Social Integration During Psychiatric Inpatient Therapy as Predictor of Treatment Response
Condition: Borderline Personality Disorder (BPD)
MeSH terms: Personality Disorders; Borderline Personality Disorder
Study type: Observational

Summary: 
      The present longitudinal study aims at (i) identifying neurobiological mechanisms associated
      with successful social integration during the treatment of inpatients with Borderline
      Personality Disorder (BPD) and (ii) improving biomarker-based predictions of treatment
      response by incorporating core metrics of social integration.
    

Detailed description: 
      Social connections have a strong impact on mental and physical health. Surprisingly, however,
      there is a paucity of studies probing the predictive validity of perceived social connections
      such as subjective social support and loneliness for the outcomes of inpatient treatment of
      BPD. Although social impairments are key features of BPD psychopathology, social integration
      has been largely neglected, which may therefore explain the minimal translation of predictive
      molecular or imaging-based biomarkers into the clinic. The investigators hypothesize that the
      assessment of negative cognitive biases at baseline will help to identify BPD patients who
      will experience less social support and more loneliness during inpatient treatment.
      Furthermore, an inclusion of social integration indices may increase the incremental validity
      for the biomarker-based prediction of treatment response.

      In this longitudinal, observational study, data from 56 BPD patients will be analyzed to
      assess negative cognitive biases and the underlying neurobiological mechanisms with
      behavioral, neuroendocrine, psychophysiological, and neural readouts before and after one
      month of inpatient Dialectical Behavior Therapy (DBT). To evaluate pathological biases, the
      patients' data will be compared with a control group of 31 healthy participants who will also
      be tested twice. Neural readouts include structural and functional magnetic resonance imaging
      (fMRI) measurements. The fMRI tasks will probe the processing of social touch, interpersonal
      trust, and interoception. To further investigate pathological distortions of social touch and
      interoception, interoceptive accuracy and comfort zones of social touch will be assessed.
      Further, patients and healthy participants will perform a positive social interaction task,
      accompanied by psychophysiological and neuroendocrinological measures. Psychometric
      questionnaires and semi-structured interviews will be used to monitor symptom load and social
      indices before, during, and after the inpatient treatment. Long-term effects will be assessed
      by questionnaires and interviews 8 and 20 weeks after inpatient treatment/waiting time, as
      well as after each DBT module (follow-ups). The investigators plan to conduct uni- and
      multivariate analyses of the baseline measurements to predict patients' social integration
      and treatment response during the inpatient therapy and examine treatment-related changes.
      The findings of this project may help identify vulnerable patients that benefit from adjunct
      therapies targeting negative social biases and improve biomarker-based models of treatment
      prediction.
    

Intervention name(s): Dialectical Behavior Therapy (DBT)
Intervention type(s): Behavioral
Intervention description(s): Evidence-based psychotherapy for the treatment of Borderline Personality Disorder
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Group 1: BPD patients are recruited from a waiting list for DBT inpatient treatment and
        directly during inpatient treatment at the University Clinic for Psychiatry and
        Psychotherapy, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany.

        Group 2: Healthy participants are recruited via the notice board of the University of
        Oldenburg, and, in order to achieve a more heterogenous sample, via online advertisments
      
Biospecimen description: 
      Saliva samples to measure cortisol, oxytocin and alpha-amylase.
    
Keywords: social integration; Borderline Personality Disorder; treatment response; psychiatric inpatient treatment; fMRI; negative social bias; social touch; interoception; trust; Dialectical Behavior Therapy