Two journal articles suggest why the mindfulness-based cognitive psychotherapies change the brain circuitry of mania, depression and anxiety.
Borderline personality disorder: The ‘perfect storm’ of emotion dysregulation
Date:January 15, 2013
Originally, the label “borderline personality disorder” [a close “cousin” to bipolar and sz] was applied to patients who were thought to represent a middle ground between patients with neurotic and psychotic disorders. Increasingly, though, this area of research has focused on the heightened emotional reactivity observed in patients carrying this diagnosis, as well as the high rates with which they also meet diagnostic criteria for posttraumatic stress disorder and mood disorders [like anxiety, mania or depression].
New research now published in Biological Psychiatry from Dr. Anthony Ruocco at the University of Toronto and his colleagues paints perhaps the sharpest picture we have so far of the patterns of brain activity which may underlie the intense and unstable emotional experiences associated with this diagnosis.
In their report, the investigators describe two critical brain underpinnings of emotion dysregulation in borderline personality disorder: heightened activity in brain circuits involved in the experience of negative emotions and reduced activation of brain circuits that normally suppress negative emotion once it is generated [circumstances we know from other research that meditation and mindfulness-based cognitive psychotherapies can influence and even change at a physiological level].
To accomplish this, they undertook a meta-analysis of previously published neuroimaging studies to examine dysfunctions underlying negative emotion processing in borderline personality disorder. A thorough literature search identified 11 relevant studies from which they pooled the results to further analyze, providing data on 154 patients with borderline personality disorder and 150 healthy control subjects.
Ruocco commented, “We found compelling evidence pointing to two interconnected neural systems which may subserve symptoms of emotion dysregulation in this disorder: the first, centered on specific limbic [emotion experience and regulation] structures, which may reflect a heightened subjective perception of the intensity of negative emotions, and the second, comprised primarily of frontal brain regions, which may be inadequately recruited to appropriately regulate emotions.”
Importantly, reduced activity in a frontal area of the brain, called the subgenual anterior cingulate, may be unique to borderline personality disorder [it isn’t; other research shows “weak” anterior cingulate activity in the brains of patients with bipolar and in some cases those with sz] and could serve to differentiate it from other related conditions, such as recurrent major depression.
“This new report adds to the impression that people with borderline personality disorder are ‘set-up’ by their brains to have stormy emotional lives, although not necessarily unhappy or unproductive lives,” commented Dr. John Krystal, Editor of Biological Psychiatry.
“Given that many of the most effective psychotherapies [including thus-far research-proven DBT, MBSR, MBCT and ACT] for borderline personality disorder work to improve emotion regulation skills, these findings could suggest that dysfunctions in critical frontal ‘control’ centers might be normalized after successful treatment,” concluded Ruocco.
Anthony C. Ruocco, Sathya Amirthavasagam, Lois W. Choi-Kain, Shelley F. McMain. Neural Correlates of Negative Emotionality in Borderline Personality Disorder: An Activation-Likelihood-Estimation Meta-Analysis.Biological Psychiatry, 2013; 73 (2): 153 DOI:10.1016/j.biopsych.2012.07.014
People who experience rage attacks have smaller ‘emotional brains’
Date: January 12, 2016
Neuroimaging studies suggest that frontolimbic regions of the brain, structures that regulate emotions, play an important role in the biology of aggressive behavior. A new article reports that individuals with intermittent explosive disorder (IED) have significantly lower gray matter volume in these frontolimbic brain structures. In other words, these people have smaller “emotional brains.”
[This research is significant to psychotherapists because other research has demonstrated that the DBT, MBCT, MBSR and ACT psychotherapies are associated with increasing volumes in the same region, and that the similar but more recently introduced – and more “concentrated” – MBBT, 10 StEP, SEPT and SMPT psychotherapies should do the same for some medicinally stabilized patients, albeit more quickly.]
“Intermittent explosive disorder is defined in DSM-5 as recurrent, problematic, impulsive aggression,” explained Dr. Emil Coccaro, the article’s lead author. “While more common than bipolar disorder and schizophrenia combined, many in the scientific and lay communities believe that impulsive aggression is simply ‘bad behavior’ that requires an ‘attitude adjustment.’ However, our data confirm that IED, as defined by DSM-5, is a brain disorder and not simply a disorder of ‘personality.’” Dr. Coccaro is the E.C. Manning Professor and Chair of Psychiatry and Behavioral Neuroscience at the University of Chicago.
Dr. Coccaro and his colleagues also report a significant inverse correlation between measures of aggression and frontolimbic gray matter volume.
The investigators collected high-resolution magnetic resonance imaging (MRI) scans in 168 subjects, including 57 subjects with IED, 53 healthy control subjects, and 58 psychiatric control subjects. The team found a direct correlation between history of actual aggressive behavior and the magnitude of reduction in gray matter volume, linking both in a dimensional relationship.
“Across all subjects, reduced volume in frontolimbic brain structures was associated with increased aggressiveness,” commented Dr. Cameron Carter, Professor of Psychiatry and Behavioral Sciences at University of California, Davis and Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. “These important findings suggest that disrupted development of the brain’s emotion-regulating circuitry may underlie an individual’s propensity for rage and aggression.”
Emil F. Coccaro, Daniel A. Fitzgerald, Royce Lee, Michael McCloskey, K. Luan Phan. Frontolimbic Morphometric Abnormalities in Intermittent Explosive Disorder and Aggression. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2016; 1 (1): 32 DOI:10.1016/j.bpsc.2015.09.006
DBT – http://behavioraltech.org/resources/whatisdbt.cfm
MBSR – http://www.mindfullivingprograms.com/whatMBSR.php
MBCT - http://www.ncbi.nlm.nih.gov/pubmed/22340145
ACT – https://contextualscience.org/act
10 StEP – http://pairadocks.blogspot.com/2015/04/the-10-steps-of-emotion-processing.html
MBBT – https://www.newharbinger.com/blog/introduction-mind-body-bridging-i-system
SEPT – https://en.wikipedia.org/wiki/Somatic_Experiencing
SMPT – https://en.wikipedia.org/wiki/Sensorimotor_psychotherapy