Academic Journal
Amygdala neurofeedback as an adjunct to residential dialectical behavior therapy for borderline personality disorder: a pilot randomized controlled trial.
| Τίτλος: | Amygdala neurofeedback as an adjunct to residential dialectical behavior therapy for borderline personality disorder: a pilot randomized controlled trial. |
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| Συγγραφείς: | Hofmanová M; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. miroslava.hofmanova@zi-mannheim.de.; German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany. miroslava.hofmanova@zi-mannheim.de., Santangelo PS; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg., Kleindienst N; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.; German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany., Schmahl C; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.; German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany., Paret C; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. christian.paret@zi-mannheim.de.; German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany. christian.paret@zi-mannheim.de. |
| Πηγή: | BMC psychiatry [BMC Psychiatry] 2026 Oct 16; Vol. 26 (1). Date of Electronic Publication: 2026 Oct 16. |
| Τύπος έκδοσης: | Journal Article; Randomized Controlled Trial |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: BioMed Central Country of Publication: England NLM ID: 100968559 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-244X (Electronic) Linking ISSN: 1471244X NLM ISO Abbreviation: BMC Psychiatry Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2001- |
| Ιατρικοί όροι (MeSH): | Neurofeedback*/methods , Amygdala*/physiopathology , Amygdala*/diagnostic imaging , Borderline Personality Disorder*/therapy , Borderline Personality Disorder*/physiopathology , Borderline Personality Disorder*/diagnostic imaging , Dialectical Behavior Therapy*/methods, Humans ; Female ; Adult ; Magnetic Resonance Imaging ; Pilot Projects ; Male ; Treatment Outcome ; Combined Modality Therapy ; Young Adult |
| Περίληψη: | Background: Borderline personality disorder (BPD) is characterized by affective instability and amygdala hyperreactivity. Although dialectical behavior therapy (DBT) reduces symptoms and amygdala-related abnormalities, many patients show only partial remission. Real-time functional magnetic resonance imaging (fMRI) amygdala neurofeedback (amy-NF) directly targets hyperactive limbic responses and has shown promise in uncontrolled trials. We examined whether amy-NF adds benefit to inpatient DBT. Methods: Thirty-six mid-therapy people with BPD and clinically significant residual symptoms (BSL-23 > 1.5) were randomized to DBT plus amy-NF (n = 23) or DBT alone, termed treatment as usual (TAU = 13). Post-treatment assessments were completed by 15/9 (amy-NF/TAU), with 15/8 and 12/7 completing the 3- and 6-month follow-ups. Ecological momentary assessment (EMA) of daily-life affective instability served as the primary outcome. Secondary outcomes included self-reports, amygdala responses during two fMRI tasks, and resting-state fMRI. Assessments occurred at pre-, post-, 3-, and 6-month follow-up. Results: Participants successfully downregulated amygdala activity during neurofeedback. EMA showed improvements in negative affect, inner tension, and affective instability over time, without consistent superiority of amy-NF. Self-reports likewise showed no additional benefit of amy-NF, and BSL-23 scores increased after discharge in both groups. Amy-NF was associated with transient pre-post reductions in amygdala activity during both viewing and regulation in the emotion regulation task, and with more stable amygdala reactivity over time than TAU in the faces task. Resting-state analyses showed transient pre-post increases in amygdala connectivity with precuneus and dorsomedial frontal regions in amy-NF. Conclusions: Amygdala neurofeedback is feasible and reduced amygdala activity in BPD, but did not yield additional clinical benefit when delivered alongside intensive residential DBT, although the small sample may have limited power to detect such effects. Trial Registration: The study protocol was preregistered 2020/03/26 on ClinicalTrials.gov and received the ID NCT04333888. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Medical Faculty Mannheim / Heidelberg University (registration code: 2020–513N) and was conducted according to the Declaration of Helsinki. All participants provided written informed consent and were financially compensated for their participation (13 €/session and 40 € per EMA assessment). Consent for publication: Not applicable. Competing interests: CS reports consultancy honoraria from Boehringer Ingelheim GmbH unrelated to the topic of this article. MH, PS, NK and CP have no conflict of interests to report. |
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| Contributed Indexing: | Keywords: Amygdala; Borderline personality disorder; Clinical trial; Dialectical beahavior therapy; Ecological momentary assessment; Neurofeedback |
| Molecular Sequence: | ClinicalTrials.gov NCT04333888 |
| Entry Date(s): | Date Created: 20261016 Date Completed: 20261017 Latest Revision: 20261020 |
| Update Code: | 20261020 |
| PubMed Central ID: | PMC13675997 |
| DOI: | 10.1186/s12888-026-08767-7 |
| PMID: | 42888408 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1471-244X |
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| DOI: | 10.1186/s12888-026-08767-7 |