Emotion Regulation in Borderline Personality Disorder: Examining the Consequences of Spontaneous and Instructed Use of Emotion Suppression and Emotion Acceptance when Viewing Negative Films

Abstract

Central to models of Borderline Personality Disorder (BPD) is the notion that dysfunctional application of avoidant emotion regulation strategies results in elevated emotional reactivity. To test this account, participants (N = 87) with varying severity of BPD underwent two negative mood inductions, the first with no particular instructions and the second following suppress or accept instructions. BPD severity was associated with greater negative affect at baseline. While BPD severity was associated with greater avoidance, this did not lead to differential reactivity or recovery when viewing the uninstructed film. Both instructed suppression and acceptance reduced emotional reactivity and accelerated recovery in the second film. While BPD severity did not influence how effectively instructed regulation could manage self-reported affect, those with more marked symptoms were trend less effective at regulating electrodermal response. Overall, these data provide little support for the notion that avoidant regulation strategies might lead to emotional hyper-reactivity in BPD, inconsistent with emotional dysregulation accounts of the disorder.

Suppression, Acceptance, and Monitoring of Personally-Relevant Unwanted Thoughts in Women Diagnosed with Borderline Personality Disorder

“…The present findings replicate other recent studies that have compared suppression to acceptance in BPD (e.g., Evans et al, 2013, Svalik et al, 2012: Suppression and thought control resulted in a reduction of self-reported subjective distress among a relatively severe group of BPD patients. The present study added additional variables and analyses, however, and the total picture suggests caution in concluding that these recent results "challenge a core assumption of DBT and other acceptance based therapies, which eschew emotional avoidance and suppression in favour of more mindful approaches" (Evans et al, 2013, p. 561).…”

“…Laboratory studies of EA (Levin et al, 2012) and thought suppression (Najmi & Wegner, 2008) usually reveal negative outcomes in normal controls and in some clinical populations (Abramowitz, Tolin, & Street, 2001;Rassin, 2005) but BPD patients and those higher in BPD symptoms, report reduced distress when asked to suppress and control difficult private experiences, as opposed to observing or accepting them (e.g., Chapman et al, 2009, Evans et al, 2013Svaldi et al, 2012). This interesting and discordant finding requires an account.…”

“…BPD patients asked to engage in acceptance showed increases in urges to engage in non-suicidal self-injury and self-punishment, while those in a suppression group did not (Svaldi, Dorn, Matthies, & Philipsen, 2012). Those diagnosed with BPD exposed to a negative mood induction procedure showed no positive benefits for acceptance over suppression in emotional reactivity and accelerated recovery (Evans, Howard, Dudas, Denman, & Dunn, 2013). The latter authors even concluded that in BPD populations there is "little support for the view that suppression is a bad strategy and that acceptance is a good one" (Evans et al, 2013, p. 561).…”

“…selfreferent) material" (Evans et al, 2013, p. 560). With the exception of a few studies that include physiological measures (e.g., Evans et al, 2013), there has been little attempt in laboratory studies to examine more overt measures of emotion regulation (Aldao & Dixon-Gordon, 2014), despite the widespread concern over self report alone as a measure of impact (e.g., Rosenthal et al, 2008). Finally, these laboratory based emotional regulation manipulations have not been linked to self-reported EA despite the fact that EA mediates emotional regulation strategies in BPD (Schramm et al, 2013), and has been found to alter the impact of laboratory manipulations in nonclinical samples (e.g., Feldner Zvolensky Eifert, & Spira, 2003).…”

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

“…emotional avoidance or suppression in healthy samples may result in lower physiological arousal (Dunn, Billotti, Murphy, & Dalgleish, 2009), and in BPD samples, may attenuate emotional reactivity (Evans et al, 2013). To our knowledge, only one published study has examined the consequences of instructed emotional avoidance in naturalistic (versus laboratory) settings among persons with BPD features (Chapman, Rosenthal, & Leung 2009).…”