Changes in the Brain as Borderline Patients Learn to Regulate Their Emotions
Condition: Borderline Personality Disorders; Avoidant Personality Disorders
MeSH terms: Personality Disorders; Borderline Personality Disorder
Study type: Interventional

Summary: 
      Borderline Personality Disorder (BPD), a prevalent psychiatric disorder found in
      approximately 2% to 6% of the population and 20% of hospitalized psychiatric patients, has
      proven quite treatment resistant. This study is designed to determine whether patients with
      BPD can be trained to improve their ability to regulate their emotions and whether this leads
      to changes in how their brans regulate emotion.
    

Detailed description: 
      Borderline Personality Disorder (BPD) is a common psychiatric disorder found in approximately
      2% to 6% of the population . It is characterized by intense and rapid mood changes,
      self-destructive behavior, suicidality, and tumultuous relationships. In additional to the
      emotional costs of the suffering experienced by borderline patients and their loved ones, BPD
      patients typically function at a level substantially below that of individuals with
      comparable intellect. The difficulty controlling emotion, so central to the disorder, has
      proved a particularly difficult to treat. The present study utilizes the latest neuroimaging
      findings in BPD to generate new ideas for the psychotherapy of the disorder.

      This project builds upon our previous neuroimaging work, which has shown that when BPD
      patients try to control their emotions by employing a method that healthy people frequently
      use quite effectively -- taking an emotional distance from what is upsetting - BPD patients
      are not able to quiet down the part of their brain that sends out emotional alarm signals.
      The objective of the present study is to determine whether giving BPD patients special
      training in using this healthy distancing strategy can help them to improve their ability to
      regulate their emotions and return their brain activity to a more normal pattern. The
      investigators will do this by using fMRI to record brain activity as BPD subjects try to use
      distancing to reduce their emotional reactions to upsetting pictures before any training,
      then to have them receive specific training in the distancing strategy. After this training
      we will again obtain an fMRI scan to determine whether their pattern of brain activation has
      normalized and whether they have been able to better reduce their negative reactions to the
      pictures. If this is effective, it will show that such training may help BPD patients better
      regulate their emotions and would support a program to further develop and incorporate
      distancing training into the psychotherapy of BPD patients.

      A second objective of the present study is to determine whether the tendency of BPD patients
      to become increasingly sensitized to negative situations when they are re-experienced (as
      shown by increased activity of the brain's emotional alarm system), will reduce with
      additional exposure, as it does in patients with phobias, or will continue to increase.
      Knowing this can help the therapist plan how to most therapeutically approach disturbing life
      experiences in the psychotherapy of BPD patients.

      This project represents an important step in brain imaging research since it applies
      information learned about brain activity patterns to develop new approaches to psychotherapy.
      It addresses a serious, prevalent and difficult to treat disorder.
    

Intervention name(s): Reappraisal Training
Intervention type(s): Behavioral
Other intervention name(s): Emotion Regulation Training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Basic Science
Keywords: Borderline Personality Disorder; Avoidant Personality Disorder; Brain Imaging