BORDERLINE PERSONALITY DISORDER Edward A. Selby, Ph.D. Assistant - PowerPoint PPT Presentation

EMOTIONAL CASCADES AND UNDERSTANDING THE CHAOS AND COMPLEXITY OF BORDERLINE PERSONALITY DISORDER Edward A. Selby, Ph.D. Assistant Professor Department of Psychology Rutgers, The State University of New Jersey Rutgers Institute for Health, Healthcare Policy, and Aging Research Families for Borderline Personality Disorder Research Investigator Brain and Behavior Research Foundation

Borderline Personality Disorder TURBULENT EMOTIONS DYSREGULATED BEHAVIORS SUICIDAL BEHAVIOR/SELF- INJURY STORMY RELATIONSHIPS

Self-Injury

Audience Poll Question #1 1. Why do people engage in self-injury (without suicidal intent)? a) To get out of doing something unpleasant. b) To feel a rush of excitement. c) To get attention from someone they love. d) To escape feelings of emotional distress. Answer: d is the most typical reason reported, though b is very common too. a & c happen, but are less common.

Kranzler, Selby, In Preparation

? Vulnerability Psychopathology Genetic Borderline Personality Biological Disorder Social/Familial Self-Injury/Suicide Eating Disordered Behavior Emotional Mechanisms!

Emotional Cascades Selby, Anestis, & Joiner, 2008, Beh Res Ther

Emotion Physical Rumination Sensations Increased Emotional Intensity EMOTIONAL CASCADE Behavioral Dysregulation

Emotion Physical Rumination Sensations Increased Emotional Intensity RELIEF EMOTIONAL CASCADE Behavioral Dysregulation

Rumination Induction 28 26 24 22 Negative Emotion 20 Baseline 18 Post-Induction 16 14 12 10 BPD Control Group Selby et al. (2009) J A BNORMAL P SY

Rumination Induction 28 26 η ^2 = .12 24 p<.05 22 Negative Emotion 20 Baseline 18 Post-Induction 16 14 12 0 10 BPD Control Group Selby et al. (2009) Brain and Behavior Research Foundation Young Investigator Grant with Joint Funding by the Families for J A BNORMAL P SY Borderline Personality Disorder Research

Do Emotional Cascades Predict Future Dysregulated Behaviors?

Experience Sampling

Number Reported % Sample Reporting Behavior Alcohol Use 50 45.30% Reckless Driving 14 20.30% Self-Injury 25 13.80% Impulsive Shopping 21 25.60% Marijuana Use 116 34.20% Binge Episode 62 36.80% Physical Fight 9 4.40% Threw Object 20 29.00%

Predictive Validity Signal 2 Signal 1 γ = .18* High Lag- γ = .20* Rumination X Immediate Future High Lag- Negative γ = .=17* Dysregulated Behavior Emotion Selby & Joiner, 2013 , PDTRT

3-Way Interaction Predicting Occurrence of a Dysregulated Behavior Selby & Joiner, 2013 , PDTRT

Instability of Rumination Stable Unstable Selby et al., 2013, J Clin Psychol

Audience Poll Question #2 2. True or False Question. Even though people with BPD get very upset, they should be able to control their emotions just as well as anyone else if they put their mind to it. a) True b) False Answer: b – because of biological and psychological vulnerabilities, people with BPD are likely to have very strong emotional responses, much stronger than the average person. However, by learning skills and practicing, they can learn to manage these emotions in a healthy way.

Concept form Chaos Theory Even small differences can lead to very extreme outcomes More precisely Easier to think known as, “Sensitive of as a “Compounding Dependence effect” on Initial Conditions” BUTTERFLY EFFECT

Even small Concept differences form Chaos can lead to Theory very extreme differences In some people, we see an extremely strong and sensitive connection between negative thought and negative emotion, particularly those with BPD More precisely Easier to think known as, “Sensitive of as a “Compounding Dependence effect” on Initial Conditions” BUTTERFLY EFFECT

Butterfly Effect in Emotional Cascades Signal 2 Signal 1 Lag-Rumination Rumination Lag-Negative Emotion Negative Emotion 2-3 Hours Later Selby et al., in press , Journal of Personality

20� Rumination 18� Effects 16� Emo on� 14� Nega ve� Fixed� Lag� Rumina on� 12� Momentary� Random� Effect� -� Upper� Bound� Random� Effect� -� Lower� Bound� 10� 8� 6� 4� 5� 6� 7� 8� 9� 10� 11� 12� 13� 14� 15� 16� 17� 18� 19� 20� 21� 22� 23� 24� 25� 26� 27� 28� 29� 30� 31� 32� 33� 34� 35� 36� 37� 38� 39� 40� Lag� Rumina on� 40� 36� 32� Rumina on� 28� 24� Fixed� Lag-Rumina on� Momentary� Random� Effect� -� Upper� Bound� 20� Random� Effect� -� Lower� Bound� 16� 12� 8� 4� 5� 6� 7� 8� 9� 10� 11� 12� 13� 14� 15� 16� 17� 18� 19� 20� 21� 22� 23� 24� 25� 26� 27� 28� 29� 30� 31� 32� 33� 34� 35� 36� 37� 38� 39� 40� Lag� Rumina on� Selby et al., in press , Journal of Personality

Negative 40� 36� Emotion 32� Rumina on� 28� Effects 24� Momentary� Fixed� Lag� Nega ve� Emo on� Random� Effect� -� Upper� Bound� 20� Random� Effect� -� Lower� Bound� 16� 12� 8� 4� 5� 6� 7� 8� 9� 10� 11� 12� 13� 14� 15� 16� 17� 18� 19� 20� Lag� Nega ve� Emo on� 20� 18� 16� Emo on� 14� Nega ve� Fixed� Lag� Nega ve� Emo on� 12� Momentary� Random� Effect� -� Upper� Bound� Random� Effect� -� Lower� Bound� 10� 8� 6� 4� 5� 6� 7� 8� 9� 10� 11� 12� 13� 14� 15� 16� 17� 18� 19� 20� Lag� Nega ve� Emo on� Selby et al., in press , Journal of Personality

Butterfly Effect in Emotional Cascades Signal 2 Signal 1 Lag-Rumination Dysregulated Behaviors Lag-Negative Emotion 2-3 Hours Later Selby et al., in press , Journal of Personality

1.8� Dysregulated 1.6� Behaviors 1.4� 1.2� Behaviors� 1� Fixed� Lag� Rumina on� Impulsive� Random� Effect� -� Upper� Bound� 0.8� Random� Effect� -� Lower� Bound� 0.6� 0.4� 0.2� 0� 5� 6� 7� 8� 9� 10� 11� 12� 13� 14� 15� 16� 17� 18� 19� 20� 21� 22� 23� 24� 25� 26� 27� 28� 29� 30� 31� 32� 33� 34� 35� 36� 37� 38� 39� 40� Lag� Rumina on� 3� 2.5� 2� Behaviors� Fixed� Lag� Nega ve� Emo on� Impulsive� 1.5� Random� Effect� -� Upper� Bound� Random� Effect� -� Lower� Bound� 1� 0.5� 0� 5� 6� 7� 8� 9� 10� 11� 12� 13� 14� 15� 16� 17� 18� 19� 20� Lag� Nega ve� Emo on� Selby et al., in press , Journal of Personality

This same effect predicted dysregulated behaviors Dysregulated behavior may serve as an “attractor” point toward Demonstrated the Butterfly Effect with which dysregulated Emotional Cascades behaviors are drawn as emotional cascades progress TAKE- AWAY

Emergence

Emergence

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

The Emotional Cascade Model S ELBY & J OINER (2009) R EV OF G EN P SY

Treatment Implications

Dialectical Behavior Therapy

Mindfulness Selby, Fehling, Panza, & Kranzler, in press, Mindfulness

Activities

Puzzles Games

Clinical Applications: Sleep • Poor Sleep Quality (Selby, 2013, JCCP ) • BPD symptoms predict problems with insomnia (initial, middle, and terminal) beyond relevant Axis I disorders • Potentially due to rumination/emotional cascades? • Nightmares • During ESM those with BPD reported more nightmares (Selby, Ribeiro, & Joiner, 2013, Dreaming )

What Can Family Members Do? • Knowing what is going on reduces negative 1. Understand the reactivity and improves empathy, even in emotion process challenging situations • Even being able to give a process a name, such of BPD as “emotional cascade” can help • Work with them to come up with activities that 2. Help your they enjoy and are willing to do when distressed loved one distract • Develop a “coping card” of distracting activities, it is easy to forget strategies when you are when upset distressed • When we get frustrated, which can be easy at 3. Try not to get times, that can feed into the emotion dysregulation process frustrated • Building emotion regulation skills takes time!