Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder.
OBJECTIVE
Borderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-focused psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aimed to investigate neural activation associated with, and predictive of, clinical improvement in emotional and behavioral regulation in BPD following TFP.


METHODS
BPD subjects (n = 10) were scanned pre- and post-TFP treatment using a within-subjects design. A disorder-specific emotional-linguistic go/no-go functional magnetic resonance imaging paradigm was used to probe the interaction between negative emotional processing and inhibitory control.


RESULTS
Analyses demonstrated significant treatment-related effects with relative increased dorsal prefrontal (dorsal anterior cingulate, dorsolateral prefrontal, and frontopolar cortices) activation, and relative decreased ventrolateral prefrontal cortex and hippocampal activation following treatment. Clinical improvement in constraint correlated positively with relative increased left dorsal anterior cingulate cortex activation. Clinical improvement in affective lability correlated positively with left posterior-medial orbitofrontal cortex/ventral striatum activation, and negatively with right amygdala/parahippocampal activation. Post-treatment improvements in constraint were predicted by pre-treatment right dorsal anterior cingulate cortex hypoactivation, and pre-treatment left posterior-medial orbitofrontal cortex/ventral striatum hypoactivation predicted improvements in affective lability.


CONCLUSIONS
These preliminary findings demonstrate potential TFP-associated alterations in frontolimbic circuitry and begin to identify neural mechanisms associated with a psychodynamically oriented psychotherapy.
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.
David L
DL
Perez
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.
David R
DR
Vago
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.|Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, USA.
Hong
H
Pan
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA.
James
J
Root
Department of Neurology, University Medical Center Freiburg, Freiburg im Breisgau, Germany.|Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
Oliver
O
Tuescher
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.
Benjamin H
BH
Fuchs
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.
Lorene
L
Leung
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.
Jane
J
Epstein
Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA.
Nicole M
NM
Cain
Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA.
John F
JF
Clarkin
Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA.|Department of Psychology, The State University of New York at Binghamton, Binghamton, USA.
Mark F
MF
Lenzenweger
Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA.
Otto F
OF
Kernberg
Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA.
Kenneth N
KN
Levy
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.|Department of Neurology, Brigham and Women's Hospital, Boston, USA.
David A
DA
Silbersweig
Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.|Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, USA.
Emily
E
Stern
D000328:Adult; D001883:Borderline Personality Disorder / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D001921:Brain / Q000502:physiology*; D004644:Emotions; D005260:Female; D006801:Humans; D007266:Inhibition, Psychological; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011613:Psychotherapy; D055815:Young Adult
anterior cingulate cortex; borderline personality disorder; functional magnetic resonance imaging; orbitofrontal cortex; transference-focused psychotherapy