4 - (IOP 17) The Impact of BPD Compass on Putative Mechanisms of Personality Change

BPD Compass is an 18-session personality-based intervention for borderline personality disorder (BPD) designed to engage negative affectivity, antagonism, and disinhibition (Sauer-Zavala et al., 2023). BPD Compass is thought to address negative affectivity by targeting aversive reactions to negative emotions; antagonism by targeting patients’ attachment insecurity; and disinhibition by targeting self-efficacy and reward responsiveness. BPD Compass has been found to engage these personality domains and to be an efficacious treatment for BPD and commonly co-occurring conditions (Sauer-Zavala et al., 2025). Although aversive reactivity, attachment insecurity, and self-efficacy/reward responsiveness are targeted as putative mechanisms of BPD Compass, it is unclear if these processes change in treatment. A treatment-seeking sample of 100 adults with BPD (Mage = 28.13, 73.7% female, 88.9% White, 64.6% sexual minorities) received BPD Compass as part of a randomized controlled trial (Sauer-Zavala et al., 2023). Before each session, participants completed the Multidimensional Experiential Avoidance Questionnaire – Distress Aversion subscale to assess aversive reactivity; the Experiences in Close Relationships Scale – Attachment Anxiety and Attachment Avoidance subscales to assess attachment insecurity; the General Self-Efficacy Scale to assess self-efficacy; and the Reward Responsiveness Scale to assess reward responsiveness. Using hierarchical linear modeling with the nlme package in R, we regressed session number on each putative mechanism in separate models, including random intercepts and slopes. Aversive reactivity, B = –.70, SE = .09, p < .01, d = -.91, attachment insecurity, Bs = –.28 - –.21, SEs: .04, ps < .01, ds = –.89 - –.49, and self-efficacy, B = .31, SE = .08, p < .01, d = .69, significantly improved across treatment. By contrast, reward responsiveness, B = .02, SE = .02, p = .28, did not significantly change across treatment. Together, these results suggest that BPD Compass targets aversive reactivity, attachment insecurity, and self-efficacy but not reward responsiveness. These results may inform and help further specify the active mechanisms involved in BPD Compass.