Learn to control your anger: neural effects of mechanism-based anti-aggression psychotherapy in borderline personality disorder
Introduction: Severe anger and overt aggression are common phenomena in borderline personality disorder (BPD) which have serious negative consequences for those affected and their environment. New developments in psychotherapy for personality disorders aim to target etiological mechanisms involved i...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
December 15, 2025
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| In: |
Psychopathology
Year: 2025, Pages: ? |
| ISSN: | 1423-033X |
| DOI: | 10.1159/000549876 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1159/000549876
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| Author Notes: | Marc Wenigmann, Corinne Neukel, Karen Spiess, Katja Bertsch, Sabine C. Herpertz |
| Summary: | Introduction: Severe anger and overt aggression are common phenomena in borderline personality disorder (BPD) which have serious negative consequences for those affected and their environment. New developments in psychotherapy for personality disorders aim to target etiological mechanisms involved in psychopathology. Since affect dysregulation is a prominent biobehavioral mechanism underlying overt aggressive behavior in BPD, we aimed to clarify whether a psychotherapy that has been shown to decrease aggression in BPD does indeed modulate this mechanism. Methods: Accordingly, the neural effects of a novel mechanism-based anti-aggression psychotherapy (MAAP) were compared to those of a nonspecific supportive psychotherapy (NSSP). Twenty-seven highly overt aggressive patients with BPD and 29 healthy controls were included in this functional magnetic resonance imaging (fMRI) study. Results: The BPD patients treated with MAAP showed an increase in neural activation in clusters comprising the left anterior insula, the right dorsomedial prefrontal cortex (PFC) and the bilateral anterior caudate being related to a reduction in overt aggression. In contrast, the BPD group that had received NSSP exhibited a decrease in activity in the aforementioned clusters, each associated with a rise in overt aggressive behavior. Furthermore, MAAP showed an increase and NSSP a decrease in context-dependent functional connectivity between the caudate seed cluster mentioned above and the left dorsolateral PFC. Likewise, this interaction effect was negatively related to the change in overt aggression with an OAS-M reduction for the MAAP and a rise for the NSSP group. Conclusion: The data may suggest that the aggression-reducing effect of MAAP is mediated through increasing cognitive control over dysregulated feelings of anger. This study aimed to investigate a presumed mechanism of efficacy of a certain type of psychotherapy for people with borderline personality disorder. Since failed social interactions often trigger strong feelings of anger and sometimes aggressive behavior in this psychiatric disorder, patients are greatly affected. It is therefore essential to tailor treatment to this specific symptom by targeting the suspected mechanisms of efficacy. One such factor is thought to be a lack of ability to regulate one's own emotions. Our working group has developed a special mechanism-based anti-aggression psychotherapy that focuses on this specific problem, among other things. Here, we used a laboratory task performed in a MRI scanner to test whether this new therapy was capable of positively influencing this affective dysregulation compared to a competing intervention and whether this was reflected in the brain activity pattern. Our therapy program increased activity in certain areas of the brain that are generally believed to play an important role in the voluntary control of emotions and behavior, which in turn was associated with a reduction in aggressive behavior among participants. However, participants in the competitive therapy program showed opposite results. Brain activity declined in the specified areas, and at the same time, more aggressive behavior was reported by the group. Our study thus makes an essential contribution to the targeted optimization of therapy programs and to the understanding of the mechanisms behind them. |
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| Item Description: | Gesehen am 22.04.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1423-033X |
| DOI: | 10.1159/000549876 |