Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran.
Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
J Affect Disord. 2020 Sep 1;274:93-102. doi: 10.1016/j.jad.2020.05.007. Epub 2020 May 20.
Borderline personality disorder (BPD) is primarily characterized by deficient emotion regulation. Impaired cognitive control over negative emotions is central to emotion dysregulation in BPD. Respective executive dysfunctions are associated with hypoactivation of prefrontal regions, and consecutive alterations of fronto-limbic network functionality. Here, we investigated the effect of increasing activity of the dorsolateral prefrontal cortex (DLPFC) with repeated transcranial direct current stimulation (tDCS) on (1) executive dysfunctions and (2) whether improving cognitive control affects emotion dysregulation and emotional processing in BPD.
Thirty-two patients diagnosed with BPD were randomly assigned to active stimulation (N = 16) or sham stimulation (N = 16) group in a randomized, sham-controlled, parallel-group design. They received 10 sessions of active (2 mA, 20 min, anodal left- cathodal right DLPFC) or sham tDCS over 10 days. Major executive functions, emotion regulation strategies, and emotional processing of the patients were assessed before and immediately after the intervention.
The active stimulation group showed a significant improvement in major executive function domains. Importantly, cognitive reappraisal strategy of emotion regulation and several factors of emotional processing involved in the control of emotion significantly improved in the active stimulation group after the intervention. Factors related to emotional expression were, however, not affected.
The single-blind design, absence of follow-up measures, and the intrinsically limited focality of tDCS are limitations of this study.
Increasing activity of the DLPFC improves executive functioning in BPD and improves ´cognitive control over negative emotions. Cognitive control interventions could be a potential, symptom-driven therapeutic approach in BPD.
边缘型人格障碍（BPD）的主要特征是情绪调节不足。对负性情绪的认知控制受损是 BPD 情绪失调的核心。各自的执行功能障碍与前额区域的低激活有关，并伴随着额 - 边缘网络功能的连续改变。在这里，我们研究了重复经颅直流电刺激（tDCS）增加背外侧前额叶皮层（DLPFC）的活动对（1）执行功能障碍和（2）改善认知控制是否会影响 BPD 中的情绪失调和情绪处理的影响。
32 名被诊断为 BPD 的患者被随机分配到积极刺激（N=16）或假刺激（N=16）组，采用随机、假对照、平行组设计。他们在 10 天内接受了 10 次 2 mA、20 分钟、左侧阳极 - 右侧阴极 DLPFC 的积极或假 tDCS。在干预前后评估了患者的主要执行功能、情绪调节策略和情绪处理。
积极刺激组在主要执行功能领域表现出显著改善。重要的是，情绪调节的认知重评策略和情绪处理的几个涉及情绪控制的因素在干预后在积极刺激组中显著改善。然而，与情绪表达相关的因素不受影响。
本研究的局限性在于单盲设计、缺乏随访措施以及 tDCS 固有的有限聚焦。
增加 DLPFC 的活动可改善 BPD 中的执行功能，并改善“对负性情绪的认知控制”。认知控制干预可能是 BPD 的一种潜在的、以症状为驱动的治疗方法。
