A fundamental aspect of Borderline Personality Disorder (BPD) is emotional dysregulation. Dialectic Behavior Therapy (DBT) is a widely used therapy program developed specifically for improving emotion regulation in BPD.

To date little is known about the neural mechanisms associated with the amelioration of BPD symptoms after DBT.

In the present study we investigated pre-post therapy changes in a) brain activity during cognitive reappraisal, one commonly acquired skill during DBT and b) brain gray matter volume attributable to successful participation in a DBT skills training.

Before and after a 12-week in-patient DBT treatment program 22 female BPD patients and 22 healthy control subjects participated in two fMRI sessions of a well-established emotion reappraisal paradigm. Using voxel-based morphometry (VBM) changes in gray matter volume were analysed. Pre-post therapy changes were compared between the group of DBT-Responders (n=12) and DBT-Non-Responders (n=10).

After participating in a DBT skills training, DBT responders exhibited a reduced activity in vlPFC compared to the first scanning session and to DBT non-responders during reappraisal of aversive stimuli. The reduction in vlPFC activity correlated significantly with symptom improvement after therapy. After therapy DBT-Responders showed a significant higher gray matter volume in an extended cluster comprising anterior insula, caudate nucleus, and putamen.

In the current study, we provide evidence that a successful participation in DBT is associated with altered activity in the vlPFC and changes in gray matter concentration in anterior insula and striatum.