Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder
Section snippets
Objectives of the study
The effects of psychotherapy are thought to be mediated by changes in the cerebral networks. In major depression, increases in posterior cingulate and basal ganglia resting activity were found during interpersonal therapy (Martin et al., 2001), while another PET study suggested increased metabolism in hippocampus and caudal anterior cingulate cortex combined with decreased metabolism in frontal areas following cognitive-behavior therapy (Goldapple et al., 2004). Successful cognitive-behavior
Sample
The study included six right-handed, medication-free female patients (age: M = 23.7, SD = 4.8; HAWI-IQ: 116, SD = 14.3) diagnosed for BPD DSM-IV criteria. They had all been recruited from a specialized DBT in-patient treatment facility for BPD at RWTH Aachen University. The BPD diagnosis was assessed by a trained psychologist using a structured interview for personality disorders, the International Personality Disorder Examination (IPDE). To secure a homogeneous group of affectively unstable BPD
Differences in the pattern of BOLD responses for a priori categorized high arousal stimuli between patients and controls before (t2) and after (t5) DBT-treatment
Altogether the differences between patients and controls were greater before DBT-treatment than after treatment (Fig. 3 and Table 1). Prior to DBT-treatment (t2) BPD-patients displayed greater activation mainly in dorsolateral and dorsomedial frontal areas of both hemispheres – including the left caudal anterior cingulate gyrus – and in the left superior temporal gyrus (Table 1). The comparison of patients and controls after DBT-treatment revealed fewer areas of increased activation in patients
Discussion
This is the first study examining neural changes in BPD patients under dialectic-behavioral-therapy. The method of multiple repeated measures appears to be suitable for fMRI studies of neurofunctional changes under psychotherapy, even in a pilot study that was subject to restricted statistical power as a result of the large number of repeated measures applied to a small number of subjects.
Our study of the neurofunctional effects of DBT treatment in six female BPD individuals identified changes
Acknowledgements
We wish to thank T. Winters, K. Willmes, R. Schnitker, J. Weber, A. Thron and the Interdisciplinary Center for CNS Research at RWTH Aachen University for support in neuroimaging; A. Ansmann for the diagnostic assessment of participating subjects; B. Winter for offering DBT treatment; and Y. von Cramon from the Cognitive Neurology Section at the Max Planck Institute for Cognitive- and Neuroscience for valuable advice on design development.
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