Seeing is believing: The effect of subtle communication in social media on viewers' beliefs about depression and anxiety symptom trajectories.

OBJECTIVE: One barrier to treatment seeking, uptake, and engagement is the belief that nothing can be done to reduce symptoms. Given the widespread use of social media to disseminate information about important issues, including psychological health, we sought to understand how the influence of social media communication regarding mental health impacts viewers' beliefs about psychopathology recovery. METHOD: Undergraduate participants from a large Midwestern university (N = 322) were randomized to view a series of Tweets characterizing psychopathology from a fixed mindset perspective, a growth mindset perspective, or, in the control condition, Tweets unrelated to psychopathology. Afterward, they completed a series of questionnaires designed to assess beliefs about recovery from depression and anxiety. RESULTS: Participants in the growth mindset condition endorsed less pessimistic beliefs about their ability (i.e., self-efficacy) to alleviate symptoms of depression and anxiety, and they believed these symptoms to be less stable and innate relative to those in the fixed mindset condition. CONCLUSION: Social media communication that characterizes psychopathology from a growth mindset perspective may be a viable intervention for improving beliefs around mental health self-efficacy and the malleable nature of mental illness, particularly depression and anxiety. Clinicians may be able to use social media platforms to promote functional beliefs around mental illness.

Protective factors in borderline personality disorder: A multi-study analysis of conscientiousness, distress tolerance, and self-compassion.

BACKGROUND: Despite a growing literature characterizing risk factors associated with the development and maintenance of borderline personality disorder (BPD), substantially less is known about potentially protective factors in BPD. METHODS: In a sample of online (N = 272) participants with likely BPD, major depressive disorder (MDD), or no disorder (ND) and an independent sample of in-person (N = 90) participants diagnosed with BPD, MDD, or ND, we tested the cross-sectional and longitudinal associations among BPD features and three putatively protective personality, cognitive, and affective-behavioral factors: conscientiousness, self-compassion, and distress tolerance. RESULTS: Only conscientiousness was significantly lower in BPD than MDD (ds: .67-.73) across both studies and more strongly related to BPD features (rs: -.68 to -.59) than MDD symptoms (rs: -.49 to -.43) in dimensional analyses across both studies. However, in a multiple regression analysis including all three factors in Study 1, only self-compassion predicted decreases in BPD features (ß = -.28) and MDD symptoms (ß = -.21) over one month. LIMITATIONS: Study 1 participants completed all measures online and exhibited some differential attrition at one month follow-up. Study 2 participants were all diagnosed by one trained assessor and the smaller sample size limited our power to detect effects. CONCLUSIONS: Low conscientiousness may be most strongly related to BPD, whereas self-compassion may be a prospective transdiagnostic protective factor.

Less is more: Decreasing the frequency of maladaptive coping predicts improvements in DBT more consistently than increasing the frequency of adaptive coping.

It is well-established that participation in dialectical behavior therapy (DBT) results in patients using adaptive coping strategies more frequently. Although coping skill instruction may be necessary to promote decreases in symptoms and behavioral targets in DBT, it is unclear if the frequency with which patients use adaptive coping skills leads to these outcomes. Alternatively, it is possible that DBT also leads patients to use maladaptive strategies less frequently and that these reductions more consistently predict improvements in treatment. We recruited 87 participants with elevated emotion dysregulation (Mage = 30.56; 83.9% female; 75.9% White) to participate in a 6-month course of full-model DBT delivered by advanced graduate students. Participants completed measures of adaptive and maladaptive strategy use, emotion dysregulation, interpersonal problems, distress tolerance, and mindfulness at baseline and after three DBT skills training modules. Both within- and between-person maladaptive strategy use significantly predicted module-to-module changes in all outcomes whereas adaptive strategy use significantly predicted changes in emotion dysregulation and distress tolerance, although the size of these effects did not significantly differ between adaptive and maladaptive strategy use. We discuss the limitations and implications of these results for optimizing DBT.

The role of symptom accommodation in trauma-focused treatment engagement and response.

Although trauma-focused treatments (TFTs) are generally effective, not all patients improve. Symptom accommodation (i.e., altering one's behavior in response to another's symptoms) by loved ones may be particularly relevant to TFT treatment response and engagement. We examined the role of symptom accommodation by support persons (SPs) in veterans' PTSD treatment response, including the mediating role of treatment engagement and the moderating role of relationship strain. Veterans engaging in prolonged exposure or cognitive processing therapy and a loved one (N = 172 dyads) were sampled at two time points approximately four months apart. Measures of treatment engagement (i.e., highest session completed from the treatment protocol and homework completion) were obtained from hospital records. We found that relationship strain moderated the effect of symptom accommodation on treatment response, ∆R2 = .02. Specifically, Time 1 (T1) accommodation predicted poorer treatment response (i.e., Time 2 [T2] PTSD symptom severity, controlling for T1 symptoms) among veterans who reported below-average relationship strain only. Additionally, symptom accommodation was indirectly related to treatment response such that T1 accommodation predicted higher T2 PTSD symptom severity specifically through reduced homework completion, ß = .01. The findings suggest that attending to accommodating behaviors of veterans' supportive partners may be an important way to boost both engagement in and response to TFTs for PTSD.

Broad strokes or fine points: Are dialectical behavior therapy modules associated with general or domain-specific changes?

Dialectical behavior therapy (DBT) has demonstrated effectiveness for a range of emotional difficulties, and DBT skills training groups may be necessary to produce symptom change. However, it is unclear how skills training groups influence outcomes. Specifically, is participation in DBT skills modules associated with general effects (i.e., changes in multiple domains) or domain-specific effects (i.e., changes in the conceptually relevant domain)? Participants recruited from a university training clinic (n = 87; 75.9% diagnosed with borderline personality disorder) participated in standard DBT for 6 months. We conducted hierarchical linear mixed models to test whether self-reported changes in emotion regulation, interpersonal problems, and distress tolerance were associated with the specific DBT module intended to target that outcome. In 3 models, we regressed end-of-module ratings of each of our measures of interest on (a) premodule ratings of each measure of interest, (b) time, and (c) dummy-coded module completed. Although all modules were associated with similar reductions in emotion dysregulation, the Emotion Regulation module was associated with the greatest improvements in both interpersonal problems and distress tolerance. In contrast, the first skills module completed was unrelated to changes in any of these domains. These results suggest that Emotion Regulation skills are associated with improvements in patient symptoms across relevant domains and offer potential directions for optimizing the delivery of DBT. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpersonal emotion regulation in the context of social networks: A focus on borderline personality disorder.

Interpersonal emotion regulation (IER) involves modulating one's emotions through social contact. Considering the extensive emotional and interpersonal difficulties associated with borderline personality disorder (BPD), it is particularly relevant to the study of IER. We examined the frequency and efficacy of IER in relation to BPD features, as well as perceived characteristics of the social network partners utilized for IER, among 149 participants. We found that BPD features were unrelated to the frequency of using IER but negatively related to the perceived efficacy of IER and perceived willingness of partners to assist in IER. Furthermore, BPD features attenuated the relation between partner closeness and both the likelihood of being an IER partner (vs. a non-IER partner) and the frequency of going to that partner for IER (partner-IER-frequency). Additionally, there was an inverse relation between relationship quality and frequency of seeking IER from a partner at higher levels of BPD features, whereas there was no association between quality and frequency of IER at lower levels of BPD features. Finally, BPD features attenuated the relation between partner centrality and the likelihood of being an IER partner. Finding that those with elevated BPD features go to less central and close others for IER, even though there is no association between IER frequency and BPD features, bolsters our understanding of the intersection of interpersonal and emotional functioning and may provide future avenues for intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A longitudinal examination of the reciprocal relationship between borderline personality features and interpersonal relationship quality.

Interpersonal dysfunction is a core characteristic of borderline personality disorder (BPD). Cross-sectional research suggests that higher BPD features are associated with lower relationship quality. Many researchers have examined the associations between interpersonal stressors and short-term increases in emotional reactivity or impulsivity among those with high levels of BPD features. Yet, most research paradigms assume that interpersonal stressors change over time, whereas BPD features remain relatively stable; however, the stability of BPD features in the context of fluctuating interpersonal stressors has yet to be tested longitudinally. In the current study, we examined co-occurring changes in relationship quality and BPD features over time. In Study 1, 126 female, undergraduate participants completed ratings of relationship quality (i.e., conflict, criticism, closeness, satisfaction, and support) with recent interpersonal partners as well as self-reported BPD features at baseline and 1-month follow-up. In Study 2, 50 female participants from the community (n = 27 with BPD; n = 23 without any psychiatric diagnoses) completed the same measures at baseline and 1-, 3-, and 6-month follow-ups. Across both studies, when participants reported decreases in the quality of their interpersonal relationships, they endorsed increases in BPD features. Similarly, when participants endorsed worsening BPD features, their perceptions of relationship quality with all recent interaction partners (in Study 1) or more frequent interaction partners (in Study 2) decreased as well. Even in samples with a wide range of BPD features, these results suggest that the quality of interpersonal relationships and BPD features may influence each other over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Validation predicting premature drop-out from treatment provided in training clinics.

BACKGROUND: Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer. AIMS: We sought to evaluate the role of therapist validation from both therapists' and clients' perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics. METHOD: Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy. RESULTS: After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists. CONCLUSIONS: Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.

Characterization of relationship instability in women with borderline personality disorder: A social network analysis.

Interpersonal dysfunction is considered a cornerstone of borderline personality disorder (BPD). Relationships are described as intense and unstable, with individuals with BPD alternating between idealization and devaluation of relationship partners. Furthermore, a lack of stable and supportive relationships may be related to symptom maintenance and exacerbation. Despite widespread recognition of the importance of relationship instability in BPD, there is little empirical evidence about the nature of such instability and how it emerges over time. We examined the stability of social networks of women diagnosed with BPD (n = 27) and healthy controls (HCs; n = 23) by assessing key characteristics of relationships (satisfaction, support, closeness, conflict, and criticism) over a 6-month period. We conducted analyses to examine whether relationship instability depended on the frequency of interaction with members of the network. Results showed that the relationships of women in the BPD group were perceived as more unstable than those of the HC group. Compared with women in the HC group, women with BPD had networks with more relationships that had undergone significant change or had been "cut off" over the course of the study. The relationship between frequency of interaction and instability in support and satisfaction differed between groups. Women in the HC group showed greater instability in support with partners they interacted with infrequently, whereas women in the BPD group showed greater instability in satisfaction with partners they interacted with more frequently. Implications for understanding interpersonal dysfunction in BPD are discussed and possible areas of relevance for treatment development are highlighted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The within-person effects of validation and invalidation on in-session changes in affect.

[Correction Notice: An Erratum for this article was reported in Vol 10(5) of Personality Disorders: Theory, Research, and Treatment (see record 2019-50033-001). In the article, some values in Table 1 were incorrectly marked with asterisks as significant. The corrected table appears in the erratum.] Validation is the accurate reflection of someone's internal experiences. Validation has been theorized to enhance the process of therapy and facilitate effective outcomes (Lynch, Chapman, Rosenthal, Kuo, & Linehan, 2006). Additionally, validation may play an integral role in reducing emotional arousal specifically for individuals with borderline personality disorder (BPD). There is little research on the relation between validation and therapy outcomes such as affect change. In the current study, we tested the relations among self-reported validation and invalidation and in-session changes in positive and negative affect with a sample of 52 clients in treatment. Further, we examined BPD features as a moderator of the relations between self-reported validation and invalidation and in-session changes in affect. We disaggregated within-person from between-person effects using client reports of validation and invalidation during Sessions 3 to 7. Greater within-person validation was associated with decreased postsession negative affect, whereas greater within-person invalidation was associated with increased postsession NA. Neither validation nor invalidation was related to changes in positive affect. Further, at elevated levels of BPD features, validation, but not invalidation, was associated with decreases in negative affect. BPD features did not moderate the relation between validation or invalidation and postsession positive affect. These results provide empirical evidence that patient-reported validation and invalidation predict changes in negative affect during sessions. Additionally, these results suggest that patients with elevated BPD features are particularly responsive to validation during therapy sessions, and as such, provide an avenue for navigating the in-session negative emotional arousal that these patients often experience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).