Key concerns for people with borderline personality disorder (BPD) are difficulties in knowing who they are, regulating their emotions and maintaining meaningful relationships. These issues significantly impact the lives of people living with BPD and the people around them. Fortunately, effective treatments are available. However, not everyone benefits from treatment and recovery does not always entail a good quality of life with particular issues remaining in identity functioning and maintaining relationships.
It is important to address this gap in treatment effectiveness and understand how we can support identity, interpersonal and emotional functioning for people with BPD. This gap could be partly due to methodological challenges in designing studies that are ecologically valid and relevant to the dynamic processes in BPD. Moreover, there is a challenge in translating research findings into clinical interventions. To this end, this symposium aims to progress the understanding of identity disturbances, interpersonal functioning and emotion regulation in BPD using personally tailored paradigms. With these studies, we aim to identify important mechanisms that may be amenable through psychotherapeutic intervention and showcase how these interventions may be implemented.
In the area of interpersonal relationships, Dr Marceau will discuss how the core conflictual relationship theme can be used to investigate interpersonal difficulties reported by people with BPD. In the area of identity, Dr van Schie will discuss how people’s pervasive negative self-views may interfere with building new relationships including the therapeutic alliance. In the area of emotion, Dr Grandjean will discuss how change in emotional arousal may be a mechanism of therapeutic change when using an idiosyncratic assessment of self-criticism. Finally, Dr Krause-Utz will discuss how research findings on emotion dysregulation can be translated into a clinical intervention via a phone application. The symposium is chaired by Prof. Brin Grenyer and consumer co-chair is Sophie Lucas.
We conclude that the identity, interpersonal and emotional challenges that people with BPD experience can be validly assessed with paradigms and neuroimaging techniques using personally relevant stimuli and that findings can be translated to clinical practice.
Ely Marceau
Getting ‘personal’ with interpersonal functioning in borderline personality disorder: Using the core conflictual relationship theme to personalise neuroimaging stimuli
The core conflictual relationship theme (CCRT) is traditionally a method of clinical case formulation. More recently the CCRT has been adapted as an experimental paradigm to generate individualised interpersonally-salient stimuli in two functional magnetic resonance imaging (fMRI) pilot studies. To date, no study has replicated this novel methodology with a representative clinical sample. We present results from the first between-groups study contrasting participants with borderline personality disorder (n=30) and healthy controls (n=30).
Participants completed a clinical interview including the relationship anecdote paradigm (RAP). Two independent raters coded the transcribed RAP interviews and derived 15 individualised CCRT sentences for each participant. These, along with 15 neutral CCRT sentences, were presented in a randomised order in the scanner. Participants used the self-assessment manikin to rate their emotional arousal and mood following passive viewing of each trial.
Results include multilevel analysis of affective data and neural responses to the individualised versus neutral CCRT stimuli. Validation of this method promotes the use of personalised assessment, bridging clinical formulation with experimental neuroimaging paradigms. This study demonstrates parallels between interpersonal difficulties reported by people with BPD and how brain processes reflect these challenges, opening the possibility of novel treatment approaches.
Charlotte van Schie
Identity dysfunction in borderline personality disorder: an experimental analogue of how negative self-views may interfere with building positive relationships
A disturbed, negative sense of self is associated with interpersonal difficulties and is characteristic of disorders such as BPD. Negative self-views may affect an individuals’ ability to build positive relationships, including a therapeutic relationship. However, it is not yet well understood how identity disturbances may give rise to interpersonal difficulties. In two studies we tested how identity disturbances are associated with interpersonal difficulties.
Participants are study 1: young people (N = 43), and study 2: participants with a diagnosis of BPD (N =30) and without a diagnosis (N = 35). In a within-subject experimental paradigm using a social feedback task, participants received evaluations, supposedly from a panel. Using multilevel models, we tested whether negative self-views were associated with how much the participants affiliated to each of the three panel members who provided either predominantly negative, intermediate, or positive feedback.
People with more negative self-views reported lower mood in response to positive feedback and had less affiliation towards the member who provided predominantly positive feedback.
We demonstrate how pervasive interpersonal challenges relevant to BPD are associated with negative self-image. Pervasive negative self-views may interfere with building new relationships including the therapeutic alliance.
Annegret Krause-Utz
The Effect of an Emotional Working Memory Training on Distractibility by Facial Expressions in Individuals with Childhood Maltreatment History.
Increased distractibility to social cues (e.g., neutral and emotional facial expressions) may contribute to rejection sensitivity and problems in goal-directed behaviour in BPD. Aim of the present study was to investigate the effectiveness of a smartphone-application version of an online Emotional Working Memory Training (EWMT) with facial distractors on emotion regulation and psychopathological symptoms. We further aimed to investigate the role of BPD symptoms and childhood maltreatment severity in training success. In a randomized control trial, women with high versus low BPD symptoms and a history of childhood maltreatment are assigned to either the eWMt (dual-n-back-task with socio-emotional distractors) or an active control group (placebo training, cognitive feature match task). At baseline (T1) and after 20 days training (T2), participants perform an adapted emotional Sternberg paradigm and an emotion regulation task online. Preliminary analysis in a sample of 52 patients with BPD revealed that, compared to a placebo training, the EWMT improved emotion regulation as measured with a cognitive reappraisal task (F(1,39)=5.15, p=.029, ɲ2=0.12). After the EWM training, patients rated negative pictures as less negatively (more positively) in the down-regulation condition (t(21)=2.24, p=.036, d=3.04) and improved their overall working memory performance (t(21)=6.54, p<.0001, d=1.34). Final results will be presented. Implications of these findings are discussed.