Massachusetts General Hospital
Impaired emotion regulation is a core feature of borderline personality disorder (BPD) and a known driver of functional impairment, interpersonal difficulties, self-harm, and suicidality. Emotion regulation refers to the ways in which people influence and control which emotions they have, when they have them, and how they experience and express them. Effective emotion regulation is a precursor to success in a range of adaptive processes including decision making, impulse control, communication and social interaction, work performance and productivity, and goal achievement, with subsequent positive effects on mood stability and well-being. Front-line behavioral approaches to teach effective emotion regulation skills in BPD (e.g. DBT) have been moderately successful, but outcomes are limited by high dropout rates due to lengthy treatment protocols and pre-existing deficits in the neurocircuitry supporting engagement in emotion regulation, with poorer outcomes in individuals with more severe emotion dysregulation. In this pilot feasibility trial, we aim to test an approach to improving emotion dysregulation in BPD by combining neuromodulation using transcranial magnetic stimulation (TMS), to improve functioning of emotion regulation related neurocircuitry, with an intensive, brief emotion regulation skills training protocol. Through this combined approach, we hypothesize increased gains in emotion regulation ability, decreased treatment dropout rates, and improved positive outcomes in patients with BPD.
Emotion dysregulation has long been established as the core characteristic feature of borderline personality disorder (BPD). Large scale mediation analyses have identified emotion dysregulation as a key driver of the most impairing effects of this disorder, including interpersonal difficulties, self-harm and suicidality.1 Further, emotion dysregulation has been found to have a transactional relationship with overall BPD symptoms, with significant bi-directional relationships between severity of emotion regulation difficulties and severity of BPD symptoms, suggesting emotion dysregulation goes…
Inclusion Criteria: * DSM-5 diagnosis of borderline personality disorder; * Clinical levels of emotion dysregulation as determined by a score ≥ 80 on the DERS; * Male and female sex as assigned at birth; * ages 22-65; * able to provide informed consent and provide verifiable contact information; * stable medication regimen. Exclusion Criteria: * current active suicidality (suicidal ideation with intent or plan) * current substance use disorder for the past 6 months (substance use disorder in remission permitted); * history of psychosis; * dementia or other major neurological disorders * med…
accelerated (multi-session) intermittent theta-burst transcranial magnetic stimulation (aiTBS)
Cognitive behavioral therapy based emotion regulation skills training using the Unified Protocol