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10b - Integrating Neuroscience and Psychotherapy: Commentary on Borderline Personality Disorder

from Part III - Individual Disorders and Clusters

Published online by Cambridge University Press:  24 February 2020

By
Inga Niedtfeld ,
Christian Paret  and
Christian Schmahl
Edited by
Carl W. Lejuez  and
Kim L. Gratz
Carl W. Lejuez
Affiliation:
University of Kansas
Kim L. Gratz
Affiliation:
University of Toledo, Ohio
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Summary

This commentary gives an overview of two types of interaction between neuroscience and psychotherapy in BPD and beyond. First, neuroscientific research, particularly neuroimaging, can be used to better understand the mechanisms how successful psychotherapy exerts its effects. Since emotion dysregulation is one of the core features of BPD and the main target of Dialectical Behavior Therapy (DBT), neuroimaging studies have investigated emotional hyperreactivity and dysfunctional regulation before and after DBT. These studies found normalization of limbic hyper-reactivity as well as a decrease of dysfunctional pain-induced emotion regulation, which is assumed to underly self-injurious behavior. A second line of research tries to use neuroimaging in the development of new therapeutic approaches such as real-time fMRI neurofeedback. Preliminary studies revealed rapid normalization of amygdala hyperreactivity and restoration of the connectivity between amygdala and medial prefrontal cortex. This was accompanied by reductions of BPD symptomatology, affective instability, and startle response. With these new approaches, there is hope to better understand mechanisms of change in BPD treatment as well as to develop innovative therapy approaches for severe emotion dysregulation.

Keywords

neuroimagingemotion regulationamygdalaprefrontal cortexreal-time fMRIneurofeedbackDialectical Behavior Therapy
Type
Chapter
Information
The Cambridge Handbook of Personality Disorders , pp. 246 - 248
Publisher: Cambridge University Press
Print publication year: 2020

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References

Brühl, A. B., Scherpiet, S., Sulzer, J., Stampfli, P., Seifritz, E., & Herwig, U. (2014). Real-time neurofeedback using functional MRI could improve down-regulation of amygdala activity during emotional stimulation: A proof-of-concept study. Brain Topography, 27(1), 138–148.CrossRefGoogle ScholarPubMed
Caria, A., Sitaram, R., Veit, R., Begliomini, C., & Birbaumer, N. (2010). Volitional control of anterior insula activity modulates the response to aversive stimuli: A real-time functional magnetic resonance imaging study. Biological Psychiatry, 68(5), 425–432.CrossRefGoogle ScholarPubMed
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495–510.Google Scholar
Dannlowski, U., Stuhrmann, A., Beutelmann, V., Zwanzger, P., Lenzen, T., Grotegerd, D., … Kugel, H. (2012). Limbic scars: Long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biological Psychiatry, 71(4), 286–293.CrossRefGoogle ScholarPubMed
deCharms, R. C., Maeda, F., Glover, G. H., Ludlow, D., Pauly, J. M., Soneji, D., … Mackey, S. C. (2005). Control over brain activation and pain learned by using real-time functional MRI. Proceedings of the National Academy of Sciences USA, 102(51), 18626–18631.CrossRefGoogle ScholarPubMed
Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. Lancet, 373(9657), 68–81.CrossRefGoogle ScholarPubMed
Goodman, M., Carpenter, D., Tang, C. Y., Goldstein, K. E., Avedon, J., Fernandez, N., … Hazlett, E. A. (2014). Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder. Journal of Psychiatric Research, 57, 108–116.Google Scholar
Hamilton, J. P., Glover, G. H., Hsu, J. J., Johnson, R. F., & Gotlib, I. H. (2011). Modulation of subgenual anterior cingulate cortex activity with real-time neurofeedback. Human Brain Mapping, 32(1), 22–31.Google Scholar
Johnston, S. J., Boehm, S. G., Healy, D., Goebel, R., & Linden, D. E. (2010). Neurofeedback: A promising tool for the self-regulation of emotion networks. NeuroImage, 49(1), 1066–1072.Google Scholar
Kramer, U., Kolly, S., Maillard, P., Pascual-Leone, A., Samson, A. C., Schmitt, R., … de Roten, Y. (2018). Change in emotional and theory of mind processing in borderline personality disorder: A pilot study. Journal of Nervous and Mental Disease, 206(12), 935–943.Google Scholar
Lawrence, E. J., Su, L., Barker, G. J., Medford, N., Dalton, J., Williams, S. C., … David, A. S. (2013). Self-regulation of the anterior insula: Reinforcement learning using real-time fMRI neurofeedback. NeuroImage, 88C, 113–124.Google Scholar
Linden, D. E. (2014). Neurofeedback and networks of depression. Dialogues in Clinical Neuroscience, 16(1), 103–112.Google Scholar
Linden, D. E., Habes, I., Johnston, S. J., Linden, S., Tatineni, R., Subramanian, L., … Goebel, R. (2012). Real-time self-regulation of emotion networks in patients with depression. PLoS ONE, 7(6), e38115.Google Scholar
Niedtfeld, I., Schmitt, R., Winter, D., Bohus, M., Schmahl, C., & Herpertz, S. C. (2017). Pain-mediated affect regulation is reduced after dialectical behavior therapy in borderline personality disorder: A longitudinal fMRI study. Social Cognitive and Affective Neuroscience, 12(5), 739–747.Google Scholar
Paret, C., Kluetsch, R., Ruf, M., Demirakca, T., Hoesterey, S., Ende, G., & Schmahl, C. (2014). Down-regulation of amygdala activation with real-time fMRI neurofeedback in a healthy female sample. Frontiers in Behavioral Neuroscience, 8, 299.CrossRefGoogle Scholar
Paret, C., Kluetsch, R., Zaehringer, J., Ruf, M., Demirakca, T., Bohus, M., … Schmahl, C. (2016). Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients. Social Cognitive and Affective Neuroscience, 11(6), 952–960.CrossRefGoogle ScholarPubMed
Paret, C., Ruf, M., Gerchen, M. F., Kluetsch, R., Demirakca, T., Jungkunz, M., … Ende, G. (2016). fMRI neurofeedback of amygdala response to aversive stimuli enhances prefrontal-limbic brain connectivity. NeuroImage, 125, 182–188.CrossRefGoogle ScholarPubMed
Ruiz, S., Birbaumer, N., & Sitaram, R. (2013). Abnormal neural connectivity in schizophrenia and fMRI-brain-computer interface as a potential therapeutic approach. Frontiers in Psychiatry, 4, 17.Google Scholar
Ruiz, S., Lee, S., Soekadar, S. R., Caria, A., Veit, R., Kircher, T., … Sitaram, R. (2013). Acquired self-control of insula cortex modulates emotion recognition and brain network connectivity in schizophrenia. Human Brain Mapping, 34(1), 200–212.Google Scholar
Scheinost, D., Stoica, T., Saksa, J., Papademetris, X., Constable, R. T., Pittenger, C., & Hampson, M. (2013). Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity. Translational Psychiatry, 3(4), e250.CrossRefGoogle ScholarPubMed
Schmitt, R., Winter, D., Niedtfeld, I., Schmahl, C., & Herpertz, S. C. (2016). Effects of psychotherapy on neuronal correlates of reappraisal in female patients with borderline personality disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. doi:10.1007/s00406-016-0689-2CrossRefGoogle Scholar
Schnell, K., & Herpertz, S. C. (2007). Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder. Journal of Psychiatric Research, 41(10), 837–847.Google Scholar
Sulzer, J., Sitaram, R., Blefari, M. L., Kollias, S., Birbaumer, N., Stephan, K. E., … Gassert, R. (2013). Neurofeedback-mediated self-regulation of the dopaminergic midbrain. NeuroImage, 83, 817–825.CrossRefGoogle ScholarPubMed
Veit, R., Singh, V., Sitaram, R., Caria, A., Rauss, K., & Birbaumer, N. (2012). Using real-time fMRI to learn voluntary regulation of the anterior insula in the presence of threat-related stimuli. Social Cognitive and Affective Neuroscience, 7(6), 623–634.CrossRefGoogle ScholarPubMed
Winter, D., Niedtfeld, I., Schmitt, R., Bohus, M., Schmahl, C., & Herpertz, S. C. (2017). Neural correlates of distraction in borderline personality disorder before and after dialectical behavior therapy. European Archives of Psychiatry and Clinical Neuroscience, 267(1), 51–62.Google Scholar
Young, K. D., Zotev, V., Phillips, R., Misaki, M., Yuan, H., Drevets, W. C., & Bodurka, J. (2014). Real-time fMRI neurofeedback training of amygdala activity in patients with major depressive disorder. PLoS ONE, 9(2), e88785.Google Scholar
Zaehringer, J., Ende, G., Santangelo, P., Kleindienst, N., Ruf, M., Bertsch, K., … Paret, C. (2019). Improved emotion regulation after neurofeedback: A single-arm trial in patients with borderline personality disorder. Retrieved from psyarxiv.com/wemfqCrossRefGoogle Scholar
Zilverstand, A., Sorger, B., Sarkheil, P., & Goebel, R. (2014). Towards therapy in the scanner: Enhancing fear regulation in spider phobia through fMRI neurofeedback. Paper presented at the Human Brain Mapping conference, Hamburg.Google Scholar
Zotev, V., Krueger, F., Phillips, R., Alvarez, R. P., Simmons, W. K., Bellgowan, P., … Bodurka, J. (2011). Self-regulation of amygdala activation using real-time FMRI neurofeedback. PLoS ONE, 6(9), e24522.Google Scholar

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