Effects of Psychotherapy on Neuronal Correlates of Reappraisal in Female Patients With Borderline Personality Disorder

Background: Emotion dysregulation is a fundamental aspect of borderline personality disorder (BPD). Accordingly, one major focus of dialectical behavior therapy (DBT) is to teach strategies to regulate emotional reactions. To date, little is known about the neural mechanisms linked to the amelioration of BPD symptoms after therapy. In the present study, we used functional magnetic resonance imaging to investigate neural correlates of explicit emotion regulation before and after DBT.

Methods: Female BPD patients (n = 32) performed a reappraisal task before and after a 12-week inpatient DBT program and were compared with 24 healthy control participants. Based on the change in symptom severity, the BPD group was separated into responders and nonresponders and compared with a clinical control group of 16 BPD patients. Both control groups were scanned twice within 12 weeks.

Results: After DBT, BPD patients showed decreased insula and anterior cingulate cortex activity during reappraisal. Anterior cingulate connectivity to medial and superior frontal gyrus, superior temporal gyrus, and inferior parietal cortices increased after DBT. Responders exhibited reduced activation in amygdala, anterior cingulate cortex, orbitofrontal, and dorsolateral prefrontal cortex together with increased connectivity within a limbic-prefrontal network during the reappraisal of negative stimuli after psychotherapy.

Conclusions: This study revealed reduced activity and increased connectivity in neural networks related to salience processing and emotion regulation after therapy. Attenuated limbic hyperarousal together with an elevated coupling between limbic and prefrontal and inferior parietal control regions in BPD patients after successful therapy may indicate more efficient emotion regulation during reappraisal of negative pictures.