Effects of mindfulness training on the default mode network in borderline personality disorder

Abstract

Patients with borderline personality disorder (BPD) present dysfunctions of the default mode network (DMN). Mindfulness training has proven effective to improve the symptoms of BPD. The present study examines the effect of mindfulness training on BPD symptomatology and DMN activity during the performance of a working memory task in patients with BPD. Sixty-five individuals with BPD were randomized to receive psychotherapy with either the mindfulness module of dialectical behavioural therapy (DBT-M) or with interpersonal effectiveness module (DBT-IE).The impact of treatments was evaluated with clinical and mindfulness variables as well as with functional magnetic resonance imaging during performance of the task.Both groups showed improvement in BPD symptoms and other clinical variables after treatment. Unexpectedly, there were no between-group differences in DMN activation or deactivation. However, activation of the left anterior insula increased in both groups after the intervention. Compared with the control group, participants in the DBT-M group presented higher deactivation in a cluster extending bilaterally from the calcarine to the cuneus and superior occipital gyri. KEYWORDSanterior insula, borderline personality disorder, default mode network, mindfulness

Neural Changes in Borderline Personality Disorder After Dialectical Behavior Therapy–A Review

“…However, there was no posttreatment difference in default mode network activation or deactivation across both groups, a brain region associated with various cognitive processes such as introspection, envisioning the future, and self-reflective thought (25). There was also no significant correlation between BPD symptoms or mindfulness outcomes and activation/deactivation of the cluster at the medial occipital location extending bilaterally from the calcarine to the cuneus and superior occipital gyri (22). These particular findings highlight how specific components of DBT, including mindfulness and interpersonal effectiveness, may be uniquely associated with post-treatment changes in specific brain regions.…”

“…With regards to the anterior insula, while two studies found reduced activation in the anterior insula after DBT treatment among patients with BPD (17,21), one study found a significant increase in activation in the anterior insula (22). One study also found that reduced activity in the anterior insula was significantly correlated with BPD symptom improvement (17).…”

“…Results indicated a significant increased activation of the left anterior insula extending to the frontal inferior operculum after the intervention across both DBT-M and DBT-IE groups (22). Furthermore, BPD patients in the DBT-M group showed higher deactivation in a cluster at the medial occipital location extending bilaterally from the calcarine to the cuneus and superior occipital gyri while performing the n-back task compared to the DBT-IE group.…”

“…In addition to examining the impact of a full DBT program on various brain structures, research has also been conducted on the specific modules of DBT. One study compared the neural correlates of BPD patients in a 10-week DBT mindfulness (DBT-M) group with BPD patients in a DBT interpersonal effectiveness (DBT-IE) group (22). DBT is primarily composed of four different modules, including mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance (3).…”

Borderline personality disorder: stress reactivity or stress generation? A prospective dimensional study

“…therapy (DBT) specifically improves inattention and impulsivity, suggesting it may have utility as a targeted treatment among those high on Disinhibition(Carmona i Farrés et al, 2019;Soler et al, 2012). Conversely, interventions that seek to improve interpersonal communication and problem-solving (e.g., DBT's interpersonal effectiveness and emotion regulation modules) may be well-suited for those high in Antagonism, who often struggle to control emotional outbursts in social interactions (indeed, interpersonal effectiveness training is associated with improvements in emotion regulation; Carmona i Farrés et al, 2019).…”