Training of Neural Responding in BPD
Condition: Borderline Personality Disorder
MeSH terms: Personality Disorders; Borderline Personality Disorder
Study type: Interventional

Summary: 
      Emotion-related brain activation is made visible for patients via neurofeedback with the aim
      to improve discriminability of emotional arousal and emotion regulation. With functional
      magnetic resonance imaging (fMRI), information of current brain activation is imaged and fed
      back to the patient via a visual display. Patients with borderline personality disorder (BPD)
      usually hyper-activate brain regions associated with emotion. In this study, BPD patients
      will be provided with neurofeedback from the amygdala, which is crucial for the processing of
      emotions. The aim of the study is to observe, whether amygdala-neurofeedback would help BPD
      patients to improve emotion regulation. Compared to a control condition, improved brain
      self-regulation and emotion regulation is expected with three neurofeedback training
      sessions.
    

Detailed description: 
      Patients with BPD show increased emotional reactivity, slow return to baseline, and severe
      emotion dysregulation symptoms. On the neural level, BPD patients hyper-activate the amygdala
      and hypo-activate the prefrontal cortex in response to emotional stimuli. The prefrontal
      cortex and the amygdala are crucial nodes of the brain's emotion regulation network and thus
      it is assumed, that dysregulation within this network is key to BPD symptoms. Psychotherapy
      treatments specialized for BPD teach patients to monitor emotional arousal and to develop
      emotion regulation skills. However in the long run and despite of important therapeutic
      advances, the majority of BPD patients keep reporting significant impairments in functioning
      after psychotherapy.

      To explore new types of therapy in BPD, the investigators have applied real-time fMRI
      neurofeedback, where patients are provided with their brain activation via a visual display.
      In previous work they found that BPD patients and healthy participants can down-regulate
      amygdala activation with real-time fMRI neurofeedback, and increase connectivity between the
      amygdala and the prefrontal cortex. Yet, we do not yet fully understand the potential effects
      of amygdala neurofeedback on emotion.

      BPD patients (n=25) participate in a three-session fMRI neurofeedback training with 2-7 days
      between sessions (within 2 weeks). The effect of the training will be measured before and
      after training. Primarily, the investigators expect an improvement in emotion regulation,
      secondarily, reductions in BPD symptoms are expected.

      Hypotheses:

      With fMRI neurofeedback, BPD patients improve significantly in self-report and
      psychophysiological measures of emotion regulation with fMRI neurofeedback training. BPD
      patients show significantly reduced symptom severity in self-report measures with
      neurofeedback training.
    

Intervention name(s): Neurofeedback; MRI
Intervention type(s): Behavioral; Device
Intervention description(s): The Blood Oxygenation Level Dependent (BOLD) signal from the amygdala, recorded with functional magnetic resonance imaging, is utilized as a feedback signal to patients.; Echo-planar Imaging of brain BOLD signal
Other intervention name(s): real-time fMRI Neurofeedback; Magnetic Resonance Imaging
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science