Mindfulness-based Neurofeedback to Augment Psychotherapy for Adults With Borderline Personality Disorder

The focus of this study is Aim 1.

• mindfulness-based Neurofeedback (Behavioral): Participants will complete one session of mindfulness-based fMRI neurofeedback prior to 20 weeks of remote online weekly DBT skills group.
• control Neurofeedback (Other): Participants will complete one session of control fMRI neurofeedback prior to 20 weeks of remote online weekly DBT skills group.

Primary outcomes

• Change in within-Default Mode Network (DMN) resting state functional connectivity after one session of neurofeedback (NF) [From baseline (immediately before neurofeedback) to immediately after neurofeedback on the same day]: Defined as within-DMN connectivity as the resting state seed-based connectivity between core nodes of medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC). Change = post-NF within-DMN connectivity - pre-NF within-DMN connectivity.
• Change in DMN-Frontoparietal Control Network (FPCN) anticorrelation in resting state functional connectivity data after one session of neurofeedback [From baseline (immediately before neurofeedback) to immediately after neurofeedback on the same day]: Defined as DMN-FPCN anticorrelation as the fMRI seed-based connectivity from mPFC to dorsolateral prefrontal cortex (dlPFC)). Change = post-NF mPFC-dlPFC anticorrelation - pre-NF mPFC-dlPFC anticorrelation

Secondary outcomes

• Change from baseline in state mindfulness on State Mindfulness Scale (SMS) score on same day after neurofeedback. [From baseline (immediately before neurofeedback) to immediately after neurofeedback on the same day]: The State Mindfulness Scale (SMS) is a validated self-reported 21 item instrument assessing state mindfulness over the past 15 minutes. Possible scores range from 21 (not mindful) to 105 (very mindful).

Sex: All, ages: 18 Years to 60 Years

Inclusion criteria:

* age 18-60,
* be able to provide written informed consent,
* meet criteria for BPD on semi-structured clinical interview,
* able to plan to keep any prescribed medications and psychotherapy constant during the study
* fluent in English.

Exclusion criteria:

* current DBT psychotherapy outside the study
* lifetime primary psychotic disorder
* manic episode in the last one year
* developmental disorder (e.g. autism)
* history of learning disorder
* severe substance use disorder in the last 3 months
* active suicidal ideation with intent or plan in the past 3 months
* history of major medical or neurologic disorder
* MRI contraindications, including pregnancy
* poor performance on reading task (WRAT > 11 errors)
* newly prescribed medications in the past 8 weeks
* daytime sedating medications (e.g. benzodiazepines, opiates, sedating neuroleptics)
* any scheduled daily benzodiazepines
* change in psychotherapy type or frequency in the past 12 weeks.
* At the discretion of the study PI

Eligibility will be determined by study personnel.

• Results publication: Jones KG, Vandewouw MM, Awasthi J, Alario AA, Bauer C, Brewer B, Campbell NA, Denning D, Greene KD, Hammoud J, Hinds O, Huffman S, Maerker C, Paprotna S, Qiu M, Swinchoski B, Taylor A, Waite E, Wighton P, Whaley M, Papa J, Dixon-Gordon K, Hampson M, Whitfield-Gabrieli S, Fineberg SK. A protocol for MIndfulness-based Neurofeedback to augment DBT psychotherapy for adults with Borderline Personality Disorder (MIND-BPD). PLoS One. 2026 Mar 20;21(3):e0338002. doi: 10.1371/journal.pone.0338002. eCollection 2026. PMID 41860884
• Results publication: Jones KG, Vandewouw MM, Awasthi J, Alario AA, Bauer C, Brewer B, Campbell N, Denning D, Greene KD, Hammoud J, Hinds O, Huffman S, Maerker C, Paprotna S, Qiu M, Swinchoski B, Taylor A, Waite E, Wighton P, Whaley M, Papa J, Gordon KD, Hampson M, Whitfield-Gabrieli S, Fineberg SK. A protocol for MIndfulness-based Neurofeedback to augment DBT psychotherapy for adults with Borderline Personality Disorder (MIND-BPD). medRxiv [Preprint]. 2025 Nov 19:2025.11.18.25340531. doi: 10.1101/2025.11.18.25340531. PMID 41332880

• Sarah K Fineberg, MD PhD, Principal investigator, Yale University

NIH grants: R61MH135009