1. www.abdn.ac.uk Social and emotional processing in Borderline Personality Disorder James Cusack Research Fellow in Psychiatry University of Aberdeen

2. www.abdn.ac.uk My aims I would like to get your views on my research plans. To understand social and emotional processing in Borderline Personality Disorder. To understand the effect of psychotherapy on Borderline Personality Disorder.

3. Background

4. www.abdn.ac.uk Theory of mind The ability to understand the intentions, desires, emotions and beliefs of another individual. The Sally-Anne task

5. www.abdn.ac.uk The brain Images from www.wellcomecollection.org

6. www.abdn.ac.uk The visual cortex Images from www.wellcomecollection.org

7. www.abdn.ac.uk A face Images from Nature Neuroscience, Vuilleumeier et al. (2003)

8. www.abdn.ac.uk Processing of faces Images from www.wellcomecollection.org

9. www.abdn.ac.uk Emotional arousal Images from www.wellcomecollection.org

10. www.abdn.ac.uk The amygdala Rapid response to emotional stimuli Emotional arousal Emotional learning Image From Frontiers in brain imaging methods, Hanson et al. (2012)

11. www.abdn.ac.uk A face Image from Nature Neuroscience, Vuilleumeier et al. (2003)

12. www.abdn.ac.uk An emotional face Image from Nature Neuroscience, Vuilleumeier et al. (2003)

13. www.abdn.ac.uk Which one excites the amygdala? Image from Nature Neuroscience, Vuilleumeier et al. (2003)

14. www.abdn.ac.uk Introducing BPD Characterised by problems with emotional regulation We know that forming relationships is something which can present challenges Complex interaction between environmental and genetic factors The amygdala is important for emotional regulation

15. www.abdn.ac.uk Social cognition in BPD Increased sensitivity to facial expression in BPD? Yes Image from Nature Neuroscience, Vuilleumeier et al. (2003)

16. www.abdn.ac.uk The amygdala in BPD Structurally smaller “Hypersensitive” “Highly vigilant” Image From Frontiers in brain imaging methods, Hanson et al. (2012)

17. www.abdn.ac.uk Theory of mind in BPD Performance on two tasks were studied in people with BPD. Image from Psychiatry Research, Harai et al. (2010) Scores

18. www.abdn.ac.uk Mirror Neurons Neurons which fire during the performance and observation of the same sensory action. Image from Neuroscience and biobehavioral reviews Molenberghs et al. (2012)

19. www.abdn.ac.uk Mirroring and BPD Social development Simulation Imitation

20. www.abdn.ac.uk Research questions How well do people with BPD imitate (copy) the facial expression of others? Intensity of simulation process as a consequence of increased affective sensitivity? Would this lead to better empathy? Or is imitation something which presents challenges? How does imitation ability relate to other skills in BPD?

21. www.abdn.ac.uk Social cognition 1.Attend to salient emotion 2.Understand perspective of individual, 3.Regulation of emotion

22. www.abdn.ac.uk How does emotion regulation work? They amygdala and the prefrontal cortex Amygdala Dorsomedial prefrontal cortex Ventromedial prefrontal cortex

23. www.abdn.ac.uk Emotional regulation in BPD Cortico-limbic disconnection model Sensitivity to facial expression Current evidence A risk factor? Cognitive reappraisal

24. www.abdn.ac.uk Performing theory of mind 1.Attend to salient emotion 2.Understand perspective of individual 3.Regulation of emotion

25. www.abdn.ac.uk Research questions How well do people with BPD imitate (copy) the facial expression of others? Intensity of simulation process as a consequence of increased affective sensitivity? Would this lead to better empathy? Or is imitation something which presents challenges? How does imitation ability relate to other skills in BPD? How do any difficulties with regulation relate to imitation?

26. www.abdn.ac.uk Mentalisation-based therapy Effective in the treatment of BPD Aims to help individual understand the mental states of others and themselves. How does this therapy work?

27. www.abdn.ac.uk Research questions How well do people with BPD imitate (copy) the facial expression of others? Does psychotherapy have an effect on the ability to imitate in BPD? What mechanisms does psychotherapy tap in to? Does psychotherapy improve imitative ability? What about emotional regulation?

28. Answering our research questions

29. www.abdn.ac.uk Aim: to develop a task to detect subtle deficits of facial imitation We need facial expressions that vary in a dimensional and meaningful way Morphing

30. www.abdn.ac.uk Blending Darwin’s six emotions

31. www.abdn.ac.uk Blending contrasting emotions in 3D ‘Face-Space’

32. www.abdn.ac.uk Facial imitation task?

33. www.abdn.ac.uk Data analysis? Manual rating

34. www.abdn.ac.uk Manual rating

35. www.abdn.ac.uk Data analysis? Manual rating Image processing and computer vision algorithms

36. www.abdn.ac.uk Facial imitation task?

37. www.abdn.ac.uk Methodological principles Quantitative measurements Reliably measure threshold of individual performance, not just group average Multiple comparison groups

38. www.abdn.ac.uk The plan We would like to recruit people with BPD and people who do not have BPD. We will compare performance on this task before and after psychotherapy. Other tasks.

39. www.abdn.ac.uk Outcome of this study Further understanding of mechanisms which underpin BPD and psychotherapy What parts of the brain are different in BPD? How can we help understand what leads to the difficulties experienced by people with BPD? Provide an explanation for BPD. How can we improve interventions? How can we aid identification of symptoms to ensure rapid treatment?

40. www.abdn.ac.uk Future research questions Psychophysiology Brain imaging Automated measures of face to face interaction – outcome measures

41. www.abdn.ac.uk Thanks Thank you to you all for your time Thank you to the psychiatry group for their comments

42. j.cusack@abdn.ac.uk James Cusack Research Fellow in Psychiatry University of Aberdeen