Borderline personality disorder and emotion dysregulation · 2025
Emotion-focused vs. cognitive interventions of schema therapy for borderline personality disorder: effects on neural emotion regulation networks - study protocol.
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Smesny Stefan, Langbein Kerstin, Krylova Marina, Li Meng, Izyurov Igor, Gussew Alexander, Güllmar Daniel, Walter Martin, Wagner Gerd, Reichenbach Jürgen R
Аннотация
BACKGROUND: While the effects of psychotherapy methods are being intensively researched, little is known about the clinical and neurobiological effects of specific psychotherapeutic interventions. This study examines the effects of experiential emotion-focused and cognitive interventions in schema therapy on emotion regulation in borderline personality disorder.
METHODS: In a randomized, single-blinded, parallel group design, clinical effects and effects on resting-state functional connectivity in neural emotion regulation networks and neurotransmitter metabolism (Glx/GABA) in key regions of these networks are compared. The 9-week treatment protocol includes emotion-focused interventions such as chair dialogues, imagery rescripting, or mode role-playing in the test condition; these interventions are omitted in the active control condition (dismantling design). Resting-state functional MR imaging (rsfMRI) and MEGA-sLASER 1 H MR spectroscopy in the pregenual cingulate cortex (pgACC), anteromedial cingulate cortex (aMCC), and dorsolateral prefrontal cortex (DLPFC) are performed before and after the therapy interval and 6 months after the end of therapy and compared with the neurobiological parameters of healthy control subjects. The clinical effects are recorded using a comprehensive test battery and specified using the Reliable Change Index (RCI). Clinical and biological data are examined using mixed model analysis both longitudinally and in terms of their interactions.
DISCUSSION: The aim is to show that different psychotherapeutic interventions have different effects on deficits in emotion regulation associated with specific effects on neural emotion regulation networks. This would contribute to a better understanding of the neurobiological effects and mechanisms underlying psychotherapeutic core interventions and to their more targeted use in BPD and other related disorders in the future.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06367907, Retrospectively registered, April 2024.
METHODS: In a randomized, single-blinded, parallel group design, clinical effects and effects on resting-state functional connectivity in neural emotion regulation networks and neurotransmitter metabolism (Glx/GABA) in key regions of these networks are compared. The 9-week treatment protocol includes emotion-focused interventions such as chair dialogues, imagery rescripting, or mode role-playing in the test condition; these interventions are omitted in the active control condition (dismantling design). Resting-state functional MR imaging (rsfMRI) and MEGA-sLASER 1 H MR spectroscopy in the pregenual cingulate cortex (pgACC), anteromedial cingulate cortex (aMCC), and dorsolateral prefrontal cortex (DLPFC) are performed before and after the therapy interval and 6 months after the end of therapy and compared with the neurobiological parameters of healthy control subjects. The clinical effects are recorded using a comprehensive test battery and specified using the Reliable Change Index (RCI). Clinical and biological data are examined using mixed model analysis both longitudinally and in terms of their interactions.
DISCUSSION: The aim is to show that different psychotherapeutic interventions have different effects on deficits in emotion regulation associated with specific effects on neural emotion regulation networks. This would contribute to a better understanding of the neurobiological effects and mechanisms underlying psychotherapeutic core interventions and to their more targeted use in BPD and other related disorders in the future.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06367907, Retrospectively registered, April 2024.