Emotion regulation in borderline personality disorder: an experimental investigation of the effects of acceptance and suppression

The primary aim of this research was to examine the effects of different emotion regulation strategies on emotions, psychophysiology, and behavioural urges among persons with BPD. Findings from several studies suggest that persons with borderline personality disorder (BPD) demonstrate heightened emotional vulnerability and a tendency to regulate emotions with potentially maladaptive avoidance strategies. Despite accumulating research on emotional responding in BPD, there is a dearth of research on the direct effects of different emotion regulation strategies in this population. For this research, participants with BPD, major depressive disorder, or non-psychiatric controls (N = 100) were randomly assigned to listen to a rationale for either emotional acceptance or emotional suppression. Subsequently, participants listened to an audio-recording of a social rejection scenario. Subjective distress, heart rate, skin conductance, respiratory sinus arrhythmia, and facial electromyography were assessed before, during, and after the emotion induction. Afterwards, participants completed a behavioural measure of distress tolerance. Participants in the acceptance condition reported more negative emotions than those in the suppression condition, particularly among BPD participants. The BPD group also reported higher urges to engage in maladaptive behaviours in the acceptance condition. The BPD participants exhibited a distinctive pattern of physiological responses, with more positively valenced facial expressions and lower skin conductance compared with the control group, despite their reported distress. These results suggest that individuals with BPD may struggle in the short-term with the use of acceptance-based regulation strategies in response to acute stressors, compared with non-psychiatric controls and other clinical groups.