Emotion word repertoire in the adult attachment interview predicts a reduction of non-suicidal self-injury in the psychotherapy of borderline personality disorder.

BACKGROUND

Borderline personality disorder (BPD) is characterized by mental representation deficits and emotion dysregulation, with non-suicidal self-injury (NSSI) often occurring as a maladaptive regulation strategy. The ability to verbally express emotions might be advantageous for coping with emotion dysregulation and benefiting from psychotherapy.

METHODS

In the present study, we used a novel text-based measure of emotional awareness to examine whether a greater emotion word repertoire (EWR) predicts improvement in psychotherapy for patients with BPD regarding NSSI, suicide attempts, attachment representations, mentalization, and personality organization. We conducted a secondary analysis of a randomized controlled trial comparing the efficacy of Transference-Focused Psychotherapy (TFP) vs. treatment as usual over one year in a sample of female BPD outpatients. The German electronic Levels of Emotional Awareness Scale (eLEAS) scoring system was applied to Adult Attachment Interviews (AAI) administered at baseline (n = 87; M = 27.4, SD = 7.4) and upon treatment termination (n = 52; M = 28.6, SD = 7.2).

RESULTS

In both treatment groups, EWR at baseline was positively correlated with a reduction of NSSI after one year of psychotherapy (r = .46, p < .001). No significant correlations were found between baseline EWR and changes in other outcome measures. Compared to baseline, mean EWR scores significantly decreased after one year of treatment.

DISCUSSION

Our findings indicate that a borderline patient's ability to verbalize emotions might be a resource facilitating a reduction of NSSI in psychotherapy. We discuss strengths and limitations of applying the eLEAS scoring system to open-ended texts in a psychotherapy context. Given the exploratory nature of this study, replication in future studies is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov (identifier NCT00714311, registration date 07/09/2008).