Academic journal article Journal of Cognitive Psychotherapy

Emotion Regulation as a Mechanism of Change in an Acceptance-Based Emotion Regulation Group Therapy for Deliberate Self-Harm among Women with Borderline Personality Pathology

Academic journal article Journal of Cognitive Psychotherapy

Emotion Regulation as a Mechanism of Change in an Acceptance-Based Emotion Regulation Group Therapy for Deliberate Self-Harm among Women with Borderline Personality Pathology

Article excerpt

Despite the clinical importance of deliberate self-harm (DSH) within borderline personality disorder (BPD), there are few empirically supported treatments for this behavior among individuals with BPD; and those that do exist are difficult to implement in many clinical settings. Thus, Gratz and colleagues developed an adjunctive emotion regulation group therapy (ERGT) for women with BPD that directly targets both DSH and its proposed underlying mechanism of emotion dysregulation. Although previous studies support the use of this ERGT in reducing DSH, no studies have examined emotion regulation as a mechanism of change in this treatment. Therefore, this study examined the mediating role of changes in emotion dysregulation in DSH improvement across two separate trials of this ERGT. As hypothesized, changes in emotion dysregulation mediated the observed reductions in DSH frequency. Results provide support for the theoretical model underlying this ERGT and highlight the importance of targeting emotion dysregulation in treatments for DSH.

Keywords: deliberate self-harm; self-injury; borderline personality; mechanisms of change; emotion regulation; treatment

Deliberate self-harm (DSH), the deliberate, direct destruction of body tissue without conscious suicidal intent (see Gratz, 2001, 2003; Weinberg, Gunderson, Hennen, & Cutter, 2006), is a clinically important behavior commonly associated with borderline personality disorder (BPD; Linehan, 1993) and implicated in the high levels of health care use among individ uals with BPD (Zanarini, 2009). Despite the clinical relevance of this behavior, however, there are few empirically supported treatments for DSH among individuals with BPD. Indeed, short-term treatments for DSH in general (not specific to BPD) have not been found to be effective for patients with BPD and may actually lead to an increase in the repetition of DSH among individuals with BPD (Tyrer et al., 2004). Moreover, the two treatments with demonstrated efficacy in the treatment of DSH among patients with BPD, in particular, dialectical behavior therapy (DBT; Linehan, 1993) and mentalization-based treatment (MBT; Bateman & Fonagy, 2004), are difficult to implement in traditional clinical settings (due to their duration and intensity) and are not readily available in many communities (Zanarini, 2009). Thus, there is a need for shorter, less intensive, and more clinically feasible interventions that directly target DSH among individuals with BPD.

Particularly useful in this regard may be treatments that target the theorized function and underlying mechanisms of DSH, consistent with a functional analytic approach to the treatment of psychopathology (see Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). According to this approach, interventions that explicitly address the function of maladaptive behaviors will be most effective in producing and maintaining behavior change. With regard to DSH, this behavior is most commonly conceptualized as serving an emotion regulating function (in the form of emotional avoidance; Gratz, 2003; Linehan, 1993)-a conceptualization with growing empirical support (Brown, Comtois, & Linehan, 2002; Kleindienst et al., 2008). Moreover, theories of the development and maintenance of DSH emphasize the central role of emotion dysregulation in this behavior (Linehan, 1993), consistent with findings of a robust association between emotion dysregulation and DSH among clinical and nonclinical samples (e.g., Gratz, Breetz, & Tull, 2010; Gratz & Roemer, 2008; Gratz & Tull, 2010b; Heath, Toste, Nedecheva, & Charlebois, 2008; Slee, Spinhoven, Garnefski, & Arensman, 2008).

This growing body of literature on the relevance of emotion dysregulation to DSH (as well as the emotion regulating function of this behavior) provided the rationale for developing an adjunctive group therapy for DSH aimed at decreasing emotion dysregulation among self-harming women with BPD (Gratz & Gunderson, 2006). …

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