Isolating the effect of opposite action in borderline personality disorder: A laboratory-based alternating treatment design

Shannon Sauer-Zavala, Julianne G. Wilner, Clair Cassiello-Robbins, Pooja Saraff, Danyelle Pagan

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Evaluating the unique effects of each component included in treatment protocols for borderline personality disorder (BPD)is a necessary step in refining these interventions so that they only include skills that drive therapeutic change. One strategy, included in several prominent treatments for BPD, is acting opposite to emotion-driven behavioral urges; engaging in behaviors that are inconsistent with an experienced emotion is thought to lead to reductions in its intensity, though this has not been empirically-tested. The present study was a single-case experiment, specifically an alternating treatment design, that explored the effects of a laboratory-based adaptation of opposite action (versus acting consistent)on emotional intensity. Sixteen individuals with BPD attended six laboratory sessions in which they were instructed to act consistent with an induced emotion in half the sessions and opposite in the other half. Participants were randomly assigned to the specific emotion (i.e., anxiety, sadness, anger, and shame/guilt)that was induced across all study sessions. Findings from visual inspection and percentage of non-overlapping data suggest that acting opposite (versus consistent)leads to significantly greater decreases in emotional intensity for those in the sadness and guilt/shame conditions, but not those in the anxiety or anger conditions. Possible interpretations of these findings are presented. Replication outside of the laboratory context is necessary to draw further conclusions of the clinical implications of these findings.

Original languageEnglish
Pages (from-to)79-86
Number of pages8
JournalBehaviour Research and Therapy
StatePublished - Jun 2019

Bibliographical note

Funding Information:
This work was funded by a Career Development Award from the National Institute of Mental Health , K23MH106648A , PI: Sauer-Zavala. The authors would like to thank Dr. David Barlow for his generous mentorship on this project. Additionally, we would like to acknowledge to contributions of our wonderful research assistants, without whom this work would never have been completed: Tara Benczkowski, Danyele Homer, Madeleine Rassaby, Keara Russell, and Rachel Snow.

Publisher Copyright:
© 2018


  • Alternating treatment design
  • Borderline personality disorder
  • Emotion
  • Opposite action

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Clinical Psychology
  • Psychiatry and Mental health


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