Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder.
BACKGROUND
Affective hyperarousal is the hallmark of borderline personality disorder (BPD) and the main target for dialectic-behavioral-therapy (DBT). This pilot study examined whether improved regulation of affective arousal following DBT translates into changes in relevant neural systems.


METHODS
We applied five sequential fMRI scans over a 12-week in-patient treatment program. Six female BPD patients and six controls were included in an event-related fMRI design which induced emotional arousal through standardized images. In addition to analyzing valence-based stimulus categories over time, the study assessed the modulation of hemodynamic responses through emotional arousal by means of parametric HRF modulation with self-ratings of stimulus dependent arousal.


RESULTS
BPD data revealed a decreasing hemodynamic response to negative stimuli in the right-sided anterior cingulate, temporal and posterior cingulate cortices as well as in the left insula. In addition, these areas displayed a continuous decrease in HRF modulation through individual arousal in BPD patients. Moreover the four DBT responders displayed reduction of HRF modulation in the left amygdala and both hippocampi.


CONCLUSIONS
fMRI designs that use multiple repeated measures are suitable for application in therapy research. In our pilot study DBT treatment was accompanied by neural changes in limbic and cortical regions resembling those reported on psychotherapy effects in other mental disorders.
Schnell
Knut
K
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
Herpertz
Sabine C
SC
D000328:Adult; D000339:Affect / Q000502:physiology*; D000679:Amygdala / Q000503:physiopathology; D001143:Arousal / Q000502:physiology*; D001521:Behavior Therapy / Q000379:methods*; D001883:Borderline Personality Disorder / Q000503:physiopathology / Q000628:therapy*; D001921:Brain / Q000503:physiopathology*; D003131:Combined Modality Therapy; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008032:Limbic System / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D010101:Oxygen Consumption / Q000502:physiology; D010364:Pattern Recognition, Visual / Q000502:physiology*; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000503:physiopathology; D011615:Psychotherapy, Group