The role of Emotion Dysregulation in Non-Suicidal Self-injury and Borderline Personality Disorder: Predictors and Mechanism-Based Treatment Approach
[eng] Emotion regulation refers to the ability to modulate one's emotional responses effectively, while emotion dysregulation reflects a persistent difficulty in managing emotions, often leading to maladaptive coping strategies, such as non-suicidal self-injury (NSSI). NSSI is defined as the di...
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| Formato: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Recursos: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/221293 |
| Acesso em linha: | https://hdl.handle.net/2445/221293 http://hdl.handle.net/10803/694570 |
| Access Level: | acceso abierto |
| Palavra-chave: | Emocions Comportament autolesiu Teràpia cognitiva basada en l'atenció plena Emotions Self-injurious behavior Mindfulness-based cognitive therapy |
| Resumo: | [eng] Emotion regulation refers to the ability to modulate one's emotional responses effectively, while emotion dysregulation reflects a persistent difficulty in managing emotions, often leading to maladaptive coping strategies, such as non-suicidal self-injury (NSSI). NSSI is defined as the direct and deliberate harm to one's body tissue without suicidal intent, and presents a significant public health challenge. Its strong association with mental health problems, particularly in young people, and its prevalence in borderline personality disorder (BPD) underscore the need for effective interventions. While emotion dysregulation is strongly implicated in both NSSI and BPD, the specific dimensions of emotion dysregulation that characterize high-risk NSSI subgroups remain unclear. In addition, mindfulness skill training, a core component of Dialectical Behavior Therapy (DBT), shows promise in enhancing emotion regulation for individuals with BPD, yet the mechanisms driving its effectiveness require further investigation. This research project comprising five studies aimed to address these gaps, exploring the complex interplay between emotion dysregulation, NSSI, and BPD. The initial two studies focused on characterizing NSSI and identifying risk factors. Study 1 revealed a direct link between non-acceptance of emotions and the function of NSSI, while a lack of emotion regulation strategies was associated with NSSI frequency. Study 2 identified a subgroup characterized by severe NSSI, heightened emotion dysregulation, and low perceived social support. This profile was associated with a greater risk for psychopathology both at baseline and at the two-year follow-up. These findings highlight the heterogeneous nature of NSSI and the need for personalized treatment approaches. ABSTRACT 13 The subsequent studies examined the mechanisms of change underlying mindfulness-based DBT skill training. Study 3 demonstrated that mindfulness skill training reduced borderline symptoms by enhancing decentering—the ability to observe thoughts and feelings non-judgmentally—which, in turn, led to decreased emotion dysregulation. Studies 4 and 5 further explored the dynamic relationship between mindfulness skills and emotion regulation in BPD. Commitment to mindfulness skill practice was associated with reduced emotion dysregulation, with a minimum effective dose of ≥ 3 days and more than 30 minutes in total per week, identified as crucial (Study 4). Notably, greater within-person effects of nonjudging the inner experience and body awareness at a given week predicted subsequent improvements in emotion regulation at the following week. Decentering moderated this associations, with stronger effects observed in those with higher decentering capacity (Study 5). Importantly, a bidirectional relationship between mindfulness practice, the proposed mechanisms of change, and emotion dysregulation was consistently observed. This research program provides valuable insights for both research and clinical practice. By identifying specific emotion regulation difficulties associated with NSSI and highlighting high-risk profiles, this work informs more targeted prevention and intervention strategies. Additionally, by elucidating the mechanisms through which mindfulness-based DBT skills training impacts emotion regulation – particularly the roles of decentering, non-judgmental awareness, and body awareness – this research offers clinicians valuable tools for optimizing treatment protocols. Lastly, the identification of a minimum effective dose of mindfulness practice and the recognition of a bidirectional relationship between mindfulness practice and emotion dysregulation underscore the need for flexible and individualized treatment approaches. |
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