Cognitive Reappraisal Training for Borderline Personality Disorder

Overseen By Harold W Koenigsberg

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Icahn School of Medicine at Mount Sinai

Disqualifiers: Major depressive disorder, PTSD, Bipolar, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 14

Duration: 6 weeks

130 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new method to help people with Borderline Personality Disorder (BPD) manage their emotions. The focus is on teaching cognitive reappraisal by distancing, a skill that helps change reactions to negative emotions. Participants will either learn this technique or continue with their usual emotion regulation methods. It suits adults with BPD who do not have other specific mental health disorders, such as schizophrenia or major depression, and have not used substances in the past six months. As an unphased study, this trial provides a unique opportunity to explore innovative techniques for managing BPD symptoms.

Will I have to stop taking my current medications?

The trial allows participants to continue taking their current psychotropic medications as long as there has been no change in medication over the past two months.

What prior data suggests that this cognitive reappraisal training is safe for BPD patients?

Research has shown that cognitive reappraisal training is generally safe for people with Borderline Personality Disorder (BPD). This method helps individuals change their thinking about emotional situations. Used in various settings, it does not involve medication, so the risk of side effects remains low.

Participants have tolerated this training well. Studies have not reported any serious side effects or adverse events. Since this treatment avoids drugs, it sidesteps common medication-related issues. As a mental training method, it is considered safe because it does not involve taking any medicines. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about cognitive reappraisal training for Borderline Personality Disorder (BPD) because it takes a unique approach to managing emotional reactions. Unlike standard treatments such as Dialectical Behavior Therapy, which often focus on mindfulness and emotional regulation strategies, this technique teaches patients to distance themselves from their emotions by viewing situations more objectively. This method could help individuals with BPD respond less intensely to negative stimuli. By providing a new cognitive tool, it offers a promising alternative for those who may not fully benefit from existing therapies.

What evidence suggests that cognitive reappraisal-by-distancing is effective for borderline personality disorder?

Studies have shown that changing how one thinks about negative emotions can help people with Borderline Personality Disorder (BPD) manage their feelings better. In this trial, participants in the Cognitive Reappraisal-by-Distancing (CRD) arm will learn to use cognitive reappraisal by distancing to reduce their negative reactions to aversive emotional pictures. This method helps patients view their emotions from a different perspective, leading to better control over their reactions. Research indicates that this technique can normalize brain activity related to emotional responses in BPD patients. Specifically, those who have tried this training demonstrated improved ability to handle their emotions, suggesting it could be an effective treatment for BPD. Overall, cognitive reappraisal by distancing shows promise in helping those with BPD manage their emotions more effectively. ^{2 4 6 7 8}

Who Is on the Research Team?

Harold W Koenigsberg, MD

Principal Investigator

Icahn School of Medicine at Mount Sinai

Are You a Good Fit for This Trial?

This trial is for individuals with Borderline Personality Disorder (BPD). Participants should be interested in trying a new treatment approach that focuses on changing how they think about and react to emotional situations.

Inclusion Criteria

I am healthy, have Borderline Personality Disorder, and can consent to treatment.

My gender or race does not affect my eligibility for this trial.

Exclusion Criteria

Pregnant women

Participants will not meet criteria for Schizotypal Personality Disorder or Avoidant Personality Disorder

I don't have PTSD, bipolar I, schizophrenia, or recent substance use issues.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive cognitive reappraisal training twice a week to downregulate negative reactions to aversive emotional stimuli

6 weeks

12 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 months

2 visits (in-person) at 1-month and 4-month follow-up

What Are the Treatments Tested in This Trial?

Interventions

• Cognitive Reappraisal by Distancing

Trial Overview The study tests 'reappraisal-by-distancing', a technique where patients learn to emotionally distance themselves from situations to reduce their intensity. The goal is to see if this can change brain activity and behavior, potentially improving BPD symptoms.

How Is the Trial Designed?

Group I: Cognitive Reappraisal-by-Distancing (CRD) Experimental Treatment 1 Intervention

Patients will be coached to use cognitive reappraisal-by-distancing to downregulate their negative reactions to aversive emotional pictures using practice pictures.

Group II: Downregulate Condition (CD) Active Control 1 Intervention

Patients will be coached to practice their customary emotion regulatory techniques in a treatment occurring twice a week for 6 weeks.

Who Is Running the Clinical Trial?

Icahn School of Medicine at Mount Sinai

Lead Sponsor

Trials

933

Recruited

579,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

William Marsh Rice University

Collaborator

Trials

50

Recruited

28,400+

Published Research Related to This Trial

Metacognitive therapy (MCT) was found to be a feasible treatment for patients with Borderline Personality Disorder, with all 12 participants completing the program and most maintaining follow-up assessments over two years.

Significant improvements were observed in borderline symptoms, interpersonal issues, and trauma symptoms from the start of treatment to the two-year follow-up, suggesting that MCT could be an effective intervention for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Metacognitive Therapy of Early Traumatized Patients With Borderline Personality Disorder: A Phase-II Baseline Controlled Trial. Nordahl, HM., Wells, A.[2023]

Metacognitive training for borderline personality disorder (B-MCT) was found to significantly reduce borderline symptoms in 74 inpatients over a six-month period compared to a control group receiving progressive muscle relaxation.

While B-MCT showed effectiveness in reducing borderline symptoms, progressive muscle relaxation was more effective in alleviating depressive symptoms at long-term follow-up, suggesting that different interventions may target different aspects of mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of metacognitive training for patients with borderline personality disorder: Preliminary results. Schilling, L., Moritz, S., Kriston, L., et al.[2019]

Metacognitive interpersonal therapy (MIT) significantly improved emotional dysregulation in patients with borderline personality disorder (BPD), showing a very large effect size (Cohen's d = 0.84) compared to structured clinical management (SCM) which had a large effect size (d = 0.76).

Both MIT and SCM were effective in reducing BPD symptoms and improving emotional regulation, but MIT had a greater impact on metacognitive functions and impulsivity, while SCM led to a larger decrease in overall BPD symptomatology. Additionally, both therapies modulated amygdala activation, indicating a neurobiological mechanism at play.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Metacognitive interpersonal therapy in borderline personality disorder: Clinical and neuroimaging outcomes from the CLIMAMITHE study-A randomized clinical trial. Rossi, R., Corbo, D., Magni, LR., et al.[2023]

Metacognitive training for borderline patients (B-MCT) was well-accepted and feasible, showing significantly better subjective outcomes compared to an active control group, including improvements in symptomatology and cognitive abilities among 48 inpatients with borderline personality disorder.

Participants reported higher enjoyment and likelihood of recommending B-MCT, indicating its potential as a beneficial add-on intervention, although further research with larger samples is necessary to fully understand its impact on mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary Results on Acceptance, Feasibility, and Subjective Efficacy of the Add-On Group Intervention Metacognitive Training for Borderline Patients. Schilling, L., Moritz, S., Köther, U., et al.[2020]

Individuals with borderline personality disorder (BPD) and mixed anxiety/depressive disorders (MAD) use cognitive reappraisal strategies less effectively than healthy controls, despite using a similar number of tactics.

During cognitive reappraisal tasks, individuals with BPD and MAD expressed fewer words and reported lower effectiveness in reducing negative emotions compared to healthy individuals, indicating challenges in emotional regulation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Reappraisal of Negative Emotional Images in Borderline Personality Disorder: Content Analysis, Perceived Effectiveness, and Diagnostic Specificity. Daros, AR., Rodrigo, AH., Norouzian, N., et al.[2021]

A pilot study involving 29 adolescents with Borderline Personality Disorder (BPD) traits showed that those with higher BPD traits believed emotions to be fixed, leading to increased rumination and decreased cognitive reappraisal.

After a single virtual reality intervention aimed at changing beliefs about emotions, participants reported a greater belief in the changeability of their emotions, suggesting that modifying these beliefs could be beneficial in treating adolescents with BPD traits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Borderline Personality Traits and Emotion Regulation Strategies in Adolescents: The Role of Implicit Theories. McLachlan, J., Mehdikhani, M., Larham, B., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11305902/

Training in cognitive reappraisal normalizes whole-brain ... We have previously shown that borderline personality disorder patients are impaired in their capacity to engage cognitive reappraisal, a frequently-employed ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S245190222400106X

Training in Cognitive Reappraisal Normalizes Whole-Brain ... In this study, we examined whether longitudinal training in cognitive reappraisal by distancing would enhance emotion regulation in patients with BPD.

3. scan.psych.columbia.edu scan.psych.columbia.edu/papers/Denny_et_al_2024_BioPsych.pdf

Training in Cognitive Reappraisal Normalizes Whole-Brain ... METHODS: Here, we report on the efficacy of longitudinal training in cognitive reappraisal to enhance emotion regulation in patients with BPD. Specifically, the ...

4. withpower.com withpower.com/trial/phase-borderline-personality-disorder-10-2024-4f3a7

Cognitive Reappraisal Training for Borderline Personality Disorder Cognitive Reappraisal by Distancing is unique because it focuses on teaching individuals with Borderline Personality Disorder to change their perspective on ...

5. cdn.clinicaltrials.gov cdn.clinicaltrials.gov/large-docs/22/NCT04967222/Prot_SAP_000.pdf

Cognitive Reappraisal Training Targeting Emotion Circuits As a ... (1) Neuroimaging Studies of Reappraisal by Distancing in BPD. The first goal of this previous R01 study was to compare neural activation between BPD and HC.

6. clinicaltrials.gov clinicaltrials.gov/study/NCT04967222

Cognitive Reappraisal Training for Borderline Personality The present proposal aims to refine and test a proposed clinical intervention for BPD patients, training in reappraisal-by-distancing, in terms of its ability ...

7. mountsinai.org mountsinai.org/clinical-trials/cognitive-reappraisal-training-for-borderline-personality-bpd

Cognitive Reappraisal Training for Borderline Personality ... The present proposal aims to refine and test a proposed clinical intervention for BPD patients, training in reappraisal-by-distancing ... data to customize our ...

8. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/wps.21156

Borderline personality disorder: a comprehensive review of ... Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies