Poster No:
731
Submission Type:
Abstract Submission
Authors:
Miroslava Jindrova1, Christian Schmahl1, Christian Paret1
Institutions:
1Central Institute for Mental Health, Mannheim, Germany
First Author:
Co-Author(s):
Introduction:
Borderline Personality Disorder (BPD) patients show hyper-response of the amygdala to emotional stimuli and decreased habituation. Moreover, the hyper-reactivity of the amygdala is linked to decreased activity in the dorsolateral prefrontal cortex. This is strongly implicated with emotion dysregulation as one of the key symptoms of BPD, causing individual suffering and leading to social turbulence. Dialectical Behavioral Therapy (DBT) is an evidence-based treatment leading to reduced amygdala activity and enhanced fronto-limbic connectivity. However, more than half of BPD patients do not respond. Real-time fMRI amygdala-neurofeedback (amy-NF) targets the amygdala-hyperactivity and weak top-down control of the amygdala by the prefrontal cortex. During amy-NF, patients learn to voluntarily decrease amygdala activation in response to real-time visual feedback when viewing affective stimuli. This study investigated if amy-NF can augment the effects of DBT in people with BPD. Outcome measures included affective instability in daily life, amygdala reactivity, and self-reported BPD symptomatology.
Methods:
Patients demonstrating ongoing high levels of BPD symptomatology after six weeks of DBT were invited to participate in the study with random assignment to either neurofeedback (N=23) or treatment as usual (N=13). fMRI amy-NF training involved three sessions scheduled in a two-week period. Outcomes are measured before the intervention, immediately after the intervention, and at 3 and 6-month follow-up timepoints. At the first three timepoints, affective instability was monitored using Ecological Momentary Assessment over 4 days in hourly intervals. Affect instability was investigated by calculating the mean square successive difference. Amygdala reactivity was assessed using an established fMRI task. BPD symptoms were assessed using the BSL-23 and other self-report questionnaires at all four timepoints. The change in outcome measures was compared between the two groups. N=12 dropped out before the second timepoint and were thus excluded from the subsequent analysis. Drop-outs were mostly caused by therapy discontinuation. The final sample size was N=15 in the neurofeedback group and N=9 in the treatment as usual. The trial is registered at clinicaltrials.gov (NCT04333888).
Results:
The mean negative affect decreased with time in both groups. We observed a significant time effect, F (1.61, 30.54) = 8.94, p < 0.01, but no significant group or group x time interaction effect. No significant differences between the groups were observed in the mean positive affect and the instability of positive and negative affect. Decrease in amygdala reactivity was observed in both groups with more stable effect in the neurofeedback group at the 3-month follow-up. However, none of these effects were significant, F (2, 30) = 0.49, p > 0.05. BPD symptomatology measured by BSL-23 showed reduced problems after the therapy in both groups. However, the symptoms increased at the 3-month and 6-month follow-ups, and no effect of neurofeedback was observed. The time effect was significant, F (2.17, 28.15) = 11.92, p < 0.001.
Conclusions:
This study couldn't prove neurofeedback to be an effective booster for BPD therapy. This was mainly caused by a small sample size and insufficient statistical power to uncover moderate or small effects. Future studies should be planned with sufficient time and financial support to enable reaching the recruitment goals. The results confirm the current knowledge that DBT is an effective treatment for BPD, but also indicate the need to strenghten the retention of the effects after the therapy.
Emotion, Motivation and Social Neuroscience:
Emotional Learning 1
Emotional Perception
Learning and Memory:
Neural Plasticity and Recovery of Function 2
Skill Learning
Modeling and Analysis Methods:
Activation (eg. BOLD task-fMRI)
Keywords:
Affective Disorders
Electroencephaolography (EEG)
Emotions
Experimental Design
Learning
MRI
Psychiatric
Therapy
Other - Neurofeedback
1|2Indicates the priority used for review
Provide references using author date format
Schulze, L. et al. (2016), 'Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis', Biological Psychiatry 79, 97–106
Goodman, M. et al. (2014), 'Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder', Journal of Psychiatric Research, 57, 108–116
Paret, C. et al. (2016), 'Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients', Social Cognitive and Affective Neuroscience, 11, 952–960