Under the Hood

People With Borderline Personality Disorder Experience Changes In Brain Activity After A Year Of Psychotherapy

borderline personality disorder
Following psychotherapy, borderline personality disorder patients showed changes in the activation patterns of specific brain regions. Britt-knee, CC by 2.0

Talk therapy, a new study suggests, has the potential to reach deeply into and effectively change a patient’s brain. Following a special form of psychotherapy, say researchers from Binghamton and Harvard Universities, patients with borderline personality disorder showed changes in the activation patterns of specific cerebral regions.

“Treatment with transference-focused psychotherapy was associated with relative activation increases in emotional and cognitive control areas and relative decreases in areas associated with emotional reactivity and semantic-based memory retrieval,” wrote the researchers in their conclusion.

Transference-focused psychotherapy uses the relationship issues that emerge during the course of therapy as the basis for treatment. A therapist will confront, clarify, and interpret the evidence of transference — when a patient unconsciously redirects his or her feelings and attitudes from the past (and about other people) onto the therapist. Common examples of transference include patients developing a crush on the therapist or patients reacting to the therapist as a parent. In particular, transference-focused psychotherapy is used to treat borderline personality disorder.

Defining Borderline Personality Disorder

This mental illness is all about instability; patients are unpredictable (or even volatile) with regard to their moods, self-image, relationships, and behavior.  As a result, they often respond to other people and many situations intensely. Borderline personality disorder patients are commonly seen as impulsive and aggressive, often they are self-destructive. The name of this illness came about because the symptoms are considered to be on the borderline for several disorders.

Specifically, the condition sits “on the border of major mood disorders and impulse control disorders,” said Dr. John Oldham, professor and executive chair, Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, in a discussion broadcast on YouTube.For the current study, researchers led by Dr. Mark F. Lenzenweger, a professor of psychology at Binghamton University, explored the effects of transference-focused psychotherapy on borderline patients. They began by recruiting 10 borderline women as volunteers. First, each participant underwent fMRI, a particular brain scanning technology that highlights blood flow changes and brain activity. Next, these 10 women participated in twice-weekly individual, 50-min sessions of transference-focused psychotherapy for an entire year. Finally, the 10 women were scanned a second time to see if any changes had occurred in their brains.

What did the researchers discover?

Treatment with transference-focused psychotherapy linked to activation increases in areas of the brain implicated in cognitive control. At the same time, activation decreases were seen in regions associated with emotional reactivity.  The specific brain structures involved were the anterior cingulate cortex, the orbitofrontal cortex, the prefrontal cortex, and across the amygdala-hippocampus.

“Think of it — talk therapy that impacts neural or brain functioning,” Lenzenweger said in a press release.

He and his colleagues believe transference-focused psychotherapy helps a patient develop his or her “observing ego,” which in turn leads to an increased awareness of negative emotions and an improved ability to interact realistically.

Source: Perez DL, Vago DR, Pan H, et al. Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder. Psychiatry and Clinical Neurosciences. 2015.

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