An experimental pilot study of response to invalidation in young women with features of borderline personality disorder

The Perceived Invalidation of Emotion Scale (PIES): Development and psychometric properties of a novel measure of current emotion invalidation

Emotion invalidation is theoretically and empirically associated with mental and physical health problems. However, existing measures of invalidation focus on past (e.g., childhood) invalidation and/or do not specifically emphasize invalidation of emotion. In this article, the authors articulate a clarified operational definition of emotion invalidation and use that definition as the foundation for development of a new measure of current perceived emotion invalidation across a series of five studies. Study 1 was a qualitative investigation of people's experiences with emotional invalidation from which we generated items. An initial item pool was vetted by expert reviewers in Study 2 and examined via exploratory factor analysis in Study 3 within both college student and online samples. The scale was reduced to 10 items via confirmatory factor analysis in Study 4, resulting in a brief but psychometrically promising measure, the Perceived Invalidation of Emotion Scale (PIES). A short-term longitudinal investigation (Study 5) revealed that PIES scores had strong test-retest reliability, and that greater perceived emotion invalidation was associated with greater emotion dysregulation, borderline features and symptoms of emotional distress. In addition, the PIES predicted changes in relational health and psychological health over a 1-month period. The current set of studies thus presents a psychometrically promising and practical measure of perceived emotion invalidation that can provide a foundation for future research in this burgeoning area. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Negative affect is more strongly associated with suicidal thinking among suicidal patients with borderline personality disorder than those without

Patients suffering from borderline personality disorder (BPD) are at elevated risk for suicidal thoughts and behaviors (STBs), but this well-described and clinically important association is not well-understood. Prior research suggests that STBs often function as an attempt to escape aversive affect, and that people with BPD experience stronger emotion reactivity and greater discomfort with emotion than those without BPD. Here, we tested whether negative affective states are more likely to predict suicidal thoughts among those with BPD than those without this disorder. Data on affective states and suicidal thoughts were collected several times per day from 35 psychiatric inpatients using their smartphones to capture real-time associations between negative affect and suicidal thoughts. Results revealed that the association between negative affective states (e.g., abandonment, desperation, guilt, hopelessness, loneliness, rage, self-hatred, and upset), and severity of suicidal thinking was stronger among those with BPD than among those without BPD. This finding has implications for risk assessment and intervention in the clinical setting: for a given degree of reported negative affect, patients with BPD experience more suicidal ideation than those without. Further research needs to be done to elucidate the mechanism of this effect.

Behaviour vs. perception: An investigation into the components of emotional invalidation

BACKGROUND

The negative effects of emotionally invalidating environments are theorized by the biosocial theory of borderline personality disorder to be vast and severe. However, findings from studies on the impact of emotional invalidation (EI) vary, perhaps due to different operational definitions of EI. The current investigation seeks to explore the relationship between the objective behavioural observations of EI and recipient's subjective perceptions of experiencing these behaviours.

METHOD

First, 58 participants watched scripted interactions between a confederate and a mock participant and identified the presence of invalidating and/or neutral behaviours. Next, 92 participants engaged in one-on-one interactions with a confederate utilizing the same scripted interactions observed by the first set of participants.

RESULTS

While the first set of participants identified invalidating behaviours accurately and consistently, the participants who experienced the behaviours demonstrated more variability in their perceptions of the behaviours as emotionally invalidating.

CONCLUSION

These preliminary findings demonstrate that the objective existence of emotionally invalidating behaviours are likely not the same as the experienced perception of EI across individuals, highlighting the need to examine how EI is operationally defined and measured. Future research should examine what individual characteristics may play a role in perceiving behaviours as emotionally invalidating. Copyright © 2017 John Wiley & Sons, Ltd.

The Messenger Matters: Invalidating Remarks From Men Provoke a More Negative Emotional Reaction Than Do Remarks From Women

Despite negative consequences of emotional invalidation, research has not examined the effect of gender on responses to validation or invalidation or how an invalidating comment from a male versus a female confederate may influence affective responses. We used a two-study quasi-experimental design to examine variables that influence the emotions of individuals validated or invalidated for their emotions. Male and female undergraduates received either validating or invalidating remarks from a gender-ambiguous confederate (Study 1) or invalidating remarks from either a male or female confederate (Study 2). Results showed that invalidation from a gender-ambiguous confederate produced more negative emotional reactions than validation regardless of participants' gender. Furthermore, being invalidated by a man rather than by a woman provoked a specifically more negative emotional response. Interpersonal interventions should explore ways to reduce invalidation and particularly strive to mitigate the effects of invalidation from men, whose criticisms may provoke heightened negative responses from others.

Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up

BACKGROUND

To date, there are no empirically validated treatments of good quality for adolescents showing suicidality and non-suicidal self-injurious behavior. Risk factors for suicide are impulsive and non-suicidal self-injurious behavior, depression, conduct disorders and child abuse. Behind this background, we tested the main hypothesis of our study; that Dialectical Behavioral Therapy for Adolescents is an effective treatment for these patients.

METHODS

Dialectical Behavioral Therapy (DBT) has been developed by Marsha Linehan - especially for the outpatient treatment of chronically non-suicidal patients diagnosed with borderline personality disorder. The modified version of DBT for Adolescents (DBT-A) from Rathus & Miller has been adapted for a 16-24 week outpatient treatment in the German-speaking area by our group. The efficacy of treatment was measured by a pre-/post- comparison and a one-year follow-up with the aid of standardized instruments (SCL-90-R, CBCL, YSR, ILC, CGI).

RESULTS

In the pilot study, 12 adolescents were treated. At the beginning of therapy, 83% of patients fulfilled five or more DSM-IV criteria for borderline personality disorder. From the beginning of therapy to one year after its end, the mean value of these diagnostic criteria decreased significantly from 5.8 to 2.75. 75% of patients were kept in therapy. For the behavioral domains according to the SCL-90-R and YSR, we have found effect sizes between 0.54 and 2.14.During treatment, non-suicidal self-injurious behavior reduced significantly. Before the start of therapy, 8 of 12 patients had attempted suicide at least once. There were neither suicidal attempts during treatment with DBT-A nor at the one-year follow-up.

CONCLUSIONS

The promising results suggest that the interventions were well accepted by the patients and their families, and were associated with improvement in multiple domains including suicidality, non-suicidal self-injurious behavior, emotion dysregulation and depression from the beginning of therapy to the one-year follow-up.

Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy

BACKGROUND

Dialectical behavior therapy (DBT) identifies emotion dysregulation as central to the dangerous impulsivity of borderline personality disorder (BPD) including substance use disorders, and DBT targets improved emotion regulation as a primary mechanism of change. However, improved emotion regulation with DBT and associations between such improvement and behavioral outcomes such as substance use has not been previously reported.

OBJECTIVE

Thus, the goal of this study was to assess for improvement in emotion regulation and to examine the relationship between improvements in the emotion regulation and substance use problems following DBT treatment.

METHOD

Emotion regulation as assessed by the Difficulties in Emotion Regulation Scale, depressed mood as assessed by the Beck Depression Inventory, and their associations with substance use frequency were investigated in 27 women with substance dependence and BPD receiving 20 weeks of DBT in an academic community outpatient substance abuse treatment program.

RESULTS

Results indicated improved emotion regulation, improved mood, and decreased substance use frequency. Further, emotion regulation improvement, but not improved mood, explained the variance of decreased substance use frequency.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

This is the first study to demonstrate improved emotion regulation in BPD patients treated with DBT and to show that improved emotion regulation can account for increased behavioral control in BPD patients. SIGNIFICANCE AND FUTURE RESEARCH: Emotion regulation assessment is recommended for future studies to further clarify the etiology and maintenance of disorders associated with emotional dysregulation such as BPD and substance dependence and to further explore emotion regulation as a potential mechanism of change for clinical interventions.