Category: Personality Disorders
Amanda Uliaszek, Ph.D.
Associate Professor
University of Toronto
Toronto, Ontario, Canada
Alexander Chapman, Ph.D.
Professor
Simon Fraser University
Burnaby, British Columbia, Canada
Maya Amestoy, PhD
University of Toronto
Thornhill, Ontario, Canada
Matthew W. Southward, Ph.D.
Research Assistant professor
University of Kentucky
Lexington, Kentucky
Amanda Uliaszek, Ph.D.
Associate Professor
University of Toronto
Toronto, Ontario, Canada
Anthony Ruocco, Ph.D.
Professor, Interim Graduate Chair and Director of Clinical Training
University of Toronto
Toronto, Ontario, Canada
Borderline personality disorder (BPD) is characterized by cognitive, emotional, interpersonal, and behavioral dysregulation. Notably, this diagnosis is often associated with non-suicidal self-injury and suicidality, resulting in high levels of mortality, risk, as well as lower levels of functioning. However, extant research supports BPD as best represented as a syndrome of heterogeneous and overlapping dimensions. Thus, research on the diagnostic entity as it stands, rates of severity within the diagnostic limits, and transdiagnostic samples experiencing generalized personality pathology and other symptoms of emotional distress are relevant to understanding the dynamic properties and the vulnerabilities associated with BPD. Because of the risk outlined above, BPD has become the focus of more treatment outcome research compared to any other personality disorder. However, as this literature expands, it is clear that 1) overall there is only minimal evidence for the efficacy of such treatments across many BPD symptoms; 2) mechanisms of action need to be identified within evidence-based treatments in order to maximize and streamline effects; 3) these mechanisms should be explored in relevant transdiagnostic samples. The present symposium seeks to answer questions related to how myriad interventions affect purported mechanisms of change in BPD, most notably the construct of emotion dysregulation. Notably, we will explore the neurological underpinnings of this dysregulation in BPD. Taken together, learners are able to understand the dynamic interplay between symptoms of personality pathology and comprehensive skill sets that certain therapies are purporting to champion; these skills and symptoms are can then be related to basic biological processes.
We will start this symposium with a focus on dialectal behavior therapy (DBT) skills group and whether the targets emphasized in this therapy can actually be validated in comparison to a non-DBT control group. Demonstration of a change in these targets as differing between other therapies and then linked to outcome provides an initial understanding of why DBT may work better than some other therapies to improve personality pathology symptoms.
Next, we will discuss a novel, CBT-based treatment for BPD. This talk demonstrates sophisticated statistical modeling to demonstrate how the weekly use of emotion regulation skills improves BPD on a session-by-session basis. This provides concrete mechanistic evidence for the link between emotion regulation and outcome.
The third talk examines both DBT-specific and non-specific mechanisms of change across three doses of DBT skills group in a transdiagnostic sample in a day treatment program. In this study, we examine the effect of skills usage and therapeutic alliance across multiple timepoints.
Finally, all of the above research relates BPD and personality pathology to difficulties with interpersonal, cognitive, behavioral, and/or emotion dysregulation. The final study elucidates these observations by examining underlying phenomena related to why people with BPD tend to respond to faces (both neutral and those conveying negative emotions) with heightened reactivity compared to those without BPD.
Presenter: Maya E. Amestoy, PhD – University of Toronto
Co-author: Tahira Gulamani, MA – University of Toronto Scarborough
Co-author: Amanda A. Uliaszek, Ph.D. – University of Toronto
Co-author: Tayyab R, p – University of Toronto Scarborough
Presenter: Matthew W. Southward, Ph.D. – University of Kentucky
Co-author: Stephen A. Semcho, M.A. – University of Kentucky
Co-author: Nicole Stumpp, M.S. – University of Kentucky
Co-author: Martina Fruhbauerova, M.S. – University Of Kentucky
Co-author: Shannon Sauer-Zavala, Ph.D. – University of Kentucky
Presenter: Amanda A. Uliaszek, Ph.D. – University of Toronto
Co-author: Judith Levy-Ajzenkopf, PhD – Centre for Addiction and mental health
Co-author: Nathan Kolla, MD – Centre for Addiction and mental health
Co-author: Ryan Klein, MD – Centre for Addiction and Mental Health
Presenter: Anthony C. Ruocco, Ph.D. – University of Toronto
Co-author: Anthony C. Ruocco, Ph.D. – University of Toronto
Co-author: Johannes Wrege, M.D., Dipl.-Psych. – University Hospital for Psychiatry
Co-author: Dean Carcone, M.A. – University of Toronto
Co-author: Udine Lang, M.D., Ph.D. – University of Basel
Co-author: Andy Lee, Ph.D. – University of Toronto
Co-author: Marc Walter, M.D., Ph.D. – University Psychiatric Clinics