Neural Mechanisms of Dialectical Behavioral Therapy in Patients with Borderline Personality Disorder

Masarykova Univerzita106 enrolled

Overview

This research examines the behavioral and neural mechanisms of dialectical behavior therapy (DBT) effect in patients with borderline personality disorder (BPD).

This project aims to evaluate the behavioral and neural mechanisms of dialectical behavior therapy (DBT) effect in patients with borderline personality disorder (BPD). The project includes three subject groups: patients with BPD undergoing the DBT program (BPD-DBT), control patients with BPD on the waiting list for the program (BPD-control), and healthy controls (HC). Patients in the BPD-DBT group undergo a 24-week DBT program in an outpatient setting. All participants undergo a test battery comprising of self-report measures, clinical evaluation and fMRI and EEG measurement in the week before the DBT program beginning (T1), after 24 weeks (follow-up, T3), and at 24 weeks after T3 (follow-up, T4). The BPD-DBT group undergoes another assessment at T2 (after 12 weeks) to monitor selected symptoms during the DBT program by a short set of questionnaires.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

106

Conditions

Borderline Personality Disorder

Interventions

Dialectical behavior therapyBEHAVIORAL

A complex psychotherapy program for patients with borderline personality disorder.

Eligibility

Sex: ALLMin age: 16 YearsHealthy volunteers:

Medical Language ↔ Plain English

BPD-DBT group: Inclusion Criteria: * diagnosis of borderline personality disorder according to Diagnostic and Statistical Manual 5th Edition (DSM-5) criteria (rated by Structured Clinical Interview for DSM-5 for Personality Disorders, BPD section) * minimum age 16, informed consent of the patient * informed consent of patient's legal representative in case of patients under age 18 * more than one self-injury incident and/or suicidal attempt in the past six months Exclusion Criteria: * neurological disorder * comorbid affective disorder or schizophrenia-related disorder * intelligence quotient\<70 * contraindications for MRI measurement * pregnancy * body mass index under 15 BPD-C group: Inclusion Criteria: * diagnosis of borderline personality disorder according to Diagnostic and Statistical Manual 5th Edition (DSM-5) criteria (rated by Structured Clinical Interview for DSM-5 for Personality Disorders, BPD section) * minimum age 16, informed consent of the patient * informed consent of patient's legal representative in case of patients under age 18 * more than one self-injury incident and/or suicidal attempt in the past six months Exclusion Criteria: * completing a DBT program or attending DBT-based therapy * neurological disorder * comorbid affective disorder or schizophrenia-related disorder * intelligence quotient\<70 * contraindications for MRI measurement * pregnancy * body mass index under 15 HC group: Inclusion criteria: * minimum age 16, informed consent of the patient * informed consent of patient's legal representative in case of patients under age 18 Exclusion criteria: * mental health problems * history of self-injury or/and suicidal attempt * neurological disorder * intelligence quotient\<70 * contraindications for MRI measurement * pregnancy * body mass index under 15

Locations (1)

University Hospital Brno and Faculty of Medicine, Masaryk University

Brno, Czech Republic, Czechia

Outcomes

Primary Outcomes

Decrease of borderline symptoms

significant decrease of symptoms measured by Borderline Symptoms List-23

Time frame: From baseline (T1), a second assessment takes place after 12 weeks (T2), the third assessment takes place 12 weeks after T2 (T3), and the fourth assessment takes place 24 weeks after T3 (T4).

Decrease of self-injury incidents and suicidal attempts

significant decrease of self-injury incidents and suicidal attempts assessed by semi-structured interview Lifetime - Suicide Attempt Self-Injury Count

Time frame: From baseline (T1), the third assessment takes place 24 weeks after T1 (T3), and the fourth assessment takes place 24 weeks after T3 (T4). The second assessment (T2) is not included in this outcome measure.

Secondary Outcomes

Decrease in the number of days spent in the hospital

significant decrease of days spent in the hospital assessed by semi-structured interview -Treatment History Interview

Ecological momentary assessment of emotional variability

EMA assesses respondents' emotions in their natural environment. They complete short questionnaires every hour from 9 AM to 9 PM for two days. First, they rate their ability to identify their current emotion (0-100). Then, they choose an emotion or select "An emotion I cannot name" / "No emotion." Next, they rate its intensity (0-100). Finally, they rate their control over the emotion and how overwhelming it feels (both 0-100).

Data from ClinicalTrials.gov

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Increase in reasons for living

significant increase in reasons for living measured by Brief Reasons for Living Inventory 10

Decrease of impulsivity

significant decrease of impulsivity measured by UPPS-P questionnaire

Increase of mindfulness

sifnigicant increase of mindfulness measured by Five Facet Mindfulness Questionnaire

Decrease of rejection sensitivity

significant decrease of rejection sensitivity measured by Rejection Sensitivity RS-Adult questionnaire

Decrease of dissociation symptoms

significant decrease of dissociation symptoms measured by Multiscale Dissociation Inventory

Decrease of anxiety

significant decrease of anxiety symptoms measured by Beck Anxiety Inventory

Decrease of depression ranking

significant decrease of depression symptoms measured by Beck Depression Inventory II, and MADRS clinical rating

Increase of emotion regulation

significant increase of emotion regulation measured by Difficulties in emotion regulation scale, and ecological momentary assessment

Changes in fMRI neural activity during "Faces task"

Significant changes in fMRI neural activity during the "Faces task". During the task, participants view images of faces expressing negative emotions or scrambled versions of the same images as a neutral control. The task is presented in pseudorandomized blocks, with each face displayed for a fixed duration. To maintain attention, participants respond based on the basis of face gender or frame color.

Changes in fMRI neural activity during fMRI neurofeedback

fMRI neurofeedback is used to measure changes in fMRI neural activity. During fMRI neurofeedback, patients try to regulate their emotions according to the direction of the arrows (up or down). They receive feedback on how well they are regulating their emotions through a colour scale.

Changes in fMRI neural activity during Cyberball task

The Cyberball task is used to measure changes in fMRI neural activity. Participants play a virtual ball-tossing game, believing they are interacting with two other players, though the game is pre-programmed. They control a hand on the screen to pass the ball, while the co-players are represented by animated figures with names and photographs to enhance ecological validity. There are three conditions: inclusion, exclusion, and overinclusion.

Changes in frontal asymmetry during social exclusion measured by EEG

EEG is used to assess changes in frontal asymmetry during Cyberball task in fMRI. Frontal asymmetry: EEG alpha power localized in frontal scalp electrodes and differences between left and right hemisphere.

Changes in ECG during fMRI

The Brain Products EEG/ExG system is used to assess heart rate variability. Heart rate variability: Mean R-R interval and standard deviation of R-R intervals evaluated in whole fMRI measurement in standard heart beats removing abnormal beats. R peaks detection performed in one channel recording localized on the chest.

Changes in skin conductance during fMRI

The Brain Products EEG/ExG system is used to assess changes in skin conductance and monitor the participant's emotional state during the experimental measurement.