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.
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