Behavioral Assessment of Mindfulness Difficulties in Borderline Personality Disorder
Although mindfulness plays an important role in the treatment of borderline personality disorder (BPD), few studies have investigated whether individuals with BPD show difficulties in mindfulness. Those studies have relied exclusively on questionnaire data. Here, we used a more objective, behavioral assessment of mindfulness difficulties in BPD that allowed us to distinguish difficulties in mindfulness, prolonged mind-wandering, and difficulties in awareness of mind-wandering. Twenty-five individuals with BPD and 28 healthy controls performed two mindful breathing tasks. Frequency of mindfulness versus mind-wandering was assessed in the experimenter-prompted mindfulness task, where participants were interrupted at random intervals and asked whether they had just been mindful or mind-wandering. Awareness of mind-wandering was assessed in the self-prompted mindfulness task, where participants were asked to press a computer key whenever they noticed mind-wandering. Length of mind-wandering was assessed in both tasks. In individuals with BPD, we found a lower frequency of mindful episodes. In addition, individuals with BPD indicated longer mind-wandering episodes in the experimenter-prompted task. However, individuals with BPD detected mind-wandering episodes as accurately as healthy controls in the self-prompted task. Finally, difficulties in mindfulness observed in the behavioral tasks positively correlated with participants’ reports of mindfulness difficulties in everyday life. Using behavioral tasks to specify difficulties in mindfulness in BPD, this study indicated that although individuals with BPD mind-wander longer and more often, their awareness of mind-wandering appear unaffected. This indicates that mindfulness difficulties can be reported by individuals with BPD and that therapists can build on this awareness through mindfulness-based treatments of BPD.
KeywordsMindfulness Mind-wandering Borderline personality disorder Behavioral research
The authors thank A. Stippl, S. Heinrich (Humboldt-Universität zu Berlin) and A. Daniels (Freie Universität Berlin) for assisting with participant recruitment and data collection and M. LaRue for manuscript editing.
The study was supported by the German Research Foundation (DFG BE 2611/2-1).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- Ackenheil, M., Stotz, G., Dietz-Bauer, R., & Vossen, A. (1999). Deutsche Fassung des Mini—international neuropsychiatric interview [German version of the Mini-International Neuropsychiatric Interview]. München: Psychiatrische Universitätsklinik München.Google Scholar
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM4) (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- Brickenkamp, R. (1962). Test d2: Aufmerksamkeits-Belastungs-Test [d2 test: attention and stress test]. Göttingen: Hogrefe.Google Scholar
- Buchheld, N., Grossman, P., & Walach, H. (2001). Measuring mindfulness in insight meditation (Vipassana) and meditation-based psychotherapy: the development of the Freiburg Mindfulness Inventory (FMI). Journal for Meditation and Meditation Research, 1(1), 11–34.Google Scholar
- Cárdenas-Morales, L., Fladung, A. K., Kammer, T., Schmahl, C., Plener, P. L., Connemann, B. J., & Schönfeldt-Lecuona, C. (2011). Exploring the affective component of pain perception during aversive stimulation in borderline personality disorder. Psychiatry Research, 186(2), 458–460.CrossRefPubMedGoogle Scholar
- Ebner-Priemer, U. W., Houben, M., Santangelo, P., Kleindienst, N., Tuerlinckx, F., Oravecz, Z., & Kuppens, P. (2015). Unraveling affective dysregulation in borderline personality disorder: a theoretical model and empirical evidence. Journal of Abnormal Psychology, 124(1), 186.CrossRefPubMedGoogle Scholar
- Farb, N., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., & Mehling, W. E. (2015). Interoception, contemplative practice, and health. Frontiers in Psychology, 6(763), 1–26.Google Scholar
- First, M. B., Gibbon, M., & Spitzer, R. L. (1997). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders: SCID-II. Arlington: American Psychiatric Publishing.Google Scholar
- First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1998). Structured clinical interview for DSM-IV axis I disorders: patient edition (February 1996 final), SCID-I/P. New York: New York State Psychiatric Institute.Google Scholar
- Frewen, P., Lundberg, E., MacKinley, J., & Wrath, A. (2011). Assessment of response to mindfulness meditation: meditation breath attention scores in association with subjective measures of state and trait mindfulness and difficulty letting go of depressive cognition. Mindfulness, 2(4), 254–269.CrossRefGoogle Scholar
- Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford Press.Google Scholar
- Kabat-Zinn, J. (1994). Wherever you go, there you are: mindfulness meditation in everyday life. New York: Hyperion.Google Scholar
- Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York: Guildford Press.Google Scholar
- Linehan, M. M. (1994). Acceptance and change: the central dialectic in psychotherapy. In S. C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.), Acceptance and change: content and context in psychotherapy (pp. 73–86). Reno: Context Press.Google Scholar
- Linehan, M. M., Bohus, M., & Lynch, T. R. (2007). Dialectical behavior therapy for pervasive emotion dysregulation. In J. Gross (Ed.), Handbook of emotion regulation (pp. 581–605). New York: Guilford Press.Google Scholar
- Michalak, J., Heidenreich, T., Ströhle, G., & Nachtigall, C. (2008). Die deutsche Version der mindful attention and awareness scale (MAAS): psychometrische Befunde zu einem Achtsamkeitsfragebogen [The German version of the mindful attention and awareness scale (MAAS): psychometric findings of a mindfulness questionnaire]. Zeitschrift für Klinische Psychologie und Psychotherapie; Forschung und Praxis, 37(3), 200–208.CrossRefGoogle Scholar
- Schmidt, K.-H., & Metzler, P. (1992). Wortschatztest: WST [Wording test: WST]. Weinheim: Beltz.Google Scholar
- Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., & Dunbar, G. C. (1998). The mini-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.PubMedGoogle Scholar
- Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martín-Blanco, A., & Pérez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research and Therapy, 50(2), 150–157.CrossRefPubMedGoogle Scholar
- Wagner, T., Roepke, S., Marschall, P., Stiglmayr, C., Renneberg, B., Gieb, D., & Fydrich, T. (2015). Krankheitskosten der Borderline Persönlichkeitsstörung aus gesellschaftlicher Perspektive [Medical expenses of borderline personality disorder from a societal perspective]. Zeitschrift für Klinische Psychologie und Psychotherapie, 42(4), 242–255.CrossRefGoogle Scholar
- Welch, S. S., Rizvi, S., & Dimidjian, S. (2006). Mindfulness in dialectical behavior therapy (DBT) for borderline personality disorder. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: clinician’s guide to evidence base and applications (pp. 117–139). London: Elsevier Academic Press.CrossRefGoogle Scholar
- Wittchen, H.-U., Zaudig, M., & Fydrich, T. (1997). Strukturiertes klinisches Interview für DSM-IV (SKID-I und SKID-II) [structured clinical interview for DSM-IV (SKID-I and SKID-II). Göttingen: Hogrefe.Google Scholar