New neuroimaging evidence links a specialized psychotherapy to measurable changes in brain activation in people with borderline personality disorder (BPD), suggesting the treatment may produce biological changes that accompany clinical improvement.
Researchers led by Mark F. Lenzenweger, Distinguished Professor of Psychology at Binghamton University, conducted a longitudinal neuroimaging study of ten women diagnosed with BPD who received one year of transference-focused psychotherapy (TFP). Using functional magnetic resonance imaging (fMRI) and a disorder-specific emotional–linguistic go/no-go task designed to probe the interaction of negative emotional processing and inhibitory control, the team examined how brain activation patterns shifted from before to after TFP treatment and how those shifts related to clinical change.
TFP is an evidence-based psychodynamic treatment shown in prior work to reduce core symptoms of BPD, including impulsivity, emotional instability, and interpersonal difficulties. In this study, treatment with TFP was associated with increased activation in dorsal prefrontal regions involved in cognitive control—specifically the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, and frontopolar cortex—and with decreased activation in regions more closely tied to emotional reactivity, including the ventrolateral prefrontal cortex and the hippocampus. These frontolimbic changes align with the clinical goals of improving inhibitory control and stabilizing affect.
The investigators also reported specific brain–behavior relationships. Greater clinical improvement in behavioral constraint correlated with increased activation in the left dorsal anterior cingulate cortex. Improvements in affective lability correlated positively with activation in left posterior-medial orbitofrontal cortex and ventral striatum, and correlated negatively with activation in the right amygdala and parahippocampal region. In addition, certain pre-treatment activation patterns predicted the degree of later symptom change: lower pre-treatment activation (hypoactivation) in the right dorsal anterior cingulate cortex predicted greater improvements in constraint, while hypoactivation in the left posterior-medial orbitofrontal cortex/ventral striatum predicted greater improvement in affective lability.
“These findings represent the genuine frontier of clinical science in understanding the effects of psychotherapy,” Lenzenweger commented. “Think of it — talk therapy that impacts neural or brain functioning.” The research team interprets the results as preliminary but important evidence that psychodynamically oriented psychotherapy can be associated with measurable changes in frontolimbic circuitry involved in emotion processing and inhibitory control.
Funding: The study received partial support from The Dworman Foundation and the Department of Psychiatry at Weill Cornell Medical College.
Source: Mark Lenzenweger, Binghamton University. The original peer-reviewed study is titled “Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder” and was published in Psychiatry and Clinical Neurosciences (online October 8, 2015).
Abstract (summary)
Aims
Borderline personality disorder is marked by deficits in self-regulation—most notably impulsivity and emotional lability. This pilot study evaluated whether one year of transference-focused psychotherapy (TFP) is associated with changes in neural activation linked to emotional processing and inhibitory control, and whether such changes relate to clinical improvement.
Methods
Ten individuals diagnosed with BPD were scanned with fMRI before and after a year of TFP using a within-subjects design. The study employed a disorder-relevant emotional–linguistic go/no-go paradigm to probe how negative emotional stimuli interact with inhibitory control processes.
Results
Treatment-related changes included relative increases in dorsal prefrontal activation (dorsal anterior cingulate, dorsolateral prefrontal, and frontopolar cortices) and relative decreases in ventrolateral prefrontal cortex and hippocampal activation after TFP. Clinical improvement in behavioral constraint correlated with increased left dorsal anterior cingulate activation. Improvement in affective lability correlated with increased activation in left posterior-medial orbitofrontal cortex/ventral striatum and decreased activation in right amygdala/parahippocampal regions. Furthermore, pre-treatment hypoactivation in specific regions predicted the magnitude of post-treatment improvement.
Conclusions
These preliminary results indicate that transference-focused psychotherapy may be associated with modulation of frontolimbic circuitry involved in emotional regulation and inhibitory control, providing an initial neural framework for how a psychodynamically informed therapy can produce clinical change in BPD.