Borderline Personality Disorder and the Effects of Instructed Emotional Avoidance or Acceptance in Daily Life

Abstract

This study examined the effects of avoidance- versus acceptance-oriented emotion regulation instructions among individuals with borderline personality disorder (BPD; n = 48), major depressive disorder (MDD; n = 54), and non-psychiatric controls (NPC; n = 50) using ecological momentary assessment. Participants were randomly assigned to either accept or avoid negative emotions, and monitored their moods, urges, and distress tolerance several times per day over 6 days. Avoidance instructions resulted in reduced negative affect and urges for maladaptive behaviors uniquely among BPD participants. Together with past research, and consistent with treatment approaches emphasizing the short-term use of skills to avoid or distract from emotions (e.g., DBT; Linehan, 1993b, 2015), these findings suggest that avoidance of negative emotions may have temporary benefits for individuals with BPD. Acceptance-oriented strategies may take longer or may require more extensive training to be beneficial for emotional functioning in everyday life in BPD.

Daily Emotion Regulation in Major Depression and Borderline Personality Disorder

“…This is in contrast to findings suggesting that suppression may have beneficial effects in BPD (e.g., Chapman et al, 2009). However, the only study demonstrating a negative effect of instructed suppression on affect in patients with diagnosed BPD instructed patients to suppress their emotional experience rather than their emotional expression (Chapman et al, 2016). In contrast, the present study assessed the extent of expressive suppression.…”

“…To the best knowledge of the authors, there has only been one previous study comparing the effect of affect regulation strategies on affect in individuals with MDD and BPD (Chapman et al, 2016). Specifically, the authors examined group differences in the effect of instructed emotion suppression or acceptance on daily negative affect using experience sampling RUNNING HEAD: AFFECT REGULATION IN BPD AND MDD -7 -methodology.…”

Self-criticism and dependency predict affective variability in borderline personality disorder: An ecological momentary assessment study.

“…Participants filled out an average of 50 of 80 repeated assessments per person ( SD = 17, min = 15, max = 75); this corresponds with a compliance rate of 63%. This result is lower than some studies (Ebner-Priemer & Sawitzki, 2007 [94.74%]; Trull et al, 2008 [87%]) but in line with other studies (Chapman, Rosenthal, Dixon-Gordon, Turner, & Kuppens, 2017 [62.5%]; Links et al, 2007 [58%]; Snir, Rafaeli, Gadassi, Berenson, & Downey, 2015 [70%]) that used similar EMA protocols in patients with BPD. Of the original 34 patients, two participants were removed from the analysis because they responded to less than 15% of the scheduled signals.…”

A Day in the Life of Borderline Personality Disorder: A Preliminary Analysis of Within-Day Emotion Generation and Regulation

“…These findings suggest that people with BPD or elevated BPD features may engage in more frequent putatively maladaptive behaviors in part because they are more effective at regulating their emotions in the moment. However, because participants were instructed to use approach-and avoidance-oriented strategies in Chapman et al (2009) and Chapman et al (2017), it is unclear if people with BPD would respond similarly without such direct prompting.…”