Regulation of negative emotions

Findings revealed that individuals with high levels of BPF are more likely to report the use of unhelpful strategies and less likely to report the use of helpful strategies for negative emotion regulation. This supports past theory which has suggested that inappropriate attempts to regulate emotions are associated with BPF (Linehan, 1993). Further to this, these predictive relationships were found after controlling for demographic variables, mood disturbance and other cluster B personality disorder scores. This means that the relationships between BPF and the use of helpful and unhelpful strategies are specific and not the result of a more general mood disturbance. This finding also provides preliminary evidence that the use of less helpful strategies for regulating emotion is unique to BPF within cluster B personality pathology. However, it must be acknowledged that this study only controlled for cluster B personality features and therefore it cannot be concluded that this pattern of strategy use is specific to BPF within the broader spectrum of personality disorder. Understanding the specificity of these findings is important to inform potential targets

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of treatment strategies. For example in order to try and improve effective strategy choice interventions may want to focus on personality features specific to BPF rather than those shared with other cluster B personality disorders or mood disorders.

The emotion regulation strategies assessed in this study using the ERP-R, were largely consistent with Gross's (1998a) process model of emotion regulation and the generic timing hypothesis, which suggests that antecedent focused strategies are likely to be more helpful than response focused strategies in the regulation of emotions (Gross, 1998a). This is because strategies referred to as helpful in this study may be regarded as antecedent emotion regulation strategies: situation modification, attention re-orientation, reappraisal and expression (a technique to seek assistance in situation modification, attention reorientation and reappraisal; Rime, 2007). Whilst strategies referred to as unhelpful in this study may largely be categorised as response modulation strategies: rumination, acting out, learned helplessness and substance abuse. These types of strategies have their impact later in the emotion generative process, when emotional intensity may be higher demanding a longer period of regulation attempts (Sheppes & Meiran, 2007). Therefore, the finding that individuals with high levels of BPF tend to use more unhelpful, response focused strategies may be taken as an indication that these individuals tend to attempt emotion regulation later in the emotion generative process, where levels of emotion intensity may be higher.

However, it could be argued that due to the wording of the scenarios included in the ERP-R that all strategies included in the questionnaire should be considered response focused. This is because phrases such as ‗this makes you feel extremely angry‘ may encourage participants to report how they would respond once the emotional response was fully active. However, it has been highlighted in the theoretical literature that the presence of an emotional response does not make all strategies

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response focused. This is because emotion is generated in cycles. As a result strategies are considered antecedent or response focused within their respective cycle (Gross & Thompson, 2007). Consequently, situation modification, attention re-orientation and reappraisal are considered antecedent-focused because they seek to alter the generation of future emotion. Whereas, rumination, acting out, learned helplessness and substance abuse are considered response-focused because they act to alter the current emotional response directly.

In addition to supporting past research by demonstrating increased use of unhelpful strategies in this population, findings from this study also make an original contribution to knowledge by demonstrating less use of helpful strategies in negative emotion regulation. Past research investigating the use of helpful emotion regulation strategies in relation to BPF has been limited. One such study reported decreased use of the helpful strategy, problem-focused coping, based on clinicians‘ reports of a sample of individuals with severe levels of BPF, sufficient for a BPD diagnosis (Conklin et al., 2006). Findings from the current study develop this idea further by demonstrating that individuals with high levels of BPF, which may not be sufficient for a diagnosis of BPD, also report using less helpful strategies for negative emotion regulation. In addition the current study explored a range of helpful strategies such as reappraisal, situation modification, attention re-orientation and expression, demonstrating that this finding is not specific to problem-focused coping.

In this study, partial correlations were used to explore the relationships between BPF and each individual emotion regulation strategy. These findings are discussed below but must be interpreted with caution, due to low Cronbach‘s alpha scores for individual strategy, which may indicate that the strength and significance of the relationships may vary according to the type of emotion to be regulated.

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It was found that learned helplessness demonstrated a significant relationship with BPF after controlling for demographics, mood and cluster B personality features. The relationship between BPF and learned helplessness (belief that the individual is unable to influence their emotions resulting in no active attempt being made) is in line with past research (Fletcher et al., 2014; Gratz & Roemer, 2004; Salsman & Linehan, 2012) and indicates low levels of emotion regulation self-efficacy in this population. Theoretically it has been suggested that low emotion regulation self-efficacy may lead to a reduction in attempts to actively regulate emotions (Bandura, 1977). Therefore, the relationship between BPF and learned helplessness may be taken as an indication that these individuals are less likely to engage in effortful emotion regulation attempts, which highlights a potential barrier to effective emotion regulation in this population that would benefit from further research.

The removal of depression, anxiety and cluster B personality scores as control variables led to BPF predicting increased use of all unhelpful strategies and decreased use of all helpful negative emotion regulation strategies assessed. With the exception of

learned helplessness, these relationships were not found to be significant when mood

disturbance and cluster B personality scores were controlled. Therefore these findings cannot be attributed to exclusively to BPF. Instead these relationships may be due to the presence of mood disturbances or cluster B personality features, which may be considered a part of BPF or as co-morbid factors. The theoretical issue of whether depression and shared cluster B personality features should be considered a part of BPF or as co-morbidity factors is presented throughout this thesis and is discussed in further detail in Chapter 8.

Nevertheless, this finding suggests that individuals with high levels of BPF tend to report more use of strategies such as rumination, acting out and substance use. The

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use of rumination is not surprising given its well documented association with increases in all components of negative emotional responding (Webb et al., 2012) and central role in the emotion cascade model of BPD (Selby & Joiner, 2009). Further to this, increased use of acting out and substance use as emotion regulation strategies provides preliminary evidence for behavioural dysregulation associated with BPF, resulting from unhelpful attempts to regulate unwanted negative emotions; a theoretical link proposed in Biosocial Theory (Linehan, 1993) and the Emotion Cascade Model (Selby & Joiner, 2009).

The negative association between BPF and reappraisal, attention-reorientation, expression and situation modification makes a unique contribution to the literature as the use of helpful strategies has not previously been explored in relation to BPF. Each of these strategies has previously been associated with benefits in reducing negative emotions (Nelis et al., 2011). Thus reduction in the use of these strategies may explain the high levels of negative emotion experienced by individuals with high levels of BPF. The finding that individuals with high levels of BPF report less use of negative emotion expression is consistent with Biosocial theory (Linehan, 1993), which suggests that as a result of invalidating environments, individuals with high levels of BPF learn not to share their negative internal experiences with others. However, it comes as some surprise that individuals with high levels of BPF would use less attention re-orientation strategies given past theoretical and empirical literature suggesting that these individuals use extreme behaviours, such as self-harm, to distract themselves from unwanted negative emotion (Brown et al., 2002; Paris, 2005; Selby & Joiner, 2009). However, the attention-reorientation responses in this study were less extreme and therefore may not have represented the distraction techniques used by individuals with high levels of BPF. Instead they referred to diverting attention away from negative stimuli and towards unrelated positive thoughts. Similarly reappraisal required looking

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for positive aspects or outcomes of the negative situation and situation modification requires disengaging from negative stimuli in order to identify ways that the situation can be improved or resolved. Therefore all of these strategies require redirecting attention away from negative information/stimuli, a skill which has been found to be problematic for individuals with high levels of BPF (Domes et al., 2006; Silbersweig et al., 2007). The inability to do this may explain why these types of strategies appear to be used less by individuals with high levels of BPF.