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Emotion regulation in borderline personality disorder: the role of self-criticism, shame, and self-compassion: (commentary on Emotional processing in a ten-session general psychiatric treatment for Borderline Personality Disorder: a case study).

This case study evaluates the efficacy of a 10-session manualized version of general psychiatric management (GPM) with a female patient diagnosed with borderline personality disorder (BPD), severe depressive disorder, and schizotypal traits. The authors hypothesized that increases in adaptive emotional processing would lead to increases in therapeutic alliance and treatment outcome. Hypotheses were not supported, and in fact, ‘a general outcome deterioration tendency and an unchanged alliance level was observed’ (p. 7). The patient’s level of emotional processing remained at the stage characterized by harsh self-criticism and shame. The authors speculate that it may take more than 10 sessions for changes in emotional processing to occur and that the patient may have been in a state where she would have benefited more from containment, support, and structure. While this case did not demonstrate therapeutic efficacy of the 10-session GPM treatment or gains in emotional processing, it does represent an attempt to explore possible mechanisms of change in the treatment of borderline personality disorder. The elucidation of mechanisms of change could potentially lead to refinement and modification of currently effective treatments and improvements in therapeutic effectiveness. Difficulties in emotion regulation are characteristic of many forms of psychopathology (Gross & Munoz, 1995). As BPD is uniquely characterized by difficulties in emotional regulation, improvements in emotional regulation would appear to be a potential core mechanism in effective treatments for BPD. In support of this, Goodman et al. (2014) reported improvement in emotion regulation associated with decreased amygdala activation in BPD