EMOTIONAL CASCADES AND UNDERSTANDING THE CHAOS AND COMPLEXITY OF BORDERLINE PERSONALITY DISORDER

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1 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

2 Borderline Personality Disorder TURBULENT EMOTIONS DYSREGULATED BEHAVIORS SUICIDAL BEHAVIOR/SELF- INJURY STORMY RELATIONSHIPS

3 Self-Injury

4 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.

5 Kranzler, Selby, In Preparation

6 Vulnerability Genetic Biological Social/Familial? Emotional Mechanisms! Psychopathology Borderline Personality Disorder Self-Injury/Suicide Eating Disordered Behavior

7 Emotional Cascades Selby, Anestis, & Joiner, 2008, Beh Res Ther

8 Emotion Rumination Physical Sensations Increased Emotional Intensity EMOTIONAL CASCADE Behavioral Dysregulation

9 Emotion Rumination Physical Sensations Increased Emotional Intensity RELIEF EMOTIONAL CASCADE Behavioral Dysregulation

10 Negative Emotion 28 Rumination Induction Baseline Post-Induction BPD Group Control Selby et al. (2009) J ABNORMAL PSY

11 Negative Emotion 28 Rumination Induction p<.05 η^2 = Baseline Post-Induction BPD Group Control Brain and Behavior Research Selby Foundation et al. (2009) Young Investigator Grant with Joint Funding by the Families for Borderline Personality Disorder J ABNORMAL Research PSY

12 Do Emotional Cascades Predict Future Dysregulated Behaviors?

13 Experience Sampling

14 Number Reported % Sample Reporting Behavior Alcohol Use % Reckless Driving % Self-Injury % Impulsive Shopping % Marijuana Use % Binge Episode % Physical Fight % Threw Object %

15 Predictive Validity Signal 2 Signal 1 γ =.18* High Lagγ =.20* Rumination X High Lag- Negative γ =.=17* Emotion Immediate Future Dysregulated Behavior Selby & Joiner, 2013, PDTRT

16 3-Way Interaction Predicting Occurrence of a Dysregulated Behavior Selby & Joiner, 2013, PDTRT

17 Instability of Rumination Stable Unstable Selby et al., 2013, J Clin Psychol

18 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.

19 Concept form Chaos Theory Even small differences can lead to very extreme outcomes Easier to think of as a Compounding effect More precisely known as, Sensitive Dependence on Initial Conditions BUTTERFLY EFFECT

21 Even small differences can lead to very extreme differences Concept form Chaos Theory In some people, we see an extremely strong and sensitive connection between negative thought and negative emotion, particularly those with BPD Easier to think of as a Compounding effect More precisely known as, Sensitive Dependence on Initial Conditions BUTTERFLY EFFECT

22 Butterfly Effect in Emotional Cascades Signal 1 Signal 2 Lag-Rumination Lag-Negative Emotion 2-3 Hours Later Rumination Negative Emotion Selby et al., in press, Journal of Personality

23 Rumination Effects Momentary Nega ve Emo on Fixed Lag Rumina on Random Effect - Upper Bound Random Effect - Lower Bound Lag Rumina on Momentary Rumina on Fixed Lag-Rumina on Random Effect - Upper Bound Random Effect - Lower Bound Lag Rumina on Selby et al., in press, Journal of Personality

24 Negative Emotion Effects Momentary Rumina on Fixed Lag Nega ve Emo on Random Effect - Upper Bound Random Effect - Lower Bound Lag Nega ve Emo on Momentary Nega ve Emo on Fixed Lag Nega ve Emo on Random Effect - Upper Bound Random Effect - Lower Bound Lag Nega ve Emo on Selby et al., in press, Journal of Personality

25 Butterfly Effect in Emotional Cascades Signal 1 Signal 2 Lag-Rumination Lag-Negative Emotion 2-3 Hours Later Dysregulated Behaviors Selby et al., in press, Journal of Personality

26 Dysregulated Behaviors Impulsive Behaviors Fixed Lag Rumina on Random Effect - Upper Bound Random Effect - Lower Bound Lag Rumina on Impulsive Behaviors Fixed Lag Nega ve Emo on Random Effect - Upper Bound Random Effect - Lower Bound Lag Nega ve Emo on Selby et al., in press, Journal of Personality

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

29 Emergence

30 Emergence

31 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

32 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

33 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

34 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

35 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

36 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

37 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

38 The Emotional Cascade Model SELBY & JOINER (2009) REV OF GEN PSY

39 Treatment Implications

40 Dialectical Behavior Therapy

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

42 Activities

43 Puzzles Games

44 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)

45 What Can Family Members Do? 1. Understand the emotion process of BPD 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 2. Help your loved one distract when upset 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 3. Try not to get frustrated When we get frustrated, which can be easy at times, that can feed into the emotion dysregulation process Building emotion regulation skills takes time!

46 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: Website:

Contents of This Packet

Contents of This Packet 1) Overview letter 2) Dialectical Behavior Therapy (DBT) Clinic flyer 3) Diagnostic criteria for borderline personality disorder 4) Guidelines and agreements for participating in