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This commentary gives an overview of two types of interaction between neuroscience and psychotherapy in BPD and beyond. First, neuroscientific research, particularly neuroimaging, can be used to better understand the mechanisms how successful psychotherapy exerts its effects. Since emotion dysregulation is one of the core features of BPD and the main target of Dialectical Behavior Therapy (DBT), neuroimaging studies have investigated emotional hyperreactivity and dysfunctional regulation before and after DBT. These studies found normalization of limbic hyper-reactivity as well as a decrease of dysfunctional pain-induced emotion regulation, which is assumed to underly self-injurious behavior. A second line of research tries to use neuroimaging in the development of new therapeutic approaches such as real-time fMRI neurofeedback. Preliminary studies revealed rapid normalization of amygdala hyperreactivity and restoration of the connectivity between amygdala and medial prefrontal cortex. This was accompanied by reductions of BPD symptomatology, affective instability, and startle response. With these new approaches, there is hope to better understand mechanisms of change in BPD treatment as well as to develop innovative therapy approaches for severe emotion dysregulation.
Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress.
Investigation of neurobiological mechanisms of NSSI in borderline personality disorder
In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed.
We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group.
Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension.
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