# Cognitive Reappraisal Training Targeting Emotion Circuits As a Therapeutic Intervention in Borderline Patients

> **NIH NIH R61** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2021 · $980,782

## Abstract

Project Summary/Abstract
 Borderline Personality Disorder (BPD) is a prevalent, enduring and disabling psychiatric condition found
in approximately 2% to 5.9% of the population [1, 2] and 20% of hospitalized psychiatric patients. Suicide
rates of approximately 10% have been reported [3]. One of the most prominent clinical features of BPD is
extreme mood shifts [4-6] occurring in response to external social/emotional events [7-9]. The emotional
instability in BPD contributes to many of the most disabling, even life-threatening, symptoms of the disorder,
including suicidality, outbursts of intense anger, and seriously impaired role functioning [10]. The severity of the
BPD symptom profile, its prevalence, chronicity and high burden upon health care services [11-13] make the
development of effective and accessible treatment for BPD a high priority. Yet there is no current medication
treatment indicated for BPD and the psychotherapies recognized for the disorder have been shown to have
small effect sizes and are of limited availability.
 The present study builds upon work by our group that has shown that deficiencies in the ability to
regulate emotion by engaging typically adaptive cognitive strategies (cognitive reappraisal, CR) and to
effectively activate associated neural systems can be corrected by focused training in CR. The R61 phase of
this study examines a manualized intensive training program in CR, tests that it effects target neural systems
implicated in emotional processing and enhances behavioral reappraisal success. It examines 2-, 4- and 6-
weeks of twice a week treatment to identify the optimal dose. Measures include fMRI imaging and clinical
ratings at baseline and each of these subsequent time points. Upon demonstrating that CR training is superior
to a control condition in enhancing performance in the neural target at one or more of these dose durations, we
will proceed to the R33 phase.
 In the R33 phase we will treat a larger sample of BPD patients at the optimal dose defined in the R61
phase to 1) demonstrate reproducibility of the R61 findings, 2) to demonstrate that CR training is superior to
control in improving BPD clinical outcomes at the end of treatment and at 1- and 4- month follow-up, and 3)
that change in activity at the neural targets is associated with clinical improvement.
 The results of this study can support the introduction of CR training as a new psychosocial approach for
the treatment of BPD, either as stand-alone treatment or as an augmenting strategy. It may, moreover, have
application to a range of psychiatric disorders characterized by severe emotional instability.

## Key facts

- **NIH application ID:** 10286406
- **Project number:** 1R61MH125130-01A1
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Harold W Koenigsberg
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $980,782
- **Award type:** 1
- **Project period:** 2021-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10286406

## Citation

> US National Institutes of Health, RePORTER application 10286406, Cognitive Reappraisal Training Targeting Emotion Circuits As a Therapeutic Intervention in Borderline Patients (1R61MH125130-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10286406. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*