Brain Signal Training to Enhance Affect Down-regulation (BrainSTEADy)

• Applicants: Dr. Christian Paret; Professor Dr. Christian Schmahl
• Subject Area: Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 502833016

Borderline Personality Disorder (BPD) is characterized by selfmutilation, suicidality, and severe interpersonal disturbances. These symptoms reflect pervasive emotion regulation problems. On the neural level, BPD patients show an inflated amygdala response to emotional cues. In addition, they have reduced neural control of the amygdala. The amygdala controls emotional experience and behavior. Therefore, current psychobiological theories consider amygdala hyper-activity a causal mechanism for emotional overreaction in BPD. Functional magnetic resonance imaging (fMRI) allows recording of activation in subcortical brain regions, such as amygdala, in real-time. Live feedback from brain activation (e.g. via a thermometer with the temperature reflecting degree of activation) allows one to learn the voluntary control of the brain. Dubbed “neurofeedback”, the method can result in long-lasting changes of neural activation patterns. Neurofeedback allows precise targeting of dysfunctional neuro-circuitries that relate to clinical symptoms. The project proposed here investigates the clinical effectivity of fMRIbased amygdala-neurofeedback training in BPD. In total, 164 patients will participate in four training sessions provided by four study centers: Tuebingen, Freiburg, Giessen and Mannheim. The training aims at reducing affective instability in everyday life, assessed primarily by ambulatory assessment before and after treatment. During neurofeedback sessions, patients receive feedback from the BOLD (Blood Oxygenation Level Dependent) signal recorded in the amygdala while they view pictures with negative emotional content. The amygdala responds to these pictures with an activation increase. The patient observes the amygdala responding, illustrated via increased temperature in a thermometer besides the picture. The task is to decrease temperature. The procedure should teach patients to master overreaction at an early stage of neural emotion processing. In order to assess effectivity of amygdala-neurofeedback, a control group receives non-veridical feedback from a different patient. We expect a significant reduction in affective instability with amygdalaneurofeedback. In addition, we expect greater reduction in affective instability in the amygdala-neurofeedback group versus the control group. Results from this study enable assessment of clinical efficacy of amygdala-neurofeedback. In future, neurofeedback could serve as a precise tool for person-centered treatment of affective instability symptoms in mental disorders with severe emotion regulation problems such as BPD.

• DFG Programme: Clinical Trials