Isolating Mechanisms in the Treatment of Borderline Personality Disorder

Borderline personality disorder (BPD) is a commonly occurring, severe, and costly condition
for which treatment efforts have been hindered by several factors. First, extant treatments
for BPD are long-term, intensive and consist of multiple components, largely focused on
resolving the life-threatening dysregulation that characterizes this disorder. It is
important to note, however, that most individuals diagnosed with BPD never attempt suicide or
require inpatient hospitalization. Multi-component interventions may not be the most
efficient approach for patients with less severe levels of BPD and also make it difficult to
draw conclusions regarding which treatment strategies are influencing mechanisms maintaining
symptoms. Additionally, extant BPD treatments do no explicitly address high rates of
comorbidity with anxiety and depressive disorders; high levels of co-occurrence amongst these
disorders underscores the utility of identifying transdiagnostic treatment components
relevant to maintaining mechanisms across diagnostic boundaries. The proposed Mentored
Patient-Oriented Research Career Development Award (K23) is a four-year plan in support of
the applicant's long-term career goal to become a clinical scientist proficient in developing
parsimonious, easily disseminated treatments for BPD and other emotional disorders. This
project will be completed in two phases. The goal of Phase I, in line with an experimental
therapeutics approach, is to investigate the effect of acting inconsistent with
emotion-driven behavioral urges on emotional intensity in a sample of individuals diagnosed
with BPD in the context of a single-case experiment (alternating treatment design). Phase II
will also utilize single-case experimental design (in this case a multiple baseline study) to
explore the effects of brief intervention focused solely on acting inconsistent to emotional
action tendencies on emotional intensity, tolerance of emotions, and BPD symptoms in a sample
diagnosed with BPD. Boston University's Center for Anxiety and Related Disorders, where all
research and the bulk of the training activities will take place, is a world-renown clinical
research institution with a successful history of treatment development research. Overall,
the broader aim of these research and training goals is to address the need for improved
treatments for BPD. This study will answer important theoretical questions about the
mechanism of treatment change, and might lead to more efficacious, cost-effective, and easily
disseminable treatment strategies for BPD, a severe and understudied disorder.

Inclusion Criteria:

1. Diagnostic and Statistical Manual (5th Edition; DSM-5) diagnosis of borderline
personality disorder;

2. willing to maintain a stable dose on prescribed psychotropic medication throughout the
study duration. This avoids problems with reluctance to discontinue or difficulty with
discontinuing, and also the confounding of outcomes from initiation of medication
during treatment; this procedure is a longstanding practice at the Center for Anxiety
and Related Disorders (CARD) at Boston University for treatment outcome research.
Additionally, participants must be

3. fluent in English.

Exclusion Criteria:

In order to maximize generalizability, exclusion criteria are based solely on the
well-being of the participant and will consist primarily of conditions that would require
prioritization for immediate treatment (e.g., severe suicidality or substance dependence).
These include:

1. Current DSM-5 diagnoses of bipolar disorder, schizophrenia, schizoaffective disorder,
or organic mental disorder;

2. Clear and current suicidal risk (intent);

3. Current or recent (within 3 months) history of drug dependence;

4. Willingness to refrain from additional psychosocial treatment across the course of the
study; and

5. has access to own smartphone.