Cognitive Reappraisal Training for Borderline Personality Disorder

(BPD Trial)

Overseen By Edward C Foran, BA

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Icahn School of Medicine at Mount Sinai

Disqualifiers: Age > 55, Schizotypal, Avoidant, others

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

Compensation: Varies

Number of Visits: 12

Duration: 6 weeks

60 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial aims to test a new way of helping people with Borderline Personality Disorder (BPD) manage their emotions by teaching them to think differently about emotional events. This method, called cognitive reappraisal training, could improve their mental health and behavior.

Will I have to stop taking my current medications?

The trial does not require you to stop your current medications, as long as there has been no change in your treatment in the last 2 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 we think about situations to alter our emotional response, 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 the treatment Cognitive Reappraisal by Distancing different from other treatments for Borderline Personality Disorder?

Cognitive Reappraisal by Distancing is unique because it focuses on teaching individuals to change their perspective on negative emotions, which can help improve emotional stability. This approach is different from other treatments that may not specifically target the way patients perceive and manage their emotions. ^{1 2 4 5 6}

Research Team

Harold Koenigsberg, MD

Principal Investigator

Icahn School of Medicine at Mount Sinai

Eligibility Criteria

This trial is for medically healthy adults with Borderline Personality Disorder who can provide informed consent. It's not open to individuals over 55 or those with Schizotypal Personality Disorder or Avoidant Personality Disorder, due to their distinct neural activity patterns.

Inclusion Criteria

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

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

Exclusion Criteria

You have been diagnosed with Schizotypal Personality Disorder or Avoidant Personality Disorder. This is because people with these disorders may affect the accuracy of the study results.

I am older than 55.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive cognitive reappraisal training twice a week for 2, 4, or 6 weeks to identify the optimal dose

6 weeks

12 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 1 and 4 months

4 months

Open-label extension (optional)

Participants may opt into continuation of cognitive reappraisal training long-term

Long-term

Treatment Details

Interventions

• Cognitive Reappraisal by Distancing
• Control Downregulate Condition

Trial Overview The study tests a new treatment approach called cognitive reappraisal training by distancing. This method could be used alone or alongside other treatments for BPD, aiming to improve emotional regulation and influence behavior.

Participant Groups

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

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

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

Subjects 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]