Behaviorist approach to treatment for borderline personality disorder

Behaviorist perspective on borderline personality disorder

Structure

B.F. Skinner viewed the primary unit in the structure of personality as the response (Cervone & Pervin, 2023). Skinner posited that responses could range from simple to complex and are external, observable behavior (Cervone & Pervin, 2023). According to Skinner, responses emitted by the organism are operants and can be changed through operant conditioning (Cervone & Pervin, 2023).

Process

Skinner postulated that responses are formed by operant conditioning and are a result of reinforcements (Cervone & Pervin, 2023). Skinner explained that through reinforcements, something that happens after a response that increases or decreases the likelihood of the response happening again, or not, can be provided intermittently or on fixed schedules and can shape behavior, or responses (Cervone & Pervin, 2023). That said, responses given by those diagnosed with BPD, should be able to be altered through shaping, causing even complex responses to be altered.

Growth and development

Skinner believed that as we develop, we learn more and more responses, which result from natural reinforcements (Cervone & Pervin, 2023). With this, one can assume that dysfunction can come from learned responses from a dysfunctional environment, which provides positive reinforcements for maladaptive responses.

Psychopathology

Skinner did not see psychopathology as a disease of the mind, as some psychologists do. Rather, he viewed psychopathology as a learned response pattern that can be unlearned through counterconditioning, the learning of new responses (Cervone & Pervin, 2023).

Clinical application of theory

Those with borderline personality disorders (BPD) evaluation of reward and punishment tend to be altered (Paret et al., 2016). In addition, those diagnosed with BPD display increased emotional reactivity and difficulty regulating emotions (Paret et al., 2016).

Dissociative symptoms are said to increase in experimental setting, especially when emotional stimuli are involved (Paret et al., 2016). For individuals diagnosed with BPD, dissociative symptoms are already increased; furthermore, learning can be affected by dissociative symptoms (Paret et al., 2016; Winter et al., 2014). Thus, classical conditioning can be impaired by dissociation, as learning will not occur for BPD patients in the same way this may occur for healthy patients (Paret et al., 2016). Despite this, Paret et al. (2016) found some results in the study they conducted using operant conditioning to reverse stimulus-outcome associations with BPD participants.

According to Paret et al. (2016), “by reversing stimulus-outcome associations in operant conditioning, one’s malleable response to reward and punishment can be assessed” (p. 194). Thus, in a study conducted by Paret et al. (2016), researchers reversed learning tasks by providing two stimuli, one of which came with a reward when selected and the other with punishment. The results preliminarily show evidence for impaired learning due to increased emotional arousal, dissociation and tension in BPD patients (Paret et al., 2016). In addition, lack of ability to process punishment was shown to be associated with symptom severity (Paret et al., 2016).

It seems then, Skinner’s treatment approach of counterconditioning, where in which a patient learns new ways of responding, may work well for an individual diagnosed with BPD. According to Levy et al. (2018), several meta-analyses suggest various efficacious treatment modalities for this disorder; in fact, there do not seem to be significant statistical differences in effectiveness between approaches.

 

References

Cervone, D., & Pervin, L. A. (2023). Personality: Theory and research (15th ed.). Wiley.

Levy, K., McMain, S., Bateman, A., & Clouthier, T. (2018). Treatment of borderline personality disorder. Psychiatric Clinics, 41(4), 711-728.

Paret, C., Hoesterey, S., Kleindienst, N., & Schmahl, C. (2016). Associations of emotional arousal, dissociation and symptom severity with operant conditioning in borderline personality disorder. Psychiatry research, 244, 194-201.

Winter, D., Elzinga, B., Schmahl, C. (2014). Emotions and memory in borderline personality disorder. Psychopathology, 47, 71–85. http://dx.doi.org/10.1159/ 000356360

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