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Borderline-Persönlichkeitsstörung

Veränderung der Hirnstruktur und -funktion durch Psychotherapie
  • C. Schmahl
  • I. Niedtfeld
  • S. C. Herpertz
Leitthema
  • 99 Downloads

Zusammenfassung

Hintergrund

Es existieren inzwischen mehrere wissenschaftlich evaluierte Psychotherapieverfahren für die Borderline-Persönlichkeitsstörung (BPS), die alle auf eine Verbesserung der Fähigkeit zur Emotionsregulation zielen. In den vergangenen Jahren wurden erste Studien zu den neuronalen Korrelaten von Mechanismen der Emotionsregulation sowie von durch psychotherapeutische Interventionen hervorgerufenen Veränderungen durchgeführt.

Methoden

Wir geben eine Übersicht über die Datenlage zu funktionellen und strukturellen Bildgebungsstudien, die Facetten der Emotionsregulationsstörung vor und nach Psychotherapie untersuchen.

Ergebnisse

Obwohl die Datenlage insgesamt noch dünn ist, scheint die klinische Besserung nach Psychotherapie mit einer Modulation von Hirnstruktur und -funktion einherzugehen. Insbesondere frontolimbische Regulationskreise einschließlich der Amygdala, der Insula, des anterioren zingulären Kortex (ACC) und andere präfrontale Bereiche scheinen in diese Veränderungen involviert zu sein scheinen. Ein wichtiger Befund ist die Reduktion der initial erhöhten Amygdalaaktivität nach erfolgreicher Dialektisch-Behavioraler Therapie (DBT).

Diskussion

Die gezeigten Veränderungen spiegeln sehr wahrscheinlich eine Verbesserung der Emotionsregulationsfähigkeiten bei der BPS wider und belegen die Möglichkeit der Modulation gestörter Emotionsregulationsprozesse. Da Langzeitverläufe bislang fehlen, muss die Nachhaltigkeit der sich andeutenden Verbesserungen in weiteren Studien noch nachgewiesen werden.

Schlüsselwörter

Dialektisch-Behaviorale Therapie Emotionsregulation Amygdala Neurofeedback Bildgebungsstudien 

Borderline personality

Alterations to brain structure and function through psychotherapy

Abstract

Background

There are now several scientifically evaluated psychotherapeutic methods for borderline personality disorder (BPD), all of which aim to improve the ability to regulate emotions. In recent years, there have been first studies on the neuronal correlates of the mechanisms of emotion regulation and of changes caused by psychotherapeutic interventions.

Methods

This article reviews the data on functional and structural imaging studies that examine facets of disturbed emotion regulation before and after psychotherapy.

Results

Although the overall database is still sparse, clinical improvement in psychotherapy appears to be associated with modulation of brain structure and function. Frontolimbic regulation circuits including the amygdala, insula, anterior cingulate cortex (ACC) and other prefrontal areas appear to be involved in these changes. An important finding is the reduction of initially increased amygdala activity after successful Dialectical Behavior Therapy (DBT).

Conclusion

The changes shown here most probably reflect an improvement in emotion regulation capacities in BPD and demonstrate the possibility of modulating disturbed emotion regulation processes. Since long-term follow-up data are still missing, the sustainability of the suggestive improvements still has to be proven in further studies.

Keywords

Dialectical Behavior Therapy Emotion regulation Amygdala Neurofeedback Imaging studies 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Schmahl, I. Niedtfeld und S.C. Herpertz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Psychosomatik und Psychotherapeutische MedizinZentralinstitut für Seelische Gesundheit, J5MannheimDeutschland
  2. 2.Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale MedizinUniversitätsklinikum HeidelbergHeidelbergDeutschland

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