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; Mage = 27.4, SDage = 7.4) and upon treatment termination (n = 52; Mage = 28.6, SDage = 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).