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Neural correlates of distraction in borderline personality disorder before and after dialectical behavior therapy

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Abstract

Neural underpinnings of emotion dysregulation in borderline personality disorder (BPD) are characterized by limbic hyperactivity and disturbed prefrontal activity. It is unknown whether neural correlates of emotion regulation change after a psychotherapy which has the goal to improve emotion dysregulation in BPD, such as dialectical behavioral therapy (DBT). We investigated distraction as a main emotion regulation strategy before and after DBT in female patients with BPD. Thirty-one BPD patients were instructed to either passively view or memorize letters before being confronted with negative or neutral pictures in a distraction task during functional magnetic resonance imaging. This paradigm was applied before and after a 12-week residential DBT-based treatment program. We compared the DBT group to 15 BPD control patients, who continued their usual, non-DBT-based treatment or did not have any treatment, and 22 healthy participants. Behaviorally, BPD groups and healthy participants did not differ significantly with respect to alterations over time. On the neural level, BPD patients who received DBT-based treatment showed an activity decrease in the right inferior parietal lobe/supramarginal gyrus during distraction from negative rather than neutral stimuli when compared to both control groups. This decrease was correlated with improvement in self-reported borderline symptom severity. DBT responders exhibited decreased right perigenual anterior cingulate activity when viewing negative (rather than neutral) pictures. In conclusion, our findings reveal changes in neural activity associated with distraction during emotion processing after DBT in patients with BPD. These changes point to lower emotional susceptibility during distraction after BPD symptom improvement.

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Acknowledgments

We thank Indre Ciurlyte, Michael Rieß, Claudia Stief, and Miriam Weiß for their help with data collection and for supporting the MRI measurements. This work was funded by the German Research Foundation (C.S., SCHM 1526/8-2; S.C.H., HE 2660/7-2).

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    1. Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany

      Dorina Winter, Inga Niedtfeld & Christian Schmahl

    2. Department of General Psychiatry, Medical Faculty Heidelberg/Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany

      Ruth Schmitt & Sabine C. Herpertz

    3. Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany

      Martin Bohus

    4. Faculty of Health, University of Antwerp, Antwerp, Belgium

      Martin Bohus

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    The authors assert that all procedures contributing to this work comply with the ethical standard of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The Research Ethics Board II of the University of Heidelberg, Germany, approved the study. All participants were informed about the study procedures and gave written informed consent (capacity assessed via clinical interview). We registered the study as clinical trial (DRKS-ID = DRKS00000778).

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    Christian Schmahl and Sabine C. Herpertz have contributed equally to this work.

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    Winter, D., Niedtfeld, I., Schmitt, R. et al. Neural correlates of distraction in borderline personality disorder before and after dialectical behavior therapy. Eur Arch Psychiatry Clin Neurosci 267, 51–62 (2017). https://doi.org/10.1007/s00406-016-0689-2

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