(PS5-A14) Positive and Negative Emotions as Predictors of Urges for Suicide During Dialectical Behavioral Therapy

Borderline Personality Disorder (BPD) is often characterized by emotion dysregulation, or increased intensity of and lack of strategies to regulate emotions. Emotion dysregulation and high negative affect can contribute to dysregulated behavior such as suicidal ideation. Dialectical Behavioral Therapy (DBT) can effectively reduce BPD symptoms, including suicidality. A potential DBT mechanism of change is a decrease in negative emotion intensity via use of emotion regulation strategies. Evidence also suggests increased positive affect confers resilience against suicidality. Few studies have examined patterns of change in both positive and negative emotions during DBT as they relate to suicidality. This study examined self-reported intensity of emotions as predictors of self-reported urges for suicide. We hypothesized that decreased intensity of negative emotions and increased intensity of positive emotions would predict decreased urges for suicide during DBT.

Participants (N=62) were adults seeking DBT via the Los Angeles County Department of Mental Health. During treatment (M=10.81 weeks, SD=9.92, range=1-50) participants completed weekly diary cards and recorded daily emotion intensity ratings and urges for suicide on a scale from 1-5, where higher scores reflected a higher intensity of peak emotion or urges for suicide that day. Emotions rated were sadness, shame, anger, fear, and joy. Mean and maximum emotion intensity scores and urges for suicide were calculated to reflect weekly average and peak ratings and were within-person centered.

Multilevel growth curve models were run to assess whether changes in weekly emotion ratings predicted changes in weekly urges for suicide throughout treatment. There was a significant interaction between time and mean weekly shame (t(533.8)=-2.02, p=.044). As shame decreased, urges for suicide decreased over time, but individuals with higher mean ratings of shame showed steeper decreases in urges for suicide over the course of treatment. There was a significant interaction between time and maximum weekly joy (t(514.9)=-2.25, p=.025). As joy increased, urges for suicide decreased over time, but individuals with higher maximum ratings of joy showed steeper decreases in urges for suicide over the course of treatment. The interactions between time and maximum weekly shame and time and average weekly joy were not significant (p’s >.05). Tests for mean and maximum sadness, anger, and fear were not significant (p’s >.05).

Results supported our initial hypothesis and showed that weekly decreases in intensity of shame and weekly increases in intensity of joy predicted decreased urges for suicide. Findings suggest that reduced lability of negative emotions are associated with reduced suicidality, while increased experience of positive emotions may serve as a protective buffer against suicidality. Findings are constrained by our assessment method, as positive emotions were only assessed using self-reported joy. Results indicate that both shame and joy may serve as important treatment targets, and future studies should use mediation to test whether changes in these particular emotions impact urges for suicide through use of emotion regulation strategies in DBT.