Mindful Continuing Education

Mindfulness for Borderline Personality Disorder

Introduction

1. With the development of dialectical behavior therapy (DBT) in 1993, a critical breakthrough came for those with borderline personality disorder (BPD) as they were presented with mindfulness techniques to help them cope with judgments, intense emotions, and emotional pain.

A. True B. False

Part 1-Chapter 1: Borderline Personality Disorder-You Are Not Alone

2. Which of the following is an accurate statement about the occurrence of BPD?

A. Depending on which survey is consulted, somewhere between three and ten million people in the United States suffer from BPD B. Approximately 5% of patients in outpatient clinics suffer from BPD, and 20% of those in an inpatient unit will suffer from the disorder C. Previous, long-standing data have indicated that BPD affects women more than men by a ratio of three to one D. All of the above

BPD and the DSM-Efforts to Avoid Abandonment

3. When an individual with BPD feels abandoned, he or she may resort to behaviors such as texting a friend or therapist so many times that the person feels annoyed, which is known as a hasty/impulsive behavior.

A. True B. False

Suicide and Self-Injury: Similar but Different

4. Research indicates that one of the most common reasons that people self-injure is to make sure that someone else pays attention to their suffering.

A. True B. False

BPD and Symptoms Not in the DSM

5. The author describes several experiences not mentioned in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) that those living with BDP may encounter, including each of the following EXCEPT:

A. Feeling misunderstood or experiencing self-hatred B. Being extremely sensitive to others' emotions C. Difficulty establishing a continuous and coherent sense of time and sense of self D. Having chronic feelings of emptiness or aloneness

An Integrated Definition of BPD

6. Dialectical behavior therapy considers five areas of dysregulation in BPD, including emotion dysregulation, interpersonal dysregulation, behavioral dysregulation, cognitive dysregulation and:

A. Self-dysregualtion B. Mood dysregualtion C. Identity dysregulation D. Communal dysregulation

Life's Behaviors as Habits-Hardwiring Ineffective Habits?

7. One of the challenges with BPD is that one behavior, such as cutting, may be judged as "bad" by others, whereas for the person with BPD, cutting may be seen as a solution to the problem of intense emotions.

A. True B. False

Cognitive Distortions and All or Nothing Thinking

8. The pattern of thinking in which a person ignores any positive aspects of a situation and focuses only on the negative is known as:

A. Black-and-white thinking B. Filtering C. Overgeneralization D. Personalization

Chapter 2: What is Mindfulness?

9. Mindfulness may be defined as "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally", "a way of being", "staying in the moment", or "being aware of what's going on around you or within you."

A. True B. False

The Four Noble Truths

10. Which of the following is NOT one of the Four Noble Truths that address the concept of suffering and the ability to be still?

A. Life means suffering B. The origin of suffering is change C. The cessation of suffering is attainable D. There is a path to end suffering

Mindfulness vs. Meditation

11. Meditation includes the formal or informal practice of mindfulness, where a person formally sets aside time each day to sit quietly in a certain place for a certain time, or when a person practices mindful awareness informally during daily activities.

A. True B. False

Chapter 3: The Brain Biology of BPD and Mindfulness-The Neurobiology of BPD

12. The most consistent finding in imaging studies of people with BPD, compared to those without BPD, is increased activity in the __________, particularly if they also experience suicidal thoughts.

A. Prefrontal cortex B. Hippocampus C. Amygdala D. Hypothalamus

Genes

13. Most researchers consider that the causes of borderline personality disorder are roughly 40 percent genetic and 60 percent environmental.

A. True B. False

The Neurobiology of Mindfulness

14. Each of the following correctly describes how mindfulness may impact brain regions and chemicals EXCEPT:

A. Mindfulness practice that focuses on paying attention activates the prefrontal cortex and helps keep the brain focused, attentive, and aware B. Mindfulness meditation has been shown to strengthen brain activity in the parts of the prefrontal cortex that are involved in impulse control C. Yoga has been shown to increase activity in the prefrontal cortex and decrease activity in the amydgala D. Transcendental meditation creates a slowing of the brain in the temporal lobes which leads to a decrease in stress reactions

Mindfulness and Other Common Problems

15. Although to date there have not been any studies that show that mindfulness leads to an increase in serotonin, there is research that shows that being mindful of stories that bring us joy can increase serotonin, which tends to be low in people with BPD.

A. True B. False

Part 2-Chapter 4: The Practice of Mindfulness-Setting Up Your Mindfulness Practice

16. For people who are just starting out, the authors recommend practicing mindfulness for a minimum of thirty minutes a day, preferably in two fifteen minute sessions.

A. True B. False

17. Although mindfulness practice can be done in various seated positions, it is recommended that participants keep their eyes closed during the process

A. True B. False

Taking Control of Your Mind

18. Paying attention to thoughts means slowing down and looking in detail at:

A. The speed and tone of the thoughts B. The quality of the thoughts C. The content of the thoughts D. All of the above

Practicing Mindfulness

19. Two important mindfulness skills are using intention and choice to return the mind to the task at hand, and _________________ your thoughts and feelings without putting labels on the experience.

A. Monitoring and guiding B. Watching and noticing C. Attending to and appreciating D. Following and respecting

20. Typical human reactions to thoughts and emotions tend to fall into the two opposing categories of suppression and enhancement.

A. True B. False

21. The skill of identifying allows people to categorize their experiences and communicate them with others and with themselves by putting words to them

A. True B. False

Nonjudgment-Emotions and Judgments

22. Often times when a person makes a judgment, he or she is more likely to search for information that affirms or validates the judgment, and ignores other important information, which is known as:

A. Confirmation bias B. Verification impulse C. Endorsement tendency D. Substantiation shift

Accepting Reality as It Is

23. Which of the following is NOT an accurate statement about accepting reality as part of mindfulness practice?

A. For some people, accepting themselves and their lives as they are can be one of the hardest skills to master B. In DBT, accepting reality as it is and doing so without judgment is called profound acceptance C. When accepting reality as it is, people can begin to look at how this reality developed and how they can change their response to it or their experience of it D. Accepting reality can profoundly influence behavior, particularly when a person is in distress, and can help the person look at the situation from a different perspective

One Thing in the Moment

24. One important component of mindfulness practice is to do one thing in the moment, which means letting go of all the thoughts racing around in your mind and putting your mind and body to the task of focusing on just one undertaking at a time in that moment.

A. True B. False

Do What the Situation Calls For

25. The skill of ______________ calls for the individual to step back from the idea of having to be right, think more about what works when responding to a situation, and being aware of what he or he is choosing to do or not to do.

A. Usefulness B. Perceptiveness C. Effectiveness D. Validation

Part 3: Chapter 5-Emotion Dysregulation

26. Emotional dysregulation is at the core of borderline personality disorder and is most readily identified by all-or-nothing thinking, relationship reactivity, and extreme sensitivity to one’s own emotions.

A. True B. False

Applying Mindfulness Skills to Emotional Dysregulation-Ride the Wave

27. In order to be mindful of one’s current emotions and to "ride the wave", each of the following steps is recommended EXCEPT:

A. Register body sensations and identify action urges B. Determine the emotion while watching and noticing it as if it were a wave C. Take deep breaths, establish a grounded position, and keep hands and body open D. Recall behaviors and judgments that pertain to the emotion

Mindfulness Practice: Use Nonanger with Others

28. When individuals become mindful of feeling angry, frustrated, or irritated with someone in their lives, it may be helpful to practice curiosity about the other person's experience rather than anger, as this habit of practicing "nonanger" will likely lead to less suffering and better interactions.

A. True B. False

Contagious Emotions

29. Experts believe that people with BPD are born with emotional sensitivity, causing them to experience emotions more intensely, but for a shorter period of time and with a quicker return to baseline, which in turn creates confusion and misunderstanding about these feelings.

A. True B. False

Chapter 6: Interpersonal Dysregulation-Unstable Relationships

30. The goal of the mindfulness practice, Get STABLE, is to recognize how the state of your mood colors how you see the other person in the relationship and to teach your mind that the other person and your mutual relationship are more than:

A. What you feel in the current moment B. Someone or something to be overidealized or underappreciated C. The sum of past interactions and experiences D. None of the above

Mindfulness Practice: Your Typical Responses

31. Many people with BPD have strong feelings, often including shame about their ineffective thoughts, and these feelings along with self-judgment can lead to avoidance and prevent the building of awareness.

A. True B. False

Fear of Abandonment-Applying Mindfulness

32. Because the fear of abandonment can quickly spiral into _________________, mindfulness can be used to slow down one's emotions.

A. Harmful behaviors B. Catastrophizing thoughts C. Anger and frustration D. Lack of awareness of reality

Feeling Misunderstood-Mindfulness Practice

33. Feeling misunderstood is a familiar feeling for people with BPD, but most will feel better if they can interact with others or embrace memories of such interactions.

A. True B. False

Chapter 7: Behavioral Dysregulation

34. Behavioral dysregulation means using behaviors such as self-injury, suicidality, drugs and alcohol, unsafe sex, and other potentially life-threatening actions to regulate one's emotions, especially in the context of personal responsibility.

A. True B. False

35. One mindfulness practice calls for getting to know your _____________ mind by labeling a mode of thinking in order to be able to step back and get some distance from your thoughts.

A. Judgmental B. Self-fulfilling C. Nonproductive D. Self-destructive

Impulsivity

36. Which of the following is NOT one of the skills that the authors recommend to help you slow down in order to deal with impulsive and reactive thoughts and behaviors?

A. Resist the urge to swallow B. Don't move from where you are until the urge has subsided C. Concentrate on a place that's away from distractions D. Focus on your toes

Chapter 8: Cognitive Dysregulation

37. Two forms of dissociation that people with BPD suffer from include derealization (the feeling that everything around you seems unreal) and depersonalization (the feeling that you yourself are not real).

A. True B. False

Dissociative Symptoms

38. Dissociative symptoms occur in about one-half of people with BPD, and these individuals experience more dissociation than do people with every other psychiatric disorder

A. True B. False

Paranoid Thoughts

39. Paranoid thoughts are those of a suspicious nature in which people believe that something is not right with them, that others are out to get them, and that another's intentions are evil, and in BPD, they tend to last minutes to hours, and are often prompted by stress.

A. True B. False

Chapter 9: Self-Dysregulation

40. Dysregulation of self includes the symptoms of ___________________, chronic feelings of emptiness, and self-hatred, which can be particularly hard to treat.

A. Mind reactivity B. Identity disturbance C. Intense emotional pain D. Extreme sensitivity to emotions

Who Am I

41. Basic building blocks for getting to know who you are include your values, morals, and judgments, your __________________, and how you identify with yourself on a more basic level through your thoughts, feelings, and body sensations.

A. Place in the world B. Relationships and experiences C. Ability to love yourself D. None of the above

Mindfulness Practice

42. Learning what is important to you is the foundation practice of mindfulness, and the most powerful tool for helping yourself to stay grounded and remain in your own skin.

A. True B. False

Chronic Feelings of Emptiness

43. When studying emptiness in the context of BPD, experts have concluded that:

A. Emptiness is closely related to feelings of sadness, boredom, and helplessness B. Chronic emptiness contributes to the development of suicidal thoughts and is often the cause for suicidal thoughts moving to suicide attempts C. Chronic emptiness seems to overlap a great deal with depression and anxiety D. There is a big overlap between emptiness and hopelessness, and hopelessness is a strong risk factor for suicide

Mindfulness Practice: Connect with Others

44. Paying attention to connectedness means paying attention to the impact you have on others and how many people you and your behaviors can affect in a positive and a negative way.

A. True B. False

Mindfulness: Random Acts of Kindness

45. Practicing random acts of kindness can be very effective in showing the positive impact you can have on others, and appear to be particularly effective when the random kindness is directed at people you know well.

A. True B. False

Common Humanity vs. Isolation

46. One aspect of self-compassion is being able to step back and see that __________ is a part of the human condition.

A. Failure B. Disappointment C. Pain D. Loss

Part 4-Chapter 10: Telling the Story of Your Life

47. The stories that we tell ourselves may either be useful or harmful, and people with BPD often feel a strong attachment to their stories, even those that bring them tremendous misery.

A. True B. False

Applying Mindfulness Skills to Telling Your Story-EDIT

48. The mindfulness practice known as EDIT calls for each of the following strategies EXCEPT:

A. Express your story on paper, mindfully attending to habitual details B. Describe the way in which general thoughts lead to general assumptions and assertions C. Identify the thoughts and emotions that cause you the most suffering D. Tell your story differently, use different assumptions, and end the story differently

Mindfulness Practice: How You Choose to Tell It-Find Alternatives

49. When telling your story, notice and label the statements that you make and the way you tell your story so that you will be able to take each statement and retell it in a less absolute and more factual way.

A. True B. False

The Mindful Journey

50. The journey of mindfulness is intended to help you notice patterns and do things differently, approaching outcomes with:

A. Recognition and choice B. Calm and resolve C. Curiosity and compassion D. Self-control and intention


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