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

Trial Summary

What is the purpose of this trial?

Previous work by the group convinced the researchers to pursue development of focused cognitive reappraisal training as a novel approach to treatment of BPD, either as stand-alone treatment or in concert with evidence-based treatments of BPD. 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 to influence hypothesized neural and behavioral targets and, once that is established, to demonstrate its ability improve clinically relevant outcome measures.

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 data supports the effectiveness of the treatment Cognitive Reappraisal by Distancing for Borderline Personality Disorder?

Research shows that cognitive reappraisal, a strategy to change how one thinks about a situation to alter its emotional impact, is used less effectively by individuals with Borderline Personality Disorder (BPD) compared to healthy individuals. However, metacognitive therapies, which include elements of cognitive reappraisal, have shown promise in reducing BPD symptoms and improving emotional regulation. ^{1 2 3 4 5}

How is Cognitive Reappraisal by Distancing treatment different from other treatments 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 negative emotions, which they typically find challenging. This approach is different from other treatments as it specifically targets the way patients perceive and manage their emotions, aiming to improve emotional stability by altering their cognitive responses to emotional stimuli. ^{1 2 4 5 6}

Research Team

Harold W Koenigsberg, MD

Principal Investigator

Icahn School of Medicine at Mount Sinai

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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 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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Preliminary Results on Acceptance, Feasibility, and Subjective Efficacy of the Add-On Group Intervention Metacognitive Training for Borderline Patients. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Metacognitive interpersonal therapy in borderline personality disorder: Clinical and neuroimaging outcomes from the CLIMAMITHE study-A randomized clinical trial. [2023]

3. Switzerland pubmed.ncbi.nlm.nih.gov

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

4. United States pubmed.ncbi.nlm.nih.gov

Cognitive Reappraisal of Negative Emotional Images in Borderline Personality Disorder: Content Analysis, Perceived Effectiveness, and Diagnostic Specificity. [2021]

5. Ireland pubmed.ncbi.nlm.nih.gov

Efficacy of metacognitive training for patients with borderline personality disorder: Preliminary results. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Borderline Personality Traits and Emotion Regulation Strategies in Adolescents: The Role of Implicit Theories. [2022]