Eastern Michigan University DigitalCommons@EMU Master's Theses, and Doctoral Dissertations, and Master's Theses and Doctoral Dissertations Graduate Capstone Projects 2016 Understanding urgency in borderline personality disorder: disinhibition or impulsive emotion regulation? Amy Paggeot Follow this and additional works at: http://commons.emich.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Paggeot, Amy, "Understanding urgency in borderline personality disorder: disinhibition or impulsive emotion regulation?" (2016). Master's Theses and Doctoral Dissertations. 855. http://commons.emich.edu/theses/855 This Open Access Dissertation is brought to you for free and open access by the Master's Theses, and Doctoral Dissertations, and Graduate Capstone Projects at DigitalCommons@EMU. It has been accepted for inclusion in Master's Theses and Doctoral Dissertations by an authorized administrator of DigitalCommons@EMU. For more information, please contact [email protected]. Running Head: URGENCY AND EMOTION IN BPD Understanding Urgency in Borderline Personality Disorder: Disinhibition or Impulsive Emotion Regulation? by Amy Paggeot Doctoral Dissertation Submitted to the Department of Psychology Eastern Michigan University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in Clinical Psychology Dissertation Committee: Thomas Waltz, PhD, PhD, Chair Steven Huprich, PhD Tamara Loverich, PhD Kenneth Rusiniak, PhD June 28, 2016 Ypsilanti, Michigan URGENCY AND EMOTION IN BPD ii Acknowledgments First and foremost, I have to express my gratitude toward Eastern Michigan University, the graduate school, and the Society for Personality Assessment, who provided support and funding for this project. Also, I must express my gratitude to the psychology department and the faculty who have supported me and trained me throughout my graduate career. In particular, my dissertation chair, Dr. Thomas Waltz, who to the best of my knowledge was not expecting to take on a project like this one, but who always pushed me to think outside the box and made the project better for it. (Not to mention tolerating my panicked emails when things didn’t go quite right!) I must also thank my committee members, Drs. Huprich, Loverich, and Rusiniak, all of whom contributed both to the project and to my development as a psychologist in their own way and at many points during my graduate career. To Dr. Huprich, who first saw my potential and accepted me into the program; to Dr. Loverich, who encouraged my interest in working with Borderline Personality Disorder patients and taught me how to be an effective clinician as well as a researcher; and to Dr. Rusiniak, who instilled in me a deep respect for experimental research methods and behavioral data, which inspired the design of this dissertation. My thanks to each of you. I also need to thank the friends, family, and boyfriend who supported me and believed in me every step of the way. For my boyfriend, who tolerated my babbling about emotional dysregulation and ANOVAs, and my friends, who dragged me away for moments of decompression at many crucial points along the journey and who provided much-needed support and uncredited nuggets of valuable advice. Most importantly, my family, and particularly my mother and my sister, both of whom put up with me at my worst while always encouraging the URGENCY AND EMOTION IN BPD iii growth of my best possible self. Without each of these people in my life, I would not be where I am now, and I am so profoundly grateful for all the love and support along the way. Finally, I have to take a moment to thank those unnamed, anonymous patients and participants. For the many patients with whom I’ve interacted over the years—your sharing and hard work has not gone unnoticed or unremembered. Ultimately, I hope that this research benefits you and others like you in the future, so that your suffering can be eased and you can find your “life worth living” sooner. Also for the participants, not just in my study but in the studies that inspired it as well—your contributions are extremely important and I could not have done this without you. (Quite literally; psychology studies without participants aren’t studies at all!) Thank you. URGENCY AND EMOTION IN BPD iv Abstract Borderline Personality Disorder (BPD) is a serious and costly disorder characterized by emotional dysregulation and risky, impulsive behaviors. Urgency is a type of impulsivity that has been strongly associated with symptoms of BPD, and it remains unclear whether Urgency represents a failure of self-regulation under conditions of strong emotions or whether Urgency reflects short-term attempts to regulate strong emotions. A useful method for studying the role of strong emotions in impulsive behaviors is “mood freezing”. Mood freezing is a technique that uses a placebo to create a context in which individuals believe that they are unable to change their mood for a period of time. The present study utilizes a mood freezing manipulation to examine whether Urgency in individuals with and without BPD is associated with emotion regulation index behaviors during a psychologically stressful task (modified PASAT-C; Lejuez, Kahler, & Brown, 2003). Two-way independent analyses of variance (ANOVAs) were utilized to examine both main effects and interaction effects of group and condition on the frequency of emotion regulation index behaviors during the stressful task to determine if these behaviors were functioning as short-term emotion regulation strategies. Analyses showed a significant main effect of condition on number of pauses during the PASAT-C, and a significant group effect on time to first pause during the PASAT-C, with trends towards both groups converging on more pausing at an earlier time point under conditions of a mood freeze manipulation. Urgency was the only significant predictor of both number of pauses and time to first pause in a linear regression analysis including BPD symptoms, experiential avoidance, and delay discounting. Secondary analyses showed slowed reaction time on a modified Stroop task in the high BPD trait group, a significantly larger effect of the mood induction manipulation on the high BPD trait group, and a significant correlation between Urgency and BPD symptoms. Study results support URGENCY AND EMOTION IN BPD v the conclusion that Urgency is the type of impulsivity most highly related to BPD symptoms, and that Urgency is related to emotional regulation and distress tolerance behaviors. Limitations and future directions are discussed. URGENCY AND EMOTION IN BPD vi Table of Contents Acknowledgments........................................................................................................................... ii Abstract .......................................................................................................................................... iv Table of Contents ........................................................................................................................... vi List of Tables .................................................................................................................................. x List of Figures ............................................................................................................................... xii Literature Review............................................................................................................................ 1 Introduction ................................................................................................................................. 1 Definitional Difficulty and Conceptual Confusion ..................................................................... 2 Broad Importance of Impulsivity Across Psychopathology ....................................................... 6 Contextual and Learning Conceptualizations of Impulsivity ..................................................... 6 Impulsivity Within a Biopsychosocial Model of BPD Development ......................................... 7 Impulsivity Associated with BPD ............................................................................................... 9 Urgency ................................................................................................................................... 9 Measurement ............................................................................................................................. 11 Experimental Manipulations of Affect Regulation ................................................................... 15 Goals and Hypotheses ............................................................................................................... 18 Goals ..................................................................................................................................... 18 Methods......................................................................................................................................... 19 Participants ................................................................................................................................ 19 Procedures ................................................................................................................................. 20 Measures ................................................................................................................................... 24 URGENCY AND EMOTION IN BPD vii Personality Assessment