Borderline personality disorder (BPD) is characterized by difficulties in several areas: 1) strong, shifting emotions, 2) conflict in relationships, and 3) impulsive behaviors including self-injury. In the past, it was thought that BPD was very difficult to treat but research shows this is NOT the case. In fact, effective treatment for BPD is now widely available. The goal of the BEST Research Program is to further improve treatment for BPD (and related phenomena like anger and suicidal thoughts/behaviors) by identifying the processes that drive these symptoms, as well as treatment strategies that directly target them.
The BEST Research Program considers BPD to be an emotional disorder. This term is used to describe mental health conditions characterized by the frequent experience of strong negative emotions, coupled with aversive reactions (“I shouldn’t be feeling this way”) to these emotions when they occur. Often, negative reactions to emotional experiences lead to efforts to avoid or suppress them; while avoidance of emotions works in the short-term (temporary relief), it backfires in the long-term, leading to more frequent and intense negative emotions. In addition to BPD, the most common emotional disorders are anxiety and depressive disorders. Given that the process that maintains symptoms (avoidant reactions to emotions) is similar across emotional disorders, these disorders tend to co-occur – in fact, individuals with BPD have a 75% chance of also having an anxiety or depressive disorder.
Given the high rates of co-occurance (or comorbidity) amongst emotional disorders, the BEST Research Team is interested in treatments that address common core mechanisms maintaining symptoms (negative reactions to emotions that lead to avoidant coping) rather than the diverse symptoms of each disorder themselves. Specifically, our group is focused on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. The Unified Protocol was developed in direct response to high rates of comorbidity amongst emotional disorders and targets core mechanisms as a means to more efficiently treat co-occuring conditions.
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- Changing Behaviors in Borderline Personality Disorder: The behaviors associated with BPD are often the most noticeable symptom. These include non-suicidal self injury (e.g., cutting, burning), binge eating, reckless spending, substance use, etc. People with BPD report engaging in these acts as a way to cope with strong emotions – these behaviors tend to make people feel better in the short-term but lead to problematic consequences in the long term. The goal of the Boston Borderline Study is to identify the best treatment strategy to help people with BPD learn to rely less on these impulsive responses to manage their emotions. This project is funded by the National Institute of Mental Health and more information can be seen here.
- What Drives Borderline Personality Disorder? BPD is highly complex and for this reason, researchers have different theories about what symptoms are at disorder’s core, possibly leading to the other symptoms. BPD has been described as a disorder of interpersonal difficulties driven by insecure styles of attachment and/or interpersonal hypersensitivity. It has also been considered an emotional disorder, driven by intolerance of emotions. The purpose of this study is to evaluate these different theories as a means to identify the most promising treatment targets for this disorder.
- Preventing Emotional Disorders Before they Emerge: Recent Reports suggest that at least 20 percent of BU undergraduates will experience anxiety and depression during their college years. The goal of this project is to create an online resource for students that teaches helpful skills for coping with difficult emotions (e.g., anxiety, sadness/homesickness, anger). Research suggests that healthy emotional coping is a protective factor that may prevent the development of common mental disorders, like anxiety and depression, during times of stress. Our team has pilot tested a two-hour coping skills workshop with a small group of BU psychology students; feedback was quite positive and students continued to access workshop materials (e.g., skills handouts) throughout the rest of the semester. Further, students who participated in the workshop demonstrated significantly lower levels of negative emotions and avoidant coping at a one-month follow-up assessment. The next step was to translate this “in-person” workshop to an online format to facilitate dissemination to more students in need. BU’s incoming freshman class of 2017 was invited to take part in a research study evaluating this intervention. Students were assigned to participate in the online course and complete questionnaires throughout out their freshman year, or simply complete questionnaires (without access to the course). Results are forthcoming. This project is funded with seed money from BU’s Digital Learning Initiative and the online course was developed in collaboration with BU’s Office of Distance Education. More information about this project can be viewed here in the February, 2018 issue of The Behavior Therapist.
- Emotion Language in Borderline Personality Disorder: Past research suggests that BPD is characterized by a lack of emotion granularity, meaning that individuals have a harder time expressing their emotions specifically. In this study, we are analyzing short essays written by individuals with BPD about strong negative events in their recent past. We want to analyze the emotion language in order to see what factors may impact the way subjects express their emotions. Ultimately, this may provide deeper knowledge about the underlying emotional dysregulation associated with the disorder.
Recently Completed Projects and Publications
- Transdiagnostic Treatment of Borderline Personality Disorder and Comorbid Disorders: BPD is characterized by high rates of co-occurrence with depressive and anxiety disorders, and recent conceptualizations of this comorbidity suggest that these disorders may result from common underlying mechanisms (e.g., temperamental vulnerabilities and functional maintenance factors). The Unified Protocol was developed to address these shared features relevant across frequently co-occurring disorders. The purpose of this study was to explore the preliminary efficacy of the Unified Protocol for the treatment of BPD with comorbid depressive and/or anxiety disorders amongst five cases. For the majority of participants, the Unified Protocol resulted in clinically significant decreases in BPD, anxiety, and depressive symptoms, as well as increases in emotion regulation skills, suggesting preliminary support for the Unified Protocol in the treatment of BPD. More information can be viewed here.
- Applications of the Unified Protocol for Suicidal Inpatients: Recently, the lab conducted a small trial using a brief, 5-session adaptation of the Unified Protocol with suicidal patients on a crisis stabilization unit. The goal of this study was to examine the acceptability and feasibility of using the Unified Protocol to treat suicidal thoughts and behaviors. Although preliminary, the results of this study suggested that the Unified Protocol was very acceptable to this patient population and that it may be useful of the treatment of high risk emotional disorder features such as suicidal thoughts and behaviors. More information can be viewed here.
- Personalizing Treatment for Emotional Disorders: There is strong evidence that the Unified Protocol, when presented in its entirety, is effective in reducing symptoms of emotional disorders. Given that the UP consists of multiple skills, the next step is to determine whether skills can be presented alone or in a varied order. Recent research conducted by our lab has shown that each module is self-contained and independently leads to change in different skills; thus it is possible that the modules could be reordered based on a patient’s presenting problem to increase the efficiency of treatment. To this end, we reordered treatment modules to either capitalize on a patient’s existing strengths or compensate for weaknesses. Results suggest that prioritizing patients’ existing strengths in treatment leads to steeper improvements in symptoms than prioritizing weaknesses.
- Addressing Anger in Psychological Treatment: Anger remains a relatively under-explored emotion in emotional disorders that is rarely addressed in treatment. Unfortunately, elevated anger in this context is associated with a variety of negative consequences including greater symptom severity and a lower likelihood of responding to existing psychological treatments. The aims of this study were to (1) learn more about what triggers and maintains the experience and/or expression of anger in emotional disorders and (2) gather preliminary data exploring the effects of two specific treatment components on anger in this context.
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