Zusammenfassung
Hintergrund
Es existieren inzwischen mehrere wissenschaftlich evaluierte Psychotherapieverfahren für die Borderline-Persönlichkeitsstörung (BPS), die alle auf eine Verbesserung der Fähigkeit zur Emotionsregulation zielen. In den vergangenen Jahren wurden erste Studien zu den neuronalen Korrelaten von Mechanismen der Emotionsregulation sowie von durch psychotherapeutische Interventionen hervorgerufenen Veränderungen durchgeführt.
Methoden
Wir geben eine Übersicht über die Datenlage zu funktionellen und strukturellen Bildgebungsstudien, die Facetten der Emotionsregulationsstörung vor und nach Psychotherapie untersuchen.
Ergebnisse
Obwohl die Datenlage insgesamt noch dünn ist, scheint die klinische Besserung nach Psychotherapie mit einer Modulation von Hirnstruktur und -funktion einherzugehen. Insbesondere frontolimbische Regulationskreise einschließlich der Amygdala, der Insula, des anterioren zingulären Kortex (ACC) und andere präfrontale Bereiche scheinen in diese Veränderungen involviert zu sein scheinen. Ein wichtiger Befund ist die Reduktion der initial erhöhten Amygdalaaktivität nach erfolgreicher Dialektisch-Behavioraler Therapie (DBT).
Diskussion
Die gezeigten Veränderungen spiegeln sehr wahrscheinlich eine Verbesserung der Emotionsregulationsfähigkeiten bei der BPS wider und belegen die Möglichkeit der Modulation gestörter Emotionsregulationsprozesse. Da Langzeitverläufe bislang fehlen, muss die Nachhaltigkeit der sich andeutenden Verbesserungen in weiteren Studien noch nachgewiesen werden.
Abstract
Background
There are now several scientifically evaluated psychotherapeutic methods for borderline personality disorder (BPD), all of which aim to improve the ability to regulate emotions. In recent years, there have been first studies on the neuronal correlates of the mechanisms of emotion regulation and of changes caused by psychotherapeutic interventions.
Methods
This article reviews the data on functional and structural imaging studies that examine facets of disturbed emotion regulation before and after psychotherapy.
Results
Although the overall database is still sparse, clinical improvement in psychotherapy appears to be associated with modulation of brain structure and function. Frontolimbic regulation circuits including the amygdala, insula, anterior cingulate cortex (ACC) and other prefrontal areas appear to be involved in these changes. An important finding is the reduction of initially increased amygdala activity after successful Dialectical Behavior Therapy (DBT).
Conclusion
The changes shown here most probably reflect an improvement in emotion regulation capacities in BPD and demonstrate the possibility of modulating disturbed emotion regulation processes. Since long-term follow-up data are still missing, the sustainability of the suggestive improvements still has to be proven in further studies.
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C. Schmahl, I. Niedtfeld und S.C. Herpertz geben an, dass kein Interessenkonflikt besteht.
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Schmahl, C., Niedtfeld, I. & Herpertz, S.C. Borderline-Persönlichkeitsstörung. Nervenarzt 89, 1232–1236 (2018). https://doi.org/10.1007/s00115-018-0587-0
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DOI: https://doi.org/10.1007/s00115-018-0587-0