.
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« Reply #15 on: February 22, 2009, 06:01:50 PM »

Note - "the person with BPD" - not the spouse of the BPD, the parent of the BPD or the child of the BPD.  We can be committed to assisting them through recovery, but they must recognize they have a problem and do something about it.

I've read that a supportive family is a very significant factor in helping someone in getting BPD under control.
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« Reply #16 on: February 23, 2009, 04:52:05 AM »

...Girl Friday , thank you for the insight...

and thank you for the guts, commitment and effort you made in going through DBT.  That says many positive things about your character. 

So this would explain why 6 years of Zoloft didn't "cure" my mother, but made her tolerable?  And why when she discontinued her Zoloft she became just as bad - if not worse - than before...because she never addressed the problem, just medicated the symptoms?

But none of that means she can't get better one day - just that it will be a long, hard journey to change 68 years of behavior?  And only then if she ever decides to?

Yes, that is pretty much it.  My husband is on meds and they do help keep things tolerable, but he has never gotten "well" because he doesn't care to do the work involved in that.  In his mind, tolerable is good enough.  I've compared it to someone with a serious injury who considers themself okay once the Emergency Room gets them stabilized so they leave the hospital, when in reality they are far from being healthy.  But getting healthy takes alot more work than just taking a pill.  Work that at this point in time anyway, my husband is not willing to do. 
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« Reply #17 on: April 26, 2009, 06:11:17 PM »

Substantial research now sheds light on many of these mythical assumptions. There is strong evidence from the McLean Study of Adult Development that 40% of patients with borderline personality disorder remit after 2 years, with 88% no longer meeting Diagnostic Interview for Borderlines—Revised or DSM-III-R criteria after 10 years (2). The temporal stability (or lack of it) in a borderline personality disorder diagnosis has also been examined in the Collaborative Longitudinal Personality Disorders Study, and findings suggest that about one-half of those who meet borderline personality disorder on intake no longer meet DSM-IV criteria 24 months later (3

My reading of "no longer meeting Diagnostic Interview for Borderlines - Revised or DSM III-R criteria" simply means that these individuals meet LESS than the five out of nine requirement.  To infer that it means that they have been "cured" would be completely unwarranted.
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« Reply #18 on: May 06, 2009, 02:16:12 PM »

I have a 100% success story.   My husband was diagnosed BPD several times...rages, suicide attempts, road rage, verbally and emotionally controlling and abusive, dissociative, emotionally VERY labile, impulsive..you name it.

He eventually got into  :)BT and stayed for 3.5 yrs. I went into codependancy therapy and DBT for family members.

He has been 100% symptom free now since last August. Period. He is able to identify his emotions, regulate them, he is not at the mercy of them..he functions on a normal and healthy level. Our relationship is VERY happy and healthy. He graduated from "advanced DBT" and his DBT therapist pronounced him well. Our DBT skilled marital therapist pronounced us well.

He did change a bit..he is not impulsive, he is better organized, he is thoughtful and very insightful into himself. He can talk about the hard stuff of the past, he doesnt melt down, implode, explode..In short, all is very, very well.

Steph
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« Reply #19 on: May 06, 2009, 02:28:03 PM »

My reading of "no longer meeting Diagnostic Interview for Borderlines - Revised or DSM III-R criteria" simply means that these individuals meet LESS than the five out of nine requirement.  To infer that it means that they have been "cured" would be completely unwarranted.

So does this mean that anyone that has ANY traits of BPD are mentally ill?

These mental disorders are comprised of common human traits taken to the extreme.   Unstable relationships?  Half of all people that marry get divorced. I'm divorced.  Impulsiveness is seen in many people. My mother is impulsive.  We all feel some level of abandonment. You, yourself, struggle with this one.

People with BPD coming out of treatment are no longer suicidal, cutting, unemployable. These are success stories and the first steps in reclaiming their lives.
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« Reply #20 on: May 06, 2009, 04:19:42 PM »

I believe in todays world that pwBPD can fully recover if they go through treatment.

Then for others you have those who learn the skills and tools that really improved their relationships.

Things can change if you change what you can and that is you.

For me my husband is undiagnosed, and for 11 years i have been using the tools and skills. stopped using it after a while, then when i came on here back in sept his rages were four months apart. That was good they use to be three times a week.

Now since i have been on here they are going on six months since last rage back in November.

So my story isn't a 100% cured , but he has improved and things are so much better... does he still have BPD oh yea.

My husband is on no meds of any sort for this, but yet he improved over the years  by 85% due to me changing the way i reacted to things and dealt with things and set some strong boundaries for my self!

I will say my husband is a recovered alcoholic of 24 years so with him going to meeting that really helps with his thinking. Being cool (click to insert in post)

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Letting go of what was or what you thought was, and accepting what is, is all part of the piece to the puzzle  we need to move forward.

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« Reply #21 on: May 06, 2009, 05:37:23 PM »

I didn't read everybody's responses, but here's my question:  (did anyone ask this - sorry if I'm repeating)

If BPD could go into remission, then wouldn't therapists be jumping at the chance to help them?  I've read some stuff, but I know that one of the things that stuck in my head was that therapists have concerns about being re-engaged...

If there are 17 million BPD sufferers, wouldn't somebody have gotten lots of recognition in some research study in "finding a cure" - or at least putting it at bay.

Just a thought.

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« Reply #22 on: May 06, 2009, 06:06:55 PM »

I didn't read everybody's responses, but here's my question:  (did anyone ask this - sorry if I'm repeating)

If BPD could go into remission, then wouldn't therapists be jumping at the chance to help them?  I've read some stuff, but I know that one of the things that stuck in my head was that therapists have concerns about being re-engaged...

If there are 17 million BPD sufferers, wouldn't somebody have gotten lots of recognition in some research study in "finding a cure" - or at least putting it at bay, or unplugging the re-engagement?

Insurance doesn't pay much for the long-term treatment which can run $20,000 or more (several years of treatment).  My 'ex' had spent $6,000 and quit after a year.  She went to so many being diagnosed with PTSD, depression, Bi-polar. etc, until finally diagnosed with BPD.

Of all those diagnosed, only a small percentage are willing to accept the long-term treatment or to even accept they do have it.

From what my "T" told me, it takes a very compassionate and skilled counselor.  It is difficult work for both the patient and the therapist.

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« Reply #23 on: May 06, 2009, 08:58:18 PM »

This is interesting because my SD (UBPD- Dxd with "emerging mood disorder/personality disorder nos) had a breakthru about her rages toward me almost 2 weeks ago, and is still amazingly putting her best foot forward with me (though is still baiting my husband a ton, but now that seems lopsided since she used to target me more than him.)

I don't dream she is in recovery without ever even knowing she has a problem, BUT I hit a rock bottom with her, and my husband (without my knowledge) shared with her that if she didn't cooperate in finding a solution to her anger then they may be moving to where he works (over an hour away and out in the middle of nowhere) to live at an apartment his employer provides if he wants to stop the long commute. She told me when he told her that she was mad, and then she raged at me over something she knows she did wrong and it all made her realize she gets mad at me for no reason, and takes her anger toward herself (or dad or mom) out on me even though it's not my fault. THAT was huge and is the first time she's made any such amends with her hatred toward me in over 2 years. I'll take it

I think it showed she is capable of growth, and I have been around enough to know that she is sincere in her efforts right now, though of course they will not last forever I'm sure. I also think that my rock bottom, and DH's ultimatum helped her to know that she has to step up to the plate or she will have no one to blame but herself. And for a 14 yo UBPD mind, that's a pretty heavy weight to bear and own up to, even if it is only temporary.

So I don't know if they can all recover, or what contributes or detracts from recovery, but I do think it's possible if they want it to be so.
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« Reply #24 on: May 07, 2009, 12:43:14 AM »

Excerpt
it stands to reason that we CANNOT change the brain structures.

My understanding of how all cognitive therapy modalities work is that people actually can change their brain to a certain extent. The process of actively thinking through all those excercises and doing that self talk--like, "when I feel x, I know that really it's y, because I have z, p, d, q evidence to support it"--actually does grow new nerve pathways.

I just googled this link sort of randomly to find something to back up the above and found a pretty interesting article and NPR interview on CBT. www.beckinstituteblog.org/?p=171

It remains true that you "have to want to"--and then you have to be able to afford to and/or have a health insurance plan that will let you. Very real obstacles, all.
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