Emotional Activation and Habituation During Imaginal Exposure for PTSD Among Women With Borderline Personality Disorder.

Abstract

The current study examined patterns and outcomes of emotional activation and habituation during imaginal exposure for posttraumatic stress disorder (PTSD). Participants were 16 women with borderline personality disorder (BPD), PTSD, and recent suicidal and/or self-injurious behavior who received imaginal exposure for PTSD concurrently with dialectical behavior therapy. The intensity of global distress and 6 specific emotions were assessed before and after imaginal exposure trials. Results indicated that significant within-session habituation (WSH) occurred for global distress (Hedge's g effect size = -2.52) and fear (g = -0.80), whereas significant between-session habituation (BSH) occurred for global distress (g = -2.18), fear (g = -1.89), guilt (g = -1.14), shame (g = -0.74), and disgust (g = -0.41). BSH significantly predicted PTSD diagnostic status at posttreatment, whereas activation and WSH were unrelated to outcome. Clients who remitted from PTSD showed significantly more BSH in global distress than nonremitters (η(2) = .39). In addition, remitters reported reductions in sadness and anger across trials, whereas sadness and anger increased for those who did not remit (η(2) = .54 and .40, respectively). Overall, BPD clients exhibited patterns of activation and habituation during imaginal exposure comparable to other client populations, and there was no evidence of persistent emotional engagement or habituation problems.