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Mindfulness

, Volume 10, Issue 7, pp 1243–1254 | Cite as

Effects of Mindfulness Training on Borderline Personality Disorder: Impulsivity Versus Emotional Dysregulation

  • Cristina Carmona i Farrés
  • Matilde Elices
  • Joaquim SolerEmail author
  • Elisabet Domínguez-Clavé
  • Edith Pomarol-Clotet
  • Raymond Salvador
  • Juan C. Pascual
ORIGINAL PAPER

Abstract

Emotion dysregulation (ED) and impulsivity are the two core characteristics of borderline personality disorder (BPD). Although the mindfulness module of dialectical behavior therapy (DBT) has proven effective to treat general BPD symptomatology, no studies have yet been conducted to determine whether mindfulness specifically targets impulsivity and/or ED in patients with BPD. Therefore, the aim of the current study was to examine the impact of mindfulness training on those two characteristics. A clinical sample (n = 70) of individuals with BPD were randomized to one of two interventions: DBT mindfulness skills training (DBT-M) or DBT interpersonal effectiveness skills training (DBT-IE). Participants were assessed prior to treatment and at the end of the 10-week training program. Assessment included measures of impulsivity, emotion dysregulation, BPD severity, and mindfulness facets. Our findings showed that impulsivity decreased in the DBT-M group but not in the DBT-IE group. BPD psychopathology and some aspects of ED (e.g., emotional clarity and emotional acceptance) improved in both groups. These results show that the mindfulness module of DBT improves both emotion regulation and impulsivity. Trial Registration: ClinicalTrials.gov: NCT03363230

Keywords

Borderline personality disorder Mindfulness Emotional dysregulation Impulsivity 

Notes

Acknowledgments

We would like to thank all participants of the study. We also thank Bradley Londres for editing and improving the text of this manuscript.

Author Contributions

CCF executed the study, assisted with data analyses, and wrote the initial version of the manuscript. ME assisted with data analyses and edited the final manuscript. JS designed the study and collaborated with data analysis and writing the manuscript. EDC collaborated with the writing of the manuscript and data analyses. EPC and RS collaborated with the writing of the manuscript. JCP collaborated with the design, writing of the study, and data analyses.

Funding Information

This study was supported by the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) and by a grant from Instituto de Salud Carlos III (PI13/00134) and co-financed by the European Regional Development Fund (ERDF).

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Clinical Research Ethics Committee of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain).

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Philadelphia: American Psychiatric Publishing.Google Scholar
  2. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.Google Scholar
  3. Barrachina, J., Soler, J., Campins, M. J., Tejero, A., Pascual, J. C., Alvarez, E., et al. (2004). Validation of a Spanish version of the Diagnostic Interview for Bordelines-Revised (DIB-R). Actas Españolas de Psiquiatría, 32(5), 293–298.Google Scholar
  4. Barratt, E. S., Patton, J., & Stanford, M. (1975). Barratt impulsiveness scale. University of Texas Texas: Barratt-Psychiatry Medical Branch.Google Scholar
  5. Beauchaine, T. P., Klein, D. N., Crowell, S. E., Derbidge, C. M., & Gatzke-Kopp, L. (2009). Multifinality in the development of personality disorders: a biology × sex × environment interaction model of antisocial and borderline traits. Development and Psychopathology, 21, 735–770.Google Scholar
  6. Becker, E. S., Rinck, M., Margraf, J., & Roth, W. T. (2001). The emotional Stroop effect in anxiety disorders: general emotionality or disorder specificity? Journal of Anxiety Disorders, 15, 147–159.Google Scholar
  7. Bertsch, K., Hillmann, K., & Herpertz, S. C. (2018). Behavioral and neurobiological correlates of disturbed emotion processing in borderline personality disorder. Psychopathology, 51, 76–82.Google Scholar
  8. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.Google Scholar
  9. Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R. D., Domsalla, M., Chapman, A. L., ... & Wolf, M. (2009). The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties. Psychopathology, 42(1), 32–39.Google Scholar
  10. Britton, W. B., Shahar, B., Szepsenwol, O., & Jacobs, W. J. (2012). Mindfulness-based cognitive therapy improves emotional reactivity to social stress: results from a randomized controlled trial. Behavior Therapy, 43(2), 365–380.Google Scholar
  11. Cackowski, S., Reitz, A.-C., Ende, G., Kleindienst, N., Bohus, M., Schmahl, C., & Krause-Utz, A. (2014). Impact of stress on different components of impulsivity in borderline personality disorder. Psychological Medicine, 44(15), 3329–3340.Google Scholar
  12. Cebolla, A., García-Palacios, A., Soler, J., Guillen, V., Baños, R., & Botella, C. (2012). Psychometric properties of the Spanish validation of the Five Facets of Mindfulness Questionnaire (FFMQ). The European Journal of Psychiatry, 26(2), 118–126.Google Scholar
  13. Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394.Google Scholar
  14. Cohen, J. (1988). Statistical power analysis for the behavioural sciences. Hillsdale, NJ: Erlbaum.Google Scholar
  15. Collie, A., Maruff, P., Darby, D. G., & McStephen, M. (2003). The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test–retest intervals. Journal of the International Neuropsychological Society, 9(3), 419–428.Google Scholar
  16. Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495–510.Google Scholar
  17. van der Heiden, C., Muris, P., & van der Molen, H. T. (2012). Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behaviour Research and Therapy, 50(2), 100–109.Google Scholar
  18. Domes, G., Winter, B., Schnell, K., Vohs, K., Fast, K., & Herpertz, S. C. (2006). The influence of emotions on inhibitory functioning in borderline personality disorder. Psychological Medicine, 36(8), 1163–1172.Google Scholar
  19. Eisenlohr-Moul, T., Peters, J. R., Chamberlain, K. D., & Rodriguez, M. (2016). Weekly fluctuations in nonjudging predict borderline personality disorder feature expression in women. Journal of Psychopathology and Behavioral Assessment, 38(1), 149–157.Google Scholar
  20. Elices, M., Pascual, J. C., Portella, M. J., Feliu-Soler, A., Martín-Blanco, A., Carmona, C., & Soler, J. (2016). Impact of mindfulness training on borderline personality disorder: a randomized trial. Mindfulness, 7(3), 584–595.Google Scholar
  21. Feliu-Soler, A., Pascual, J. C., Borràs, X., Portella, M. J., Martín-Blanco, A., Armario, A., et al. (2014). Effects of dialectical behaviour therapy-mindfulness training on emotional reactivity in borderline personality disorder: preliminary results. Clinical Psychology & Psychotherapy, 21(4), 363–370.Google Scholar
  22. Fidell, S., Pearsons, K., Tabachnick, B. G., & Howe, R. (2000). Effects on sleep disturbance of changes in aircraft noise near three airports. The Journal of the Acoustical Society of America, 107(5), 2535–2547.Google Scholar
  23. First, M. B., Gibbon, M., Spitzer, R. L., & Benjamin, L. S. (1997). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders: SCID-II. Washington: American Psychiatric Pub.Google Scholar
  24. Franco, C., Amutio, A., López-González, L., Oriol, X., & Martínez-Taboada, C. (2016). Effect of a mindfulness training program on the impulsivity and aggression levels of adolescents with behavioral problems in the classroom. Frontiers in Psychology, 7, 1385.Google Scholar
  25. Fresco, D. M., Moore, M. T., van Dulmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007). Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering. Behavior Therapy, 38(3), 234–246.Google Scholar
  26. Gómez-Beneyto, M., Villar, M., Renovell, M., Pérez, M., Herández, M., & Leal, C. (1994). The diagnosis of personality disorder with a modified version of the SCID-II in a Spanish clinical sample. Journal of Personality Disorders, 8, 104–110.Google Scholar
  27. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.Google Scholar
  28. Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37(1), 14–25.Google Scholar
  29. Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2010). An experimental investigation of emotional reactivity and delayed emotional recovery in borderline personality disorder: the role of shame. Comprehensive Psychiatry, 51(3), 275–285.Google Scholar
  30. Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7–17.Google Scholar
  31. Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: understanding and treating human suffering. New York: Guilford.Google Scholar
  32. Herpertz, S. C., Schneider, I., Schmahl, C., & Bertsch, K. (2018). Neurobiological mechanisms mediating emotion dysregulation as targets of change in borderline personality disorder. Psychopathology, 51(2), 96–104.Google Scholar
  33. Hervás, G., & Jódar, R. (2008). Adaptación al castellano de la Escala de Dificultades en la Regulación Emocional. Clínica y Salud, 19(2), 139–156.Google Scholar
  34. Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559.Google Scholar
  35. Jankowski, T., & Holas, P. (2014). Metacognitive model of mindfulness. Consciousness and Cognition, 28, 64–80.Google Scholar
  36. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delacorte.Google Scholar
  37. Kaiser, D., Jacob, G. A., Domes, G., & Arntz, A. (2017). Attentional Bias for emotional stimuli in borderline personality disorder: a meta-analysis. Psychopathology, 49(6), 383–396.Google Scholar
  38. Keng, S. L., Robins, C. J., Smoski, M. J., Dagenbach, J., & Leary, M. R. (2013). Reappraisal and mindfulness: a comparison of subjective effects and cognitive costs. Behaviour Research and Therapy, 51(12), 899–904.Google Scholar
  39. Keng, S., Yan Tan, E., Eisenlohr-Moul, T. A., & Smoski, M. (2017). Effects of mindfulness, reappraisal, and suppression on sad mood and cognitive resources. Behavior Research and Therapy, 91, 33–42.Google Scholar
  40. Klonsky, E. D. (2007). The functions of deliberate self-injury: a review of the evidence. Clinical Psychology Review, 27(2), 226–239.Google Scholar
  41. Kotsou, I., Leys, C., & Fossion, P. (2018). Acceptance alone is a better predictor of psychopathology and well-being than emotional competence, emotion regulation and mindfulness. Journal of Affective Disorders, 226, 142–145.Google Scholar
  42. Krishnakumar, S., & Robinson, M. D. (2015). Maintaining an even keel: an affect-mediated model of mindfulness and hostile work behavior. Emotion, 15(5), 579.Google Scholar
  43. Kross, E., Card, D., Deldin, P., Clifton, J., & Ayduk, O. (2012). “Asking why” from a distance: its cognitive and emotional consequences for people with major depressive disorder. Journal of Abnormal Psychology, 121, 559e569.Google Scholar
  44. Lee, J. K., & Orsillo, S. M. (2014). Investigating cognitive flexibility as a potential mechanism of mindfulness in generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 208–216.Google Scholar
  45. Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377(9759), 74–84.Google Scholar
  46. Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.Google Scholar
  47. Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. New York City: Guilford Press.Google Scholar
  48. Linehan, M. M. (2014). DBT Skills Training Manual (2nd ed.). New York, NY: Guilford Press.Google Scholar
  49. Linehan, M. M., Bohus, M., & Lynch, T. (2007). Dialectical behavior therapy for pervasive emotion dysregulation. Theoretical and practical underpinnings. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 581–605). New York, NY: The Guilford Press.Google Scholar
  50. Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder a randomized clinical trial and component analysis. JAMA, 98195, 1–8.Google Scholar
  51. Little, R., & Rubin, D. (1987). Statistical analysis with missing data. New York, NY: Wiley.Google Scholar
  52. MacLeod, C. M. (1992). The Stroop task: the “gold standard” of attentional measures. Journal of Experimental Psychology: General, 121(1), 12.Google Scholar
  53. Peckham, A. D., McHugh, R. K., & Otto, M. W. (2010). A meta-analysis of the magnitude of biased attention in depression. Depression and Anxiety, 27(12), 1135–1142.Google Scholar
  54. Peters, J. R., Erisman, S. M., Upton, B. T., Baer, R. A., & Roemer, L. (2011). A preliminary investigation of the relationships between dispositional mindfulness and impulsivity. Mindfulness, 2(4), 228–235.Google Scholar
  55. Peters, J. R., Eisenlohr-moul, T. A., Upton, B. T., & Baer, R. A. (2013). Nonjudgment as a moderator of the relationship between present-centered awareness and borderline features: synergistic interactions in mindfulness assessment. Personality and Individual Differences, 55(1), 24–28.Google Scholar
  56. Peters, J. R., Smart, L. M., Eisenlohr-Moul, T. A., Geiger, P. J., Smith, G. T., & Baer, R. A. (2015). Anger rumination as a mediator of the relationship between mindfulness and aggression: the utility of a multidimensional mindfulness model. Journal of Clinical Psychology, 71(9), 871–884.Google Scholar
  57. Portella, M. J., Soler, J., Tejero, A., Barrachina, J., Tiana, T., Pascual, J. C., et al. (2011). Slow processing in borderline personality disorder: the emotional Stroop paradigm. Actas Espanolas de Psiquiatria, 39(6), 356–362.Google Scholar
  58. Sauer, S., Walach, H., Schmidt, S., Hinterberger, T., Horan, M., & Kohls, N. (2011). Implicit and explicit emotional behavior and mindfulness. Consciousness and Cognition, 20(4), 1558–1569.Google Scholar
  59. Sebastian, A., Jacob, G., Lieb, K., & Tüscher, O. (2013). Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation? Current Psychiatry Reports, 15(2), 339.Google Scholar
  60. Shapiro, S., Carlson, L. E., Astin, J., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386.Google Scholar
  61. Siegrist, M. (1997). Test-retest reliability of different versions of the Stroop test. The Journal of Psychology, 131(3), 299–306.Google Scholar
  62. Sieswerda, S., Arntz, A., Mertens, I., & Vertommen, S. (2007). Hypervigilance in patients with borderline personality disorder: specificity, automaticity, and predictors. Behaviour Research and Therapy, 45(5), 1011–1024.Google Scholar
  63. Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M. J., et al. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47(5), 353–358.Google Scholar
  64. Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martín-Blanco, A., et al. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research and Therapy, 50(2), 150–157.Google Scholar
  65. Soler, J., Vega, D., Feliu-Soler, A., Trujols, J., Soto, A., Elices, M., et al. (2013). Validation of the Spanish version of the Borderline Symptom List, short form (BSL-23). BMC Psychiatry, 13, 139.Google Scholar
  66. Soler, J., Franquesa, A., Feliu-Soler, A., Cebolla, A., García-Campayo, J., Tejedor, R., et al. (2014). Assessing decentering: validation, psychometric properties, and clinical usefulness of the experiences questionnaire in a Spanish sample. Behavior Therapy, 45(6), 863–871.Google Scholar
  67. Soler, J., Elices, M., Pascual, J. C., Martín-Blanco, A., Feliu-Soler, A., Carmona, C., & Portella, M. J. (2016). Effects of mindfulness training on different components of impulsivity in borderline personality disorder: results from a pilot randomized study. Borderline Personality Disorder and Emotion Dysregulation, 51(1), 411–416.Google Scholar
  68. Stoffers, J., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder (Review). In Cochrane Database of Systematic Reviews (Cochrane D). John Wiley & Sons.Google Scholar
  69. Strauss, G. P., Allen, D. N., Jorgensen, M. L., & Cramer, S. L. (2005). Test-retest reliability of standard and emotional stroop tasks: an investigation of color-word and picture-word versions. Assessment, 12(3), 330–337.Google Scholar
  70. Teasdale, J. D., Moore, R., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287.Google Scholar
  71. Travers-Hill, E., Dunn, B. D., Hoppitt, L., Hitchcock, C., & Dalgleish, T. (2017). Beneficial effects of training in self-distancing and perspective broadening for people with a history of recurrent depression. Behaviour Research and Therapy, 95, 19–28.Google Scholar
  72. Van den Hurk, P. A. M., Giommi, F., Gielen, S. C., Speckens, A. E. M., & Barendregt, H. P. (2010). Greater efficiency in attentional processing related to mindfulness meditation. The Quarterly Journal of Experimental Psychology, 63(6), 1168e1180.Google Scholar
  73. Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and psychopathology. Psychological Bulletin, 120(1), 3–24.Google Scholar
  74. Wimmer, L., Bellingrath, S., & von Stockhausen, L. (2016). Cognitive effects of mindfulness training: results of a pilot study based on a theory driven approach. Frontiers in Psychology, 7, 1–14.Google Scholar
  75. Wingenfeld, K., Rullkoetter, N., Mensebach, C., Beblo, T., Mertens, M., Kreisel, S., et al. (2009). Neural correlates of the individual emotional Stroop in borderline personality disorder. Psychoneuroendocrinology, 34(4), 571–586.Google Scholar
  76. Wupperman, P., Neumann, C. S., Whitman, J. B., & Axelrod, S. R. (2009). The role of mindfulness in borderline personality disorder features. The Journal of Nervous and Mental Disease, 197(10), 766–771.Google Scholar
  77. Zanarini, M., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised diagnostic interview for borderlines: discriminating BPD from other axis II disorders. Journal of Personality Disorders, 3(1), 10–18.Google Scholar

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Authors and Affiliations

  • Cristina Carmona i Farrés
    • 1
    • 2
  • Matilde Elices
    • 1
    • 3
  • Joaquim Soler
    • 1
    • 3
    Email author
  • Elisabet Domínguez-Clavé
    • 1
  • Edith Pomarol-Clotet
    • 3
    • 4
  • Raymond Salvador
    • 3
    • 4
  • Juan C. Pascual
    • 1
    • 3
  1. 1.Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain
  2. 2.Department of Psychiatry and Forensic MedicineAutonomous University of BarcelonaBarcelonaSpain
  3. 3.Centro de Investigación Biomédica en Red de Salud Mental CIBERSAMMadridSpain
  4. 4.FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain

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