Neurofeedback for Borderline Personality Disorder

Overseen By Kymberly Young, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Kymberly Young

Must be taking: SSRI antidepressants

Must not be taking: Antipsychotics, Benzodiazepines, Beta-blockers

Disqualifiers: Substance use, Traumatic brain injury, others

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

Compensation: Varies

Number of Visits: 4

100 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this study is to evaluate whether rtfMRI-nf training to increase the amygdala response to positive memories may serve as an intervention for borderline personality disorder.

Will I have to stop taking my current medications?

You can continue taking your current SSRI antidepressants if you've been stable on them for at least 3 weeks. However, you must stop taking any antipsychotics, benzodiazepines, beta-blockers, or other medications that might affect brain blood flow at least 3 weeks before the study.

What data supports the effectiveness of the treatment Amygdala Neurofeedback for Borderline Personality Disorder?

Research shows that amygdala neurofeedback can help people with Borderline Personality Disorder (BPD) improve their ability to manage emotions and reduce symptoms like emotional instability. Studies found that patients could learn to control their brain activity related to emotions, which led to a decrease in BPD symptoms and better emotional regulation. ^{1 2 3 4 5}

Is neurofeedback safe for humans?

The studies on neurofeedback for borderline personality disorder (BPD) suggest that it is generally safe, as participants were able to complete the sessions without reported adverse effects. However, more research, such as randomized controlled trials, is needed to confirm its safety and effectiveness. ^{1 2 3 6 7}

How is the treatment Amygdala Neurofeedback different from other treatments for borderline personality disorder?

Amygdala Neurofeedback is unique because it uses real-time brain imaging to help patients learn to control their brain activity, specifically targeting the amygdala, which is involved in emotion regulation. This approach directly addresses the neurobiological mechanisms of emotion dysregulation in borderline personality disorder, unlike traditional therapies that may focus more on behavioral or psychoanalytic methods. ^{1 2 3 8 9}

Research Team

Kymberl Young, PhD

Principal Investigator

University of Pittsburgh

Eligibility Criteria

This trial is for right-handed English-speaking adults aged 18-55 with Borderline Personality Disorder, as diagnosed by specific criteria. Participants must be able to consent and should either not be on medication or stable on SSRI antidepressants for at least three weeks.

Inclusion Criteria

Must be able to give written informed consent prior to participation

English speaking

I am not on medication or have been stable on SSRI antidepressants for at least 3 weeks.

Exclusion Criteria

I am not currently taking any medications that could affect brain blood flow, except for SSRIs.

Are unable to complete questionnaires written in English

Have any eye problems or difficulties in corrected vision

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Neurofeedback Training

Participants undergo real-time fMRI neurofeedback training to increase amygdala response while recalling positive autobiographical memories

1 week

2 sessions (in-person)

Follow-up

Participants are monitored for changes in borderline and depressive symptoms

12 weeks

Every 2 weeks

Treatment Details

Interventions

• Amygdala Neurofeedback

Trial Overview The study tests if a type of brain training called rtfMRI-nf, which aims to increase the amygdala's response to positive memories, can help people with Borderline Personality Disorder.

Participant Groups

Group I: Amygdala Neurofeedback Experimental Treatment 1 Intervention

Participants will undergo real-time fMRI neurofeedback training to increase their amygdala response while recalling positive autobiographical memories. 2 sessions will occur within a one week period.

Who Is Running the Clinical Trial?

Kymberly Young

Lead Sponsor

Trials

4

Recruited

440+

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

AE Foundation

Collaborator

Trials

3

Recruited

150+

AE Foundation

Collaborator

Trials

3

Recruited

150+

Findings from Research

Patients with borderline personality disorder (BPD) were able to down-regulate their right amygdala activity during neurofeedback training, indicating potential for improved emotional regulation.

Although there were no long-term improvements observed over time, the training altered brain connectivity patterns, suggesting that amygdala neurofeedback may enhance healthy brain function and emotion regulation in BPD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients. Paret, C., Kluetsch, R., Zaehringer, J., et al.[2022]

In a study involving 24 female patients with borderline personality disorder (BPD), real-time fMRI neurofeedback training successfully enabled participants to downregulate their amygdala activity, which is linked to emotion regulation issues.

Post-training assessments showed a significant decrease in BPD symptoms and emotion dysregulation, indicating potential improvements in emotional stability, although further research with a control group is necessary to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improved emotion regulation after neurofeedback: A single-arm trial in patients with borderline personality disorder. Zaehringer, J., Ende, G., Santangelo, P., et al.[2021]

Functional neuroimaging studies have identified abnormal activity in frontolimbic brain regions associated with borderline personality disorder (BPD), suggesting a mechanistic model for understanding its core symptoms.

The research emphasizes the importance of integrating neuroimaging findings with developmental perspectives and proposes that future studies should consider multiple biological and psychological factors to enhance treatment approaches for BPD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Defining the neurocircuitry of borderline personality disorder: functional neuroimaging approaches. Brendel, GR., Stern, E., Silbersweig, DA.[2019]

Healthy individuals can learn to self-regulate the activity of the amygdala using real-time fMRI neurofeedback, leading to significant increases in blood oxygen level dependent (BOLD) signals during training.

This training not only enhances amygdala activation but also improves functional connectivity within a broader brain network, indicating potential therapeutic applications for neuropsychiatric disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-regulation of amygdala activation using real-time FMRI neurofeedback. Zotev, V., Krueger, F., Phillips, R., et al.[2021]

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]

In a study involving 12 women with borderline personality disorder (BPD) and 12 healthy controls, BPD patients exhibited lower connectivity between the amygdala and mid-cingulate cortex during neutral emotional processing, indicating potential difficulties in emotional regulation.

During fear processing, BPD patients showed increased amygdala connectivity with frontal and thalamic regions, suggesting they engage both emotional processing pathways more intensely than healthy individuals, which may contribute to their affect dysregulation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Amygdala functional connectivity in young women with borderline personality disorder. Cullen, KR., Vizueta, N., Thomas, KM., et al.[2021]

Neuroimaging studies have identified dysfunction in specific brain regions, particularly within the frontolimbic network, which may contribute to the symptoms of borderline personality disorder.

Various methodologies, including volumetry and studies of brain metabolism and neurotransmission, have been utilized to explore these neurobiological underpinnings, highlighting the complexity of the disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuroimaging in borderline personality disorder. Schmahl, C., Bremner, JD.[2018]

In a study involving 20 unmedicated female patients with borderline personality disorder (BPD) and 17 healthy controls, BPD patients showed increased resting-state functional connectivity (RSFC) between the amygdala and several brain regions, indicating heightened emotional processing.

BPD patients also exhibited decreased negative RSFC between the dorsal anterior cingulate cortex and the posterior cingulate cortex, suggesting disruptions in self-referential processing and emotional regulation compared to healthy controls.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Amygdala and anterior cingulate resting-state functional connectivity in borderline personality disorder patients with a history of interpersonal trauma. Krause-Utz, A., Veer, IM., Rombouts, SA., et al.[2022]

Recent research suggests that borderline personality disorder (BPD) may be better understood through a neuroscience model, which identifies dysfunctional neural circuits as the basis for symptoms like emotion dysregulation and impulsive aggression.

The article advocates for a research approach that focuses on the underlying neurobiological abnormalities of BPD, rather than just viewing it as a single diagnostic entity, to enhance understanding and treatment of its diverse symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Neuroscience-Oriented Research Approach to Borderline Personality Disorder. Stanley, B., Perez-Rodriguez, MM., Labouliere, C., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Improved emotion regulation after neurofeedback: A single-arm trial in patients with borderline personality disorder. [2021]

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

Defining the neurocircuitry of borderline personality disorder: functional neuroimaging approaches. [2019]

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

Self-regulation of amygdala activation using real-time FMRI neurofeedback. [2021]

5. 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]

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

Amygdala functional connectivity in young women with borderline personality disorder. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Neuroimaging in borderline personality disorder. [2018]

8. England pubmed.ncbi.nlm.nih.gov

Amygdala and anterior cingulate resting-state functional connectivity in borderline personality disorder patients with a history of interpersonal trauma. [2022]

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

A Neuroscience-Oriented Research Approach to Borderline Personality Disorder. [2022]