132 Chapter 6 appointments, may be perceived as onerous. Staff are therefore reminded to compliment her regularly, even with seemingly trivial accomplishments. She best thrives when she experiences support that is clear and structured, because that makes her feel calm and secure. Before she lived in the care facility, during her childhood and teenage years, she experienced traumatic events that undoubtedly contributed to challenges she faces nowadays. She often perceives her life as a struggle, some days more than others. She mostly communicates her struggles calmly to others, but sometimes her tensions become explicit to her environment when she self-injures or is physically aggressive. According to her care professionals, her overall well-being is poorer on days when she shows these behaviors. Her care professionals have several hypotheses about factors contributing to her challenging behaviors. One is that she does not trust herself to be alone. The self-injuring and aggressive incidents are, at least sometimes, perceived as a call for reassuring attention from staff. Another hypothesis is that her challenging behaviors are a maladaptive emotion-regulation strategy. Unpleasant emotions can (sometimes unexpectedly) accumulate very rapidly. Over time, she has learned that she can immediately achieve short-term relief from this overwhelming emotional experience by self-injuring. Alternatively, difficulties regulating negative emotions are also considered a cause of aggressive behaviors. After self-injurious or aggressive incidents, staff need to ensure the participant’s and others’ safety, sometimes by imposing freedom restricting measures such as seclusion or fixation. Such drastic measures are resented by staff and the participant alike. She is highly motivated to change her challenging behavioral patterns, and therefore follows dialectical behavior therapy, which aims to increase her emotion regulatory abilities (Heard & Linehan, 2019). 2.2 Procedure and measures As part of dialectical behavior therapy, the participant completed daily selfregistrations via a mobile phone application. Hence, these EMA data were initially not collected for research purposes. The participant and her clinician formulated the application’s daily EMA questions together. Emotions, behaviors and cognitions with maximum relevance to her treatment goals and daily life were translated into questions that the app prompted automatically on her phone at 7:00 PM. Seven of those questions could be answered on a slider with six answer options that ranged between “not feeling at all” and “an intense feeling”. These questions inquired to what extend she (1) felt happy, (2) felt scared, (3) felt sad, (4) felt angry, (5) had the urge to self-injure, (6) thought of death, and (7) had the urge to be aggressive, on that particular day. She also self-rated with either a “yes” or “no” whether she, on
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