Symposia
Personality Disorders
Matthew W. Southward, Ph.D.
Research Assistant professor
University of Kentucky
Lexington, Kentucky
Stephen A. Semcho, M.A.
Clinical Psychology Doctoral Student
University of Kentucky
Lexington, Kentucky
Nicole Stumpp, M.S.
Graduate Researcher
University of Kentucky
Lexington, Kentucky
Martina Fruhbauerova, M.S.
Doctoral Student
University Of Kentucky
Lexington, Kentucky
Shannon Sauer-Zavala, Ph.D.
Assistant Professor
University of Kentucky
Lexington, Kentucky
According to Linehan’s (1993) influential biosocial theory, borderline personality disorder (BPD) is characterized in large part by emotion regulation skills deficits. Treatments for BPD, such as dialectical behavior therapy, have led to more frequent emotion regulation skill use (Neacsiu et al., 2010), but there is mixed evidence regarding the impact of skills on BPD features and comorbid symptoms (e.g., anxiety, depression, anger; Neacsiu et al., 2010; Wilks et al., 2016). We tested whether emotion regulation skill use in a novel, modular, cognitive-behavioral treatment for BPD predicted session-to-session reductions in BPD features, anxiety, and depression. The 18-session treatment, BPD Compass (Sauer-Zavala et al., 2022), included modules composed of cognitive, behavioral, and mindfulness skills to target neuroticism, antagonism, and disinhibition (the three personality dimensions most characteristic of BPD; Samuel & Widiger, 2008). Before each session, 42 patients with BPD (Mage = 28.17; SD = 9.72; 83.3% female; 95.2% white; 52.4% sexual minority) reported on their emotion regulation skillfulness (i.e., skill knowledge, frequency, quality, and effectiveness) using the Dimensions of Skillfulness and Use Scale (Southward & Sauer-Zavala, 2021) as well as past-week BPD features (ZAN-BPD; Zanarini et al., 2015), anxiety (OASIS; Norman et al., 2006), and depression (ODSIS; Bentley et al., 2014). We disaggregated between- from within-person variability in emotion regulation skillfulness in hierarchical linear models to predict current session clinical outcomes, including prior session clinical outcomes and session number as covariates and modeling random intercepts. Greater within-person skillfulness significantly predicted session-to-session decreases in BPD features, B = –.20, SE = .07, p < .01, 95% CI [–.33, –.06], but not anxiety, B = –.10, SE = .05, p = .06, 95% CI [–.19, .02], or depression, B = –.10, SE = .06, p = .10, 95% CI [–.22, .02]. There were no significant between-person relations, ps > .10. Thus, when patients used their skills more skillfully than their personal average, they experienced decreases in BPD features but not necessarily anxiety or depression. These findings suggest that emotion regulation skillfulness may be a mechanism by which BPD Compass leads to reductions in BPD features and that the skills taught in BPD Compass may exert relatively specific effects on BPD features compared to comorbid anxiety and depression.