(PS10-C71) Change in Daily Interpersonal Emotion Regulation Strategies Used During Brief, Mechanism-informed Interventions for Borderline Personality Disorder

Background: Focusing on impaired interpersonal functioning in borderline personality disorder (BPD), a hallmark characteristic of the disorder, may provide a useful microcosm for understanding the mechanisms driving BPD psychopathology. This study sought to evaluate changes in daily interpersonal emotion regulation (IER) strategies across different distinct, brief, mechanism-informed interventions for BPD.


Methods: Using a single case experimental design, N = 8 patients with BPD (6 female, mean age 27 years, range 19-55 years) were randomized to a 2- or 4-week assessment-only baseline phase, then randomized to receive either an emotion regulation or attachment security intervention (both 4 sessions long), prior to completing a 4-week follow-up phase. Patients reported event-or signal-contingent daily logs of interpersonal conflict including IER strategy (as defined by the Difficulties in Interpersonal Emotion Regulation Scale; Dixon-Gordon et al., 2018), associated emotion, and associated emotional intensity, for up to 16 weeks. Frequencies of IER, interpersonal-prompted emotions, and emotional intensities were averaged across phases of the study per patient, coded as either increasing or decreasing when receiving the intervention compared to their respective baseline, and then compared across intervention groups.

Results: There was variation in the type of IER strategies used amongst patients when receiving either intervention when compared to baseline levels, with the majority of patients demonstrating increases in avoidance, reassurance-seeking, and venting when receiving the attachment condition, and more patients demonstrating decreases in avoidance, seeking-reassurance, and venting amongst those in the emotion regulation condition. Emotional intensity increased for most patients regardless of type of intervention they received, though intensity largely decreased by follow-up across patients in both interventions. Type of emotion experienced during conflicts greatly varied across patients, with the majority of patients reporting increases in sadness in both conditions, decreases in guilt/shame in both conditions, and an increase in anxiety amongst those receiving the emotion regulation condition, whereas most patients in the attachment security intervention reported more decreases in anxiety in interpersonal conflicts.

Conclusions: Results suggest variance in 1) types of IER strategies used amongst patients with BPD, and 2) whether IER strategies increased or decreased when receiving different mechanism-informed treatments. Differences in interpersonal-prompted emotions and associated emotional intensity were observed, with results suggesting increases in emotional intensity during active treatment for BPD. Results underscore the importance of idiographic, personalized treatment approaches and the usability of accessible real-time data collection for patients with BPD.