Amygdala neurofeedback as an adjunct to residential dialectical behavior therapy for borderline personality disorder: a pilot randomized controlled trial.
Miroslava Hofmanová, Philip S Santangelo, Nikolaus Kleindienst et al.
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In 30 seconds
This pilot randomized controlled trial tested whether real-time fMRI amygdala neurofeedback (amy-NF) adds benefit to residential dialectical behavior therapy (DBT) for people with borderline personality disorder and residual symptoms. Thirty-six participants were assigned to DBT plus amy-NF or DBT alone. Participants receiving neurofeedback could downregulate amygdala activity, but daily-life affective instability and self-reported symptoms improved over time without consistent clinical superiority for amy-NF. Neuroimaging changes were observed, including transient reductions in amygdala activity during an emotion-regulation task; BSL-23 scores increased after discharge in both groups.
Key findings
- Daily-life negative affect, inner tension, and affective instability improved over time, without consistent superiority of amy-NF over DBT alone.
- Self-reports showed no additional benefit from amy-NF, and BSL-23 scores increased after discharge in both groups.
- Participants successfully downregulated amygdala activity during neurofeedback; transient pre-post neuroimaging changes were also observed.
Why it matters
The trial distinguishes target engagement from clinical benefit: participants could regulate amygdala activity during neurofeedback, but this did not translate into consistent additional symptom improvement alongside intensive residential DBT. This is relevant when evaluating neurofeedback as an adjunct, since changes in brain activity alone do not establish added patient benefit.
What to keep in mind
The authors note that the small sample may have limited power to detect clinical effects. Follow-up assessments were completed by fewer participants than were randomized.