Emotion regulation in Borderline Personality Disorder: functional neuronal correlates of habitual and instructed acceptance and suppression of positive and negative emotions

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Patients with borderline personality disorder (BPD) are characterized by affective instability which comprises the experience of rapidly changing, intensive emotional states. It has been argued that affective instability is reinforced and preserved by the use of maladaptive emotion regulation strategies, i. e. suppression of emotions. Behavioral research indicates that emotional suppression consecutively leads to a rebound-effect which includes a paradoxical increase of emotional arousal. It seems likely that the same applies for patients with BPD. In contrast, it is assumed, e.g. in Dialectical Behavior Therapy of BPD, that acceptance of emotions has positive effects on emotional well-being. However, research is missing on the short- and long-term effects of suppression and acceptance of emotions on a neuronal level in patients with BPD. With functional magnetic resonance tomography (fMRT) we address the question of whether emotional suppression contributes to enhanced affect intensity in BPS. On the one hand, we correlate the habitual use of emotional suppression and acceptance as assessed with questionnaires with the neuronal activity in reaction to emotional (negative and positive) visual stimuli. On the other hand, we examine the effects of instructed use of suppression and acceptance of emotions in reaction to emotional visual stimuli after completion of a short emotion regulation training. We expect that emotional suppression in contrast to acceptance causes a rebound-effect of emotional arousal in (para-) limbic brain regions, which is particularly pronounced in patients with BPD compared to a depressive and a healthy control group. Our research findings also provide important implications for the therapy of BPS.