Emotion-related cognitive processes in borderline personality disorder: a review of the empirical literature.

Maladaptive cognitive processes, including selective attention and memory, distorted beliefs and interpretations, and thinking processes such as rumination and thought suppression, are strongly associated with many emotional disorders. This paper reviews research that extends these findings to the emotional dysfunction characteristic of borderline personality disorder (BPD). Results suggest that people with BPD habitually attend to negative stimuli, have disproportionate access to negative memories, endorse a range of BPD-consistent negative beliefs about themselves, the world, and other people, and make negatively biased interpretations and evaluations of neutral or ambiguous stimuli. They also engage in thought suppression and rumination and these tendencies are significantly associated with the severity of their BPD symptoms. It remains unclear whether maladaptive cognitive processes play a causal role in the development and maintenance of BPD or are correlates or consequences of having the disorder. Continued study of emotion-related cognitive processing in BPD may improve understanding and treatment of this severe disorder.

Ruminative and mindful self-focused attention in borderline personality disorder.

The current study investigated the short-term effects of mindful and ruminative forms of self-focused attention on a behavioral measure of distress tolerance in individuals with borderline personality disorder (BPD) who had completed an angry mood induction. Participants included 40 individuals who met criteria for BPD and were currently involved in mental health treatment. Each completed an individual 1-hr session. Following an angry mood induction, each participant was randomly assigned to engage in ruminative or mindful self-focus for several minutes. All participants then completed the computerized Paced Auditory Serial Addition Test (PASAT-C), a behavioral measure of willingness to tolerate distress in the service of goal-directed behavior. The mindfulness group persisted significantly longer than the rumination group on the distress tolerance task and reported significantly lower levels of anger following the self-focus period. Results are consistent with previous studies in suggesting that distinct forms of self-focused attention have distinct outcomes and that, for people with BPD, mindful self-observation is an adaptive alternative to rumination when feeling angry.

Relationships between depressive rumination, anger rumination, and borderline personality features.

We examined relationships between depressive rumination, anger rumination, and features of borderline personality disorder in a sample of 93 students with a wide range of borderline symptoms. All completed self-report measures of borderline features; trait-level negative affect; depressive and anger rumination; and current symptoms of depression, anxiety, and stress. Depressive and anger rumination were strongly associated with borderline features after controlling for comorbid symptoms of depression, anxiety, and stress. Both types of rumination showed significant incremental validity over trait-level sadness, anger, and general negative affect in predicting borderline features. Relationships with borderline features were stronger for anger rumination than for depressive rumination. Relationships between trait-level negative affect and borderline features were substantially reduced when anger rumination was included in regression models, suggesting the need for longitudinal analyses of mediation. Findings suggest that severity of borderline symptoms is influenced by ruminative thinking in response to negative affect, especially anger.

Validation of measures of biosocial precursors to borderline personality disorder: childhood emotional vulnerability and environmental invalidation.

Linehan's biosocial theory suggests that borderline personality disorder (BPD) results from a transaction of two childhood precursors: emotional vulnerability and an invalidating environment. Until recently, few empirical studies have explored relationships between these theoretical precursors and symptoms of the disorder. Psychometrically sound assessment tools are essential to this area of research. The present study examined psychometric characteristics of recently developed self-report measures of childhood emotional vulnerability and parental invalidation. A large sample of undergraduates completed these measures; parent reports were collected to examine agreement between young adults' and parents' recollections of their emotional style in childhood and the parenting they received. Both measures were internally consistent, showed clear factor structures, and were significantly correlated with BPD features and related constructs. In addition, both showed modest, yet significant agreement between participants' and parents' reports. Overall, this study supports the utility of these measures of childhood emotional vulnerability and environmental invalidation.

New directions in the management of chronic pain: self-regulation theory as a model for integrative clinical psychology practice.

The next generation of empirically derived clinical health psychology involves use of self-regulation theory for understanding and treating chronic pain. Temporomandibular disorders serve as a model to illustrate how increasing self-regulatory strength facilitates small, behavioral changes that positively influence the underlying physiological factors known to be important in the etiology and maintenance of chronic pain conditions. For individuals with chronic temporomandibular disorders, physical self-regulation is an integrative clinical health psychology intervention that decreases both physical and psychological symptoms via improvements in self-regulatory strength and autonomic nervous system regulation. Suggestions for the application of self-regulation to other chronic pain disorders and future research directions are provided.

Relationships between thought suppression and symptoms of borderline personality disorder.

The current study examined relationships among childhood emotional vulnerability, an invalidating childhood environment, thought suppression, and symptoms of borderline personality disorder (BPD). Emotional vulnerability and an invalidating childhood environment are described by Linehan (1993) as important biosocial precursors to the development of BPD. Using a student sample selected to have a wide range of BPD symptoms, we examined whether thought suppression mediates the relationship between these biosocial precursors and symptoms of BPD. Results supported the hypothesis that thought suppression fully mediates the relationship between invalidating environment and BPD symptoms. Mixed support was found for the hypothesis that thought suppression mediates the relationship between emotional vulnerability and BPD symptoms. We also examined whether fear of emotions mediates the relationship between the biosocial precursors and thought suppression. Results supported this hypothesis, and also suggested that fear of emotion contributes independently to mediating the relationship between biosocial precursors and BPD symptoms.

Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples.

Previous research on assessment of mindfulness by self-report suggests that it may include five component skills: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. These elements of mindfulness can be measured with the Five Facet Mindfulness Questionnaire (FFMQ). The authors investigated several aspects of the construct validity of the FFMQ in experienced meditators and nonmeditating comparison groups. Consistent with predictions, most mindfulness facets were significantly related to meditation experience and to psychological symptoms and well-being. As expected, relationships between the observing facet and psychological adjustment varied with meditation experience. Regression and mediation analyses showed that several of the facets contributed independently to the prediction of well-being and significantly mediated the relationship between meditation experience and well-being. Findings support the construct validity of the FFMQ in a combination of samples not previously investigated.