Randomized trial to assess Metacognitive Interpersonal Therapy's impact on BPD clinical and neurobiological markers

Patients with Borderline Personality Disorder (BPD) often experience severe emotion dysregulation and interpersonal difficulties, leading to significant distress and functional impairment. Current standard-of-care treatments, while helpful, may not fully address the complex interplay of cognitive, emotional, and neurobiological factors. Metacognitive Interpersonal Therapy (MIT-SA) offers a structured approach to improve metacognitive abilities and emotion regulation, potentially leading to more profound and sustained changes by targeting underlying neurobiological mechanisms, including BDNF, oxytocin, and vasopressin pathways.

This randomized clinical trial will enroll N=90 participants: 30 BPD patients receiving Metacognitive Interpersonal Therapy -standard approach (MIT-SA), 30 BPD patients receiving Clinical Structured Treatment (CST) based on APA guidelines, and 30 healthy controls. BPD patients, aged 18-50 years, will undergo multidimensional assessments at baseline, 6, 12, and 18 months. Assessments include structural and functional MRI scans at baseline and post-treatment, and blood analyses for BDNF, oxytocin, and vasopressin levels before and after treatments. Clinical changes in metacognitive abilities and emotion regulation will be measured via questionnaires like the Interpersonal Reactivity Index (SPF-IRI). Participants will be screened using SCID-II and DIB-R for BPD diagnosis.