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Change in Emotional and Theory of Mind Processing in Borderline Personality Disorder

A Pilot Study

Kramer, Ueli, PhD*†‡; Kolly, Stéphane, MD; Maillard, Pauline, MPs*; Pascual-Leone, Antonio, PhD; Samson, Andrea C., PhD§∥¶; Schmitt, Ruth, PhD#; Bernini, Adriano, PhD**; Allenbach, Gilles, MD; Charbon, Patrick, MD; de Roten, Yves, PhD*; Conus, Philippe, MD; Despland, Jean-Nicolas, MD*; Draganski, Bogdan, MD**††

The Journal of Nervous and Mental Disease: December 2018 - Volume 206 - Issue 12 - p 935–943
doi: 10.1097/NMD.0000000000000905
Original Articles

Changes in emotional processing (EP) and in theory of mind (TOM) are central across treatment approaches for patients with borderline personality disorder (BPD). Although the assessment of EP relies on the observation of a patient's self-criticism in a two-chair dialogue, an individual's TOM assessments is made based on responses to humorous stimuli based on false beliefs. For this pilot study, we assessed eight patients with BPD before and after a 3-month-long psychiatric treatment, using functional magnetic resonance imaging and behavioral tasks. We observed arousal increase within the session of the two-chair dialogue (d = 0.36), paralleled by arousal decrease between sessions (d = 0.80). We found treatment-associated trends for neural activity reduction in brain areas central for EP and TOM. Our exploratory findings using an integrative assessment procedure of changes in EP and TOM point toward evidence for treatment effects at the brain systems level related to behavioral modulation.

*Institute of Psychotherapy, and

Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland;

Department of Psychology, University of Windsor, Windsor, Ontario, Canada;

§Swiss Center for Affective Sciences, University of Geneva, Geneva;

Swiss Distance Learning University, Brig;

Institut of Special Education, University of Fribourg, Switzerland;

#Department of Psychiatry, University of Heidelberg, Heidelberg, Germany;

**Laboratory for Research in Neuroimaging (LREN), Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; and

††Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.

Send reprint requests to PD Dr Ueli Kramer, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Place Chauderon 18, CH-1003 Lausanne, Switzerland. E-mail:

Ueli Kramer, Stéphane Kolly, Jean-Nicolas Despland, and Bogdan Draganski contributed equally to this work.

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