# Emotion-focused vs. cognitive interventions of schema therapy for borderline personality disorder: effects on neural emotion regulation networks - study protocol

## TL;DR

This study investigates how emotion-focused and cognitive therapy methods in schema therapy affect brain networks related to emotion regulation in people with borderline personality disorder.

## Contribution

The study introduces a dismantling design to compare specific schema therapy interventions' effects on neural and clinical outcomes in BPD.

## Key findings

- Emotion-focused interventions will be compared to cognitive ones using neuroimaging and clinical assessments.
- Resting-state functional connectivity and neurotransmitter metabolism will be measured in key brain regions before, after, and six months post-treatment.
- The study aims to identify how different interventions impact neural emotion regulation networks in BPD.

## Abstract

While the effects of psychotherapy methods are being intensively researched, little is known about the clinical and neurobiological effects of specific psychotherapeutic interventions. This study examines the effects of experiential emotion-focused and cognitive interventions in schema therapy on emotion regulation in borderline personality disorder.

In a randomized, single-blinded, parallel group design, clinical effects and effects on resting-state functional connectivity in neural emotion regulation networks and neurotransmitter metabolism (Glx/GABA) in key regions of these networks are compared. The 9-week treatment protocol includes emotion-focused interventions such as chair dialogues, imagery rescripting, or mode role-playing in the test condition; these interventions are omitted in the active control condition (dismantling design). Resting-state functional MR imaging (rsfMRI) and MEGA-sLASER 1 H MR spectroscopy in the pregenual cingulate cortex (pgACC), anteromedial cingulate cortex (aMCC), and dorsolateral prefrontal cortex (DLPFC) are performed before and after the therapy interval and 6 months after the end of therapy and compared with the neurobiological parameters of healthy control subjects. The clinical effects are recorded using a comprehensive test battery and specified using the Reliable Change Index (RCI). Clinical and biological data are examined using mixed model analysis both longitudinally and in terms of their interactions.

The aim is to show that different psychotherapeutic interventions have different effects on deficits in emotion regulation associated with specific effects on neural emotion regulation networks. This would contribute to a better understanding of the neurobiological effects and mechanisms underlying psychotherapeutic core interventions and to their more targeted use in BPD and other related disorders in the future.

ClinicalTrials.gov Identifier: NCT06367907, Retrospectively registered, April 2024.

The online version contains supplementary material available at 10.1186/s40479-025-00311-5.