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Section 4
Interventions for Borderline Personality Disorder

Question 4 | Test | Table of Contents | Borderline
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed aspects that contribute to an angry BPD client’s sense of helplessness. These aspects are  thought process; low self-esteem; and isolation.

On this track, we will examine ways for BPD clients to reflect on their anger in order to understand and prepare for outbursts using the "Anger Journal". These ways are basic entry; four questions; and specific incidents.

Technique: Anger Journal
The first technique using the "Anger Journal" is the basic entry.  In addition to recording incidences in which the BPD client loses his or her temper, I ask the client to record such things as the patterns of chronic tension in his or her body, his or her physiological response, and his or her triggering thoughts. 

I ask the client to pay special attention to the triggering thoughts, as recognizing these is vital in preventing future impulsive outbursts.  I ask my clients to make Daily Entries that address the following points.

  1. The number of times the client got angry in the last 24 hours.
  2. How aroused the client felt when he or she was his or her angriest during the last 24 hours.  I ask the client to use a scale of 1 to 10, where 1 is minimal arousal and 10 is the most anger arousal he or she has ever felt.
  3. How aggressively the client acted when he or she was at his or her angriest during the last 24 hours.  Again, I ask him or her to use a 1 to 10 scale, where 1 is minimal aggression and 10 is the most aggression he or she has ever displayed.

Scott was a 29 year old BPD client who was using the "Anger Journal".  One of his entries looked like this:  December 4.  arousal 6.  Aggression 2. 

Technique: Anger Journal (Four Questions)
In addition to the three main points, I also give my BPD clients a list of four questions they might ask themselves when writing about a certain incident in their anger journal.  The four questions included the following.

  1. What stresses preexisted my anger?  Prior to the moment of anger, were you aware of any painful feelings such as hurt, anxiety, sadness, or guilt?  Did you experience any sense of threat, frustration, or uncomfortable physical sensations?
  2. What trigger thoughts did you use?  What were the thoughts that ignited your feelings?  Can you identify the point where the trigger thoughts turn your stress into anger?
  3. Were you angry or were you feeling some other kind of stress before the trigger statements? 
  4. Was some of your preexisting stress blocked or discharged by the anger?  Did the anger give you even a few seconds of relief

Scott found a few stresses that precluded his angry outburst which included:  work, parents, and house payments. Scott’s triggering thoughts included:  "My son is lazy."  "My wife is a shrew."  "No one cares about my needs." 

Technique: Anger Journal (Specific Incidents)
In addition to the general entries in his "Anger Journal", I asked Scott to try thinking of a specific incident during which he responded with anger.  Scott stated, "Well, when I came home and both my son and my wife were shouting at each other, I started yelling too."  I asked Scott to think back on this incident and to answer the following questions.

  1. What stress underlay my anger?  Scott stated, "I was feeling overwhelmed at work, and I thought I could relax when I got home.  When I heard them shouting, I knew there was no way I was going to be relaxing, so I got even more stressed."
  2. What were my trigger thoughts?  Scott wrote, "I never get a moment’s rest and it’s their fault."
  3. Are there more effective strategies than anger for reinforcing others to meet my needs?  Scott wrote, "I could have tried and help reach a compromise between my wife and son.  I was in a position to help the situation and I only escalated the problem, and no one got what they wanted."
  4. What can I do to meet my own needs?  Scott stated, "I could not let their anger influence me so much and try to reduce their own hostility towards one another."
  5. Can I find other sources of support, nourishment, or appreciation besides the person with whom I feel angry?  Scott wrote, "I could always go to my office until my wife and son learn to resolve their disputes."
  6. What limits do I want to set but feel afraid to acknowledge or insist on?  Scott stated, "I have to accept the fact that my son and wife don’t get along.  I need to remember to limit myself on choosing sides."
  7. How can I negotiate for what I want?  Scott wrote, "I could defuse some of the hostility between my wife and son.  Or, in a quiet and rational tone, ask them to take their anger down a notch.
  8. How might I eventually let go?  Scott wrote, "I will not expect certain things from my home life that at this point cannot be supplied.  I won’t just expect my wife and son to get along when I come home."

After examining his specific incident, Scott stated, "Now I know what gets me going. I have these expectations, and when they’re not met, I fly off the handle." By being able to predict his triggers and reasons for becoming angry, Scott can more easily control his anger.

On this track, we discussed three activities in using the "Anger Journal". These three activities were basic entry; four questions; and specific incidents.

On the next track, we will examine the various forms of "should" trigger thoughts in BPD clients. These forms include  predetermined rules; conditional assumptions; and punishment fallacy.

Aggression in Borderline Personality Disorder: A Multidimensional Model

- Mancke, F., Herpertz, S. C., and Bertsch, K. (2015). Aggression in Borderline Personality Disorder: A Multidimensional Model. Personality Disorders: Theory, Research, and Treatment, 3(6). p. 278-391. doi: 10.1037/per0000098.

Peer-Reviewed Journal Article References:
Bateman, A., & Fonagy, P. (2019). A randomized controlled trial of a mentalization-based intervention (MBT-FACTS) for families of people with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 10(1), 70–79.

Harpøth, T. S. D., Kongerslev, M. T., Moeyaert, M., Bo, S., Bateman, A. W., & Simonsen, E. (2019). Evaluating “mentalizing positive affect” as an intervention for enhancing positive affectivity in borderline personality disorder using a single-case multiple-baseline design. Psychotherapy. Advance online publication.

Stepp, S. D., Whalen, D. J., Pilkonis, P. A., Hipwell, A. E., & Levine, M. D. (2012). Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention. Personality Disorders: Theory, Research, and Treatment, 3(1), 76–91.

What are three activities used in the "Anger Journal"? To select and enter your answer go to Test.

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