Publication details
Combining Dialectical behavior therapy (DBT) and Repetitive transcranial magnetic stimulation (rTMS) in Borderline personality disorder (BPD): A double-blinded placebo-controlled longitudinal study – pilot data presentation
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| Year of publication | 2025 |
| Type | Conference abstract |
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| Description | Borderline personality disorder (BPD) is a highly prevalent psychiatric condition associated with one of the highest suicide rates among mental health disorders. Core symptoms, including emotion dysregulation, impulsive behavior, interpersonal ineffectiveness often lead to life-threatening and quality-of-life interfering behavior. Although DBT is considered one of the most effective evidence-based treatment for people with BPD, high dropout rates - particularly within the first quarter of treatment - remain a significant challenge (Arntz et al., 2022). Repetitive transcranial magnetic stimulation (rTMS) in a non-invasive, well-tolerated brain stimulation method with broad range of clinical applications, including BPD. Research data from rTMS in BPD show improvements in emotion regulation, impulsivity and other BPD symptoms, but its major disadvantage is a lack of long-term effect duration (lasting up to 3 months). Based on our previous findings we aim to combine these two novel methods to overcome their disadvantages and enhance their mutual treatment effects. This study is the first placebo-controlled, double-blind, longitudinal investigation to examine the combined effects of DBT and rTMS in BPD. Participants were assigned to one of four groups: (1) DBT + active rTMS, (2) DBT + sham rTMS, (3) no DBT + active rTMS, and (4) no DBT + sham rTMS. This design allowed us to study the effects of DBT, rTMS and their combination. DBT group underwent full 6 months comprehensive DBT program (two skills groups per week), non-DBT group consisted of individuals on waiting list receiving treatment as usual (TAU). rTMS protocol consisted of 15 stimulations in 15 days, with an intensity of 120% RMT, 2000 pulses per session with 10Hz frequency in the right DLPFC. For sham stimulation sham coil that produces very similar audio and somatic experience was used. DBT treatment and rTMS treatment had the same starting point. Neuroimaging, clinical, behavioral and ecological momentary assessment data (EMA) collection followed a longitudinal design with five assessment points: T1 to two weeks prior to treatment, T2 up to two weeks after rTMS stimulation, T3 nine to ten weeks after (halfway point of DBT), T4 twelve weeks after (DBT completion) and T5 six months post-treatment. For neuroimaging and behavioral assessment Go/No-Go task, Hariri task and fMRI amygdala neurofeedback were used. To assess clinical outcomes, we used both self-report methods (e.g. UPPSP, DERS, BSL-23, BDI-II, BAI, MDI) and semi-structured interviews (MADRS, LSASI, THI). This abstract presents preliminary findings from an ongoing study. The results will contribute to a deeper understanding of the efficacy of DBT and rTMS in BPD treatment and may inform future clinical applications. |
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