Cognitive Reappraisal Training for Borderline Personality Disorder
Recruiting in Palo Alto (17 mi)
Overseen byHarold W Koenigsberg, MD
Age: 18 - 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Icahn School of Medicine at Mount Sinai
Disqualifiers: Major depressive disorder, PTSD, Bipolar, others
No Placebo Group
Trial Summary
What is the purpose of this trial?Previous work by the group convinced the researchers to pursue development of focused cognitive reappraisal training as a novel approach to treatment of BPD, either as stand-alone treatment or in concert with evidence-based treatments of BPD. The present proposal aims to refine and test a proposed clinical intervention for BPD patients, training in reappraisal-by-distancing, in terms of its ability to influence hypothesized neural and behavioral targets and, once that is established, to demonstrate its ability improve clinically relevant outcome measures.
Will I have to stop taking my current medications?
The trial allows participants to continue taking their current psychotropic medications as long as there has been no change in medication over the past two months.
What data supports the effectiveness of the treatment Cognitive Reappraisal by Distancing for Borderline Personality Disorder?
Research shows that cognitive reappraisal, a strategy to change how one thinks about a situation to alter its emotional impact, is used less effectively by individuals with Borderline Personality Disorder (BPD) compared to healthy individuals. However, metacognitive therapies, which include elements of cognitive reappraisal, have shown promise in reducing BPD symptoms and improving emotional regulation.
12345How is Cognitive Reappraisal by Distancing treatment different from other treatments for Borderline Personality Disorder?
Cognitive Reappraisal by Distancing is unique because it focuses on teaching individuals with Borderline Personality Disorder to change their perspective on negative emotions, which they typically find challenging. This approach is different from other treatments as it specifically targets the way patients perceive and manage their emotions, aiming to improve emotional stability by altering their cognitive responses to emotional stimuli.
12456Eligibility Criteria
This trial is for individuals with Borderline Personality Disorder (BPD). Participants should be interested in trying a new treatment approach that focuses on changing how they think about and react to emotional situations.Inclusion Criteria
I am healthy, have Borderline Personality Disorder, and can consent to treatment.
My gender or race does not affect my eligibility for this trial.
I am between 18 and 55 years old.
Exclusion Criteria
Pregnant women
Participants will not meet criteria for Schizotypal Personality Disorder or Avoidant Personality Disorder
I don't have PTSD, bipolar I, schizophrenia, or recent substance use issues.
+4 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive cognitive reappraisal training twice a week to downregulate negative reactions to aversive emotional stimuli
6 weeks
12 visits (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 months
2 visits (in-person) at 1-month and 4-month follow-up
Participant Groups
The study tests 'reappraisal-by-distancing', a technique where patients learn to emotionally distance themselves from situations to reduce their intensity. The goal is to see if this can change brain activity and behavior, potentially improving BPD symptoms.
2Treatment groups
Experimental Treatment
Active Control
Group I: Cognitive Reappraisal-by-Distancing (CRD)Experimental Treatment1 Intervention
Patients will be coached to use cognitive reappraisal-by-distancing to downregulate their negative reactions to aversive emotional pictures using practice pictures.
Group II: Downregulate Condition (CD)Active Control1 Intervention
Patients will be coached to practice their customary emotion regulatory techniques in a treatment occurring twice a week for 6 weeks.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Icahn School of Medicine at Mount SinaiNew York, NY
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Who Is Running the Clinical Trial?
Icahn School of Medicine at Mount SinaiLead Sponsor
National Institute of Mental Health (NIMH)Collaborator
William Marsh Rice UniversityCollaborator
References
Preliminary Results on Acceptance, Feasibility, and Subjective Efficacy of the Add-On Group Intervention Metacognitive Training for Borderline Patients. [2020]The add-on intervention "metacognitive training for borderline patients (B-MCT)" targets cognitive biases in patients with borderline personality disorder (BPD). We aimed to evaluate acceptance, feasibility, and subjective use of this group intervention.
Metacognitive interpersonal therapy in borderline personality disorder: Clinical and neuroimaging outcomes from the CLIMAMITHE study-A randomized clinical trial. [2023]Different psychotherapeutic approaches demonstrated their efficacy but the possible neurobiological mechanism underlying the effect of psychotherapy in borderline personality disorder (BPD) patients is poorly investigated. We assessed the effects of metacognitive interpersonal therapy (MIT) on BPD features and other dimensions compared to structured clinical management (SCM). We also assessed changes in amygdala activation by viewing emotional pictures after psychotherapy. One hundred forty-one patients were referred and 78 BPD outpatients were included and randomized to MIT or SCM. Primary outcome was emotional dysregulation assessed with the Difficulties in Emotion Regulation Scale (DERS). We also assessed BPD symptomatology, number of PD criteria, metacognitive abilities, state-psychopathology, depression, impulsiveness, interpersonal functioning, and alexithymia. A subset of 60 patients underwent functional magnetic resonance imaging before and after 1 year of psychotherapy to assess amygdala activation by viewing standardized emotional pictures (secondary outcome). DERS scores decreased in both groups (time effect p < .001). The Cohen's d effect size for change (baseline posttreatment) on DERS was very large (d = 0.84) in MIT, and large (d = 0.76) in SCM. Both groups significantly improved in depressive symptoms, state-psychopathology, alexithymia, and interpersonal functioning. MIT showed larger effect on metacognitive functions than SCM (Time × Group p < .001). Both interventions showed a significant effect on BPD symptomatology although SCM group showed a larger decrease. On the contrary, MIT group showed larger decrease in impulsivity and number of PD criteria. Interestingly, both MIT and SCM modulated amygdala activation in BPD patients. MIT is a valid and effective psychotherapy for BPD with an impact on amygdala activation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Metacognitive Therapy of Early Traumatized Patients With Borderline Personality Disorder: A Phase-II Baseline Controlled Trial. [2023]Metacognitive therapy (MCT) is proving to be an effective and brief treatment for anxiety disorders and depression, but there are no investigations of its feasibility and effect on primary personality disorders. We conducted a baseline controlled phase II trial of MCT on a group of patients with Borderline personality disorder all reporting early trauma history with sexual or physical abuse. All had been referred to our study after hospitalization and subsequently treated at the university outpatient clinic at NTNU. Twelve patients referred for severe long-term trauma and emotional instability were offered participation in the program. All gave their consent and were included in the trial. We aimed to examine retention over treatment and follow-up, if the treatment can be delivered in a standardized way across complex and heterogeneous patients and any evidence associated with treatment effects on a range of measures to inform subsequent trials. We measured change in mood, borderline-related symptoms, interpersonal problems, trauma symptoms, suicidal thoughts and self-harming behaviors across pre- post-treatment and by 1- and 2-year follow-up. Treatment appeared feasible with all patients completing the course and 11 out of 12 completing all follow-up assessments. All outcome measures showed a high retention rate and no drop-outs from the treatment. Large improvements over time and treatment gains were maintained at 2 years. There was significant reduction of borderline symptom severity, interpersonal problems and trauma symptoms from pre to 2-year follow-up. The results indicate that MCT may be applied to Borderline personality disorder and that future more definitive trials are warranted.
Cognitive Reappraisal of Negative Emotional Images in Borderline Personality Disorder: Content Analysis, Perceived Effectiveness, and Diagnostic Specificity. [2021]Individuals with borderline personality disorder (BPD) report using cognitive reappraisal less often than healthy individuals despite the long-term benefits of the emotion regulation strategy on emotional stability. Individuals with BPD, mixed anxiety and/or depressive disorders (MAD), and healthy controls (HC) completed an experimental task to investigate the tactics contained in cognitive reappraisal statements vocalized for high and low emotional intensity photographs. Self-reported effectiveness after using cognitive reappraisal to decrease negative emotions was also evaluated. Although BPD and MAD used a similar number of cognitive reappraisal tactics, they perceived themselves as less effective at reducing their negative emotions compared to HC. During cognitive reappraisal, BPD and MAD uttered fewer words versus HC, while BPD uttered fewer words versus MAD. Results suggest that individuals with BPD and MAD are less fluent and perceive themselves as less effective than HC when using cognitive reappraisal to lower negative emotions regardless of stimulus intensity.
Efficacy of metacognitive training for patients with borderline personality disorder: Preliminary results. [2019]'Metacognitive training for borderline personality disorder' (B-MCT) represents a complementary group intervention. It aims at raising awareness for cognitive biases that may play an important role in the development and maintenance of borderline symptomatology. For the present study, we evaluated the effectiveness of this new approach against a control condition. Seventy-four inpatients with borderline personality disorder (BPD) were randomly assigned to metacognitive training for BPD or progressive muscle relaxation training as an add-on intervention to treatment as usual. Severity of symptomatology was assessed at baseline, four weeks after beginning and six months after completion of the intervention. The per-protocol and intention-to-treat analyses revealed that patients in the metacognitive training group showed significantly greater reductions on the primary outcome (Borderline Symptom List-23) after six months. Progressive muscle relaxation was superior in alleviating depressive symptoms (secondary outcome: Beck Depression Inventory) at the long-term follow-up. Findings provide preliminary evidence that metacognitive training for BPD yields surplus effects to standard treatment.
Borderline Personality Traits and Emotion Regulation Strategies in Adolescents: The Role of Implicit Theories. [2022]Borderline Personality Disorder (BPD) is associated with emotion dysregulation. The emotion regulation strategies people adopt may depend on one's belief about emotion as either fixed or changeable (termed "implicit theory"). We test this experimentally by modifying beliefs about emotions using virtual reality (VR). A sample of 29 adolescents (ages 14-17 years) were recruited from two adolescent inpatient units for an uncontrolled pilot trial of a new brief intervention. We measured BPD traits, beliefs about emotion, treatment preference, cognitive reappraisal and rumination, before the VR game and 14-31 days later. Adolescents with higher levels of BPD traits endorsed fixed beliefs of emotion and reported higher levels of rumination and lower levels of cognitive reappraisal. After a one-time message delivered via VR, adolescents evidenced an increase in belief that their emotions were changeable. These findings suggest beliefs about emotions may have an important role in interventions for adolescents with BPD traits.