Borderline Personality Disorder
Inability to regulate emotional states has been identified as one of the hallmarks of BPD (Grotstein, 1987; Linehan, 1993a; Herpertz et al., 2001). The significance of this finding for the present discussion lies in the fact that there exists a strong re-ciprocal relationship between emotion regulation and attentional focus: an increase in emotional arousal narrows attention to a focus on emotion-relevant stimuli. Conversely, the ability to shift attention away from affect-inducing stimuli may be central to the process of emotion modulation. Therefore, it has been hypoth-esized that the characteristic difficulties with emotion regulation of the patient with BPD may be directly linked to a relative lack of attentional control (Linehan, 1993a; Coolidge et al., 2000).
Linehan’s (1989, 1993a) dialectical behavior therapy (DBT) has been shown in a series of clinical trials to be effective in ame-liorating many of the more serious symptoms of BPD, including parasuicidal behavior and impulsive angry outbursts (Linehan et al., 1991, 1993; Shearin and Linehan, 1994; Koons et al., 2001). Significantly, the DBT protocol includes numerous interventions that seek to address the dysregulations in attention characteristic of patients with BPD.
A central goal of DBT is the cultivation of core mindful-ness, a frame of mind described by Linehan as “[being] in control of attentional processes – that is, what one pays attention to and how long one pays attention to it” (Linehan, 1993b, p. 65). The patient with BPD is taught to recognize the connection between attentional fixation on distressing stimuli and a commensurate escalation in affective arousal, especially problematical nega-tive affective states such as rage and depression. Thus, in DBT there is explicit recognition that enhanced attentional control is a primary treatment goal.