Metacognitive interpersonal therapy in borderline personality disorder: Clinical and neuroimaging outcomes from the CLIMAMITHE study-A randomized clinical trial.

Roberta Rossi, Daniele Corbo, Laura R Magni, Michela Pievani, Giuseppe Nicolò, Antonio Semerari, Giulia Quattrini, Ilaria Riccardi, Livia Colle, Laura Conti, Roberto Gasparotti, Ambra Macis, Clarissa Ferrari, Antonino Carcione
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引用次数: 3

Abstract

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).

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边缘型人格障碍的元认知人际治疗:climmithe研究的临床和神经影像学结果-一项随机临床试验。
不同的心理治疗方法证明了它们的疗效,但心理治疗对边缘型人格障碍(BPD)患者影响的可能的神经生物学机制尚不清楚。与结构化临床管理(SCM)相比,我们评估了元认知人际治疗(MIT)对BPD特征和其他维度的影响。我们还通过观看心理治疗后的情绪图片来评估杏仁核激活的变化。141名患者被纳入,78名BPD门诊患者被随机分配到MIT或SCM组。主要结局是用情绪调节困难量表(DERS)评估情绪失调。我们还评估了BPD的症状、PD标准的数量、元认知能力、状态精神病理学、抑郁、冲动、人际功能和述情障碍。60名患者在心理治疗前后分别接受了功能性磁共振成像,通过观看标准化的情绪图片来评估杏仁核的激活情况(次要结果)。两组患者的DERS评分均降低(时间效应p < 0.001)。在MIT中,DERS变化(基线治疗后)的Cohen's d效应量非常大(d = 0.84),在SCM中则很大(d = 0.76)。两组在抑郁症状、状态精神病理、述情障碍和人际功能方面均有显著改善。MIT对元认知功能的影响大于SCM(时间×组p < 0.001)。两种干预措施均对BPD症状有显著影响,但SCM组下降幅度更大。相反,MIT组在冲动性和PD标准数量上有较大的下降。有趣的是,MIT和SCM都能调节BPD患者的杏仁核激活。MIT是一种有效的治疗BPD的方法,对杏仁核激活有影响。(PsycInfo数据库记录(c) 2023 APA,版权所有)。
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