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

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

Nov 01, 2022 515 likes •987 views

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,

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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

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Borderline Personality Disorder

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

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Self-Injury

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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.

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Kranzler, Selby, In Preparation

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Vulnerability Psychopathology

Genetic Biological Social/Familial Borderline Personality Disorder Self-Injury/Suicide Eating Disordered Behavior

Emotional Mechanisms!

?

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Emotional Cascades

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

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Increased Emotional Intensity

EMOTIONAL CASCADE

Emotion Rumination

Behavioral Dysregulation

Physical Sensations

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Increased Emotional Intensity

EMOTIONAL CASCADE

Emotion Rumination

Behavioral Dysregulation

Physical Sensations

RELIEF

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Selby et al. (2009) J ABNORMAL PSY

10 12 14 16 18 20 22 24 26 28 BPD Control Negative Emotion Group

Rumination Induction

Baseline Post-Induction

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Selby et al. (2009) J ABNORMAL PSY

10 12 14 16 18 20 22 24 26 28 BPD Control Negative Emotion Group

Rumination Induction

Baseline Post-Induction

p<.05 η^2 = .12

Brain and Behavior Research Foundation Young Investigator Grant with Joint Funding by the Families for Borderline Personality Disorder Research

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Do Emotional Cascades Predict Future Dysregulated Behaviors?

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Experience Sampling

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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%

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High Lag- Rumination X High Lag- Negative Emotion

Predictive Validity

Immediate Future Dysregulated Behavior Signal 1 Signal 2

γ = .18*

γ = .20* γ = .=17*

Selby & Joiner, 2013, PDTRT

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3-Way Interaction Predicting Occurrence of a Dysregulated Behavior

Selby & Joiner, 2013, PDTRT

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Instability of Rumination

Unstable Stable Selby et al., 2013, J Clin Psychol

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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.

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Concept form Chaos Theory

More precisely known as, “Sensitive Dependence

  • n Initial

Conditions” Easier to think

  • f as a

“Compounding effect”

Even small differences can lead to very extreme

  • utcomes

BUTTERFLY EFFECT

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Concept form Chaos Theory

More precisely known as, “Sensitive Dependence

  • n Initial

Conditions” Easier to think

  • f as a

“Compounding effect”

Even small differences can lead to very extreme differences

BUTTERFLY EFFECT

In some people, we see an extremely strong and sensitive connection between negative thought and negative emotion, particularly those with BPD

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Selby et al., in press, Journal of Personality

Butterfly Effect in Emotional Cascades

Signal 1 Signal 2 Lag-Rumination Lag-Negative Emotion Rumination Negative Emotion 2-3 Hours Later

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Selby et al., in press, Journal of Personality

4 6 8 10 12 14 16 18 20 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 Momentary Nega ve Emo on Lag Rumina on Fixed Lag Rumina on Random Effect
  • Upper
Bound Random Effect
  • Lower
Bound 4 8 12 16 20 24 28 32 36 40 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

Momentary Rumina on Lag Rumina on

Fixed Lag-Rumina on Random Effect
  • Upper
Bound Random Effect
  • Lower
Bound

Rumination Effects

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Selby et al., in press, Journal of Personality

4 8 12 16 20 24 28 32 36 40 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Momentary Rumina on Lag Nega ve Emo on Fixed Lag Nega ve Emo on Random Effect
  • Upper
Bound Random Effect
  • Lower
Bound 4 6 8 10 12 14 16 18 20 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Momentary Nega ve Emo on Lag Nega ve Emo on Fixed Lag Nega ve Emo on Random Effect
  • Upper
Bound Random Effect
  • Lower
Bound

Negative Emotion Effects

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Selby et al., in press, Journal of Personality

Butterfly Effect in Emotional Cascades

Signal 1 Signal 2 Lag-Rumination Lag-Negative Emotion Dysregulated Behaviors 2-3 Hours Later

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Selby et al., in press, Journal of Personality

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 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

Impulsive Behaviors Lag Rumina on

Fixed Lag Rumina on Random Effect
  • Upper
Bound Random Effect
  • Lower
Bound 0.5 1 1.5 2 2.5 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Impulsive Behaviors Lag Nega ve Emo on Fixed Lag Nega ve Emo on Random Effect
  • Upper
Bound Random Effect
  • Lower
Bound

Dysregulated Behaviors

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TAKE- AWAY

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

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Emergence

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Emergence

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The Emotional Cascade Model

SELBY & JOINER (2009) REV OF GEN PSY

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The Emotional Cascade Model

SELBY & JOINER (2009) REV OF GEN PSY

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The Emotional Cascade Model

SELBY & JOINER (2009) REV OF GEN PSY

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SELBY & JOINER (2009) REV OF GEN PSY

The Emotional Cascade Model

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SELBY & JOINER (2009) REV OF GEN PSY

The Emotional Cascade Model

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SELBY & JOINER (2009) REV OF GEN PSY

The Emotional Cascade Model

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SELBY & JOINER (2009) REV OF GEN PSY

The Emotional Cascade Model

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SELBY & JOINER (2009) REV OF GEN PSY

The Emotional Cascade Model

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Treatment Implications

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Dialectical Behavior Therapy

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Mindfulness

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

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Activities

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Puzzles Games

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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)

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What Can Family Members Do?

  • Knowing what is going on reduces negative

reactivity and improves empathy, even in challenging situations

  • Even being able to give a process a name, such

as “emotional cascade” can help

  • 1. Understand the

emotion process

  • f BPD
  • Work with them to come up with activities that

they enjoy and are willing to do when distressed

  • Develop a “coping card” of distracting activities,

it is easy to forget strategies when you are distressed

  • 2. Help your

loved one distract when upset

  • When we get frustrated, which can be easy at

times, that can feed into the emotion dysregulation process

  • Building emotion regulation skills takes time!
  • 3. Try not to get

frustrated

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Funding Acknowledgements and Thanks to:

  • Brain and Behavior Research Foundation (NARSAD) –

Young Investigator Grant

  • Families for Borderline Personality Disorder Research
  • National Institute of Mental Health
  • Neil S. Jacobson Award for Outstanding and Innovative

Clinical Research Contact: edward.selby@rutgers.edu Website: www.edwardaselby.com