Potential psychological processes linking mindfulness to borderline personality disorder symptoms: a systematic review and thematic synthesis.
Aamer Aldbyani, Afnan Alhimaidi, Chunhong Shen, Zhai Shuna, Naif S. Al-barha
Borderline Personality Disorder and Emotion Dysregulation July 28, 2026 DOI: 10.1186/s40479-026-00365-z (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Longitudinal Peer reviewed |
|---|---|
| Topics | Meditation |
| Keywords | Borderline personality disorder Distress tolerance Emotion regulation Psychological processes Self-compassion Systematic review Thematic synthesis |
| Key findings | The review identifies emotion regulation as the most consistently supported candidate pathway linking mindfulness and BPD symptoms, alongside mindfulness facets, self-compassion, cognitive-control processes, and interpersonal factors. The authors argue that these processes may operate as interconnected pathways rather than isolated variables, while noting that existing studies are fragmented and that longitudinal, process-focused research is needed before firm mechanistic conclusions can be drawn. |
Abstract
Borderline personality disorder (BPD) is characterized by pervasive instability in affect regulation, impulse control, and interpersonal functioning. Mindfulness has been increasingly examined as a key construct associated with BPD; however, existing research has primarily focused on direct associations rather than on the psychological processes that may account for this relationship. This systematic review aimed to identify and synthesize empirical evidence on the potential psychological processes associated with the relationship between mindfulness and borderline personality disorder symptoms. The review was conducted in accordance with PRISMA guidelines, and the protocol was registered with PROSPERO. A systematic search was performed across PsycINFO, PubMed, Scopus, Web of Science, EBSCO, and Google Scholar for studies published between 2010 and April 2026. Quantitative studies examining mindfulness in relation to BPD symptoms or related clinical outcomes were included. A total of 31 studies met the eligibility criteria and were included in the review. Data were extracted using a structured form, and findings were synthesized using a narrative and thematic approach due to methodological heterogeneity. The included studies identified several psychological processes that may contribute to the relationship between mindfulness and BPD symptoms, although the strength of evidence varied across study designs and analytical approaches. Emotion regulation emerged as the most consistently supported candidate pathway, alongside other potentially relevant processes, including mindfulness facets (e.g., nonjudging and acting with awareness), self-related processes (e.g., self-compassion), cognitive-control processes (e.g., decentering and attentional control), and interpersonal factors (e.g., attachment and rejection sensitivity). Behavioral outcomes such as nonsuicidal self-injury, aggression, and treatment dropout were also associated with these processes. The findings suggest that these candidate processes may operate as interconnected pathways rather than as isolated variables. The literature suggests that studies examining the relationship between mindfulness and borderline personality disorder symptoms, including both direct associations and studies assessing potential psychological processes. However, existing studies remain fragmented and typically examine single pathways in isolation. This review provides a structured synthesis of these potential processes within a coherent conceptual framework, while highlighting the need for further longitudinal and process-focused research before firm mechanistic conclusions can be drawn. Not applicable.
Comparable studies
Other systematic reviews and meta-analyses on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Meditation Programs for Psychological Stress and Well-being Diverse adult clinical populations | 2014 | Meta-analysis | n = 3,515 |
| Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis Healthy subjects | 2009 | Systematic review and meta-analysis | |
| The psychological effects of meditation: A meta-analysis. Nonclinical groups of adult meditators | 2012 | Meta-analysis | n = 163 |
| Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse Adults with recurrent depression in full or partial remission | 2016 | Meta-analysis of individual patient data from randomized controlled trials | n = 1,258 |
| Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy – a systematic review of randomized controlled trials | 2011 | Systematic review |
Citations in the library
Cites 7
- How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective Perspectives on Psychological Science October 14, 2011
- Ayahuasca improves emotion dysregulation in a community sample and in individuals with borderline-like traits Psychopharmacology November 7, 2018
- The Relationship Between Feelings of Emptiness and Self-Harm Among Thai Patients Exhibiting Borderline Personality Disorder Symptoms: The Mediating Role of the Inner Strengths. Medicina (Kaunas, Lithuania) October 30, 2024
- Target validation in dialectical behavior therapy skills group: Emotion regulation, mindfulness, and distress tolerance as mediators of outcome Psychotherapy Research July 2, 2025
- The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training. Personality disorders May 1, 2020
and 2 more in the library