{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T07:07:23Z","timestamp":1779347243300,"version":"3.51.4"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:p>Although psychotherapy is the first-line treatment for borderline personality disorder (BPD), a substantial set of patients shows limited improvement, underscoring the need for reliable predictors to guide personalized interventions. Neurobiological markers have emerged as promising candidates, yet a comprehensive synthesis of neural predictors is lacking. This mini-review examined six structural and functional magnetic resonance imaging (MRI) studies investigating pre-treatment brain features associated with psychotherapy response in BPD. The studies varied in design, including structural MRI and task-based functional MRI paradigms assessing emotion regulation, inhibitory control, autobiographical memory, affective interference, and attachment-related processing. They also differed in therapy type (primarily Dialectical Behavior Therapy), outcome measures (ranging from global symptom severity, affective instability, emotion regulation, to impulsivity), and analytic approaches, including univariate approaches and machine-learning predictive models, using region-of-interest or whole-brain analyses. Across studies, converging evidence highlights the salience network, particularly the amygdala and anterior cingulate cortex, as central predictor of treatment response. Despite promising findings, current evidence is constrained by small samples, heterogeneous methodologies, and limited follow-up. Larger, longitudinal, and multimodal studies are needed to establish robust neurobiological predictors and support the development of precision-tailored treatments for BPD.<\/jats:p>","DOI":"10.3389\/fnhum.2026.1787003","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T06:17:25Z","timestamp":1779344245000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Neural predictors of psychotherapy response in borderline personality disorder: a mini review of neuroimaging studies"],"prefix":"10.3389","volume":"20","author":[{"given":"Teresa","family":"Baggio","sequence":"first","affiliation":[{"name":"Faculty of Social and Communication Sciences, Mercatorum University","place":["Rome, Italy"]},{"name":"Department of Psychology and Cognitive Science, University of Trento","place":["Trento, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arianna","family":"Teti","sequence":"additional","affiliation":[{"name":"Faculty of Social and Communication Sciences, Mercatorum University","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodolfo","family":"Rizzi","sequence":"additional","affiliation":[{"name":"Faculty of Social and Communication Sciences, Mercatorum University","place":["Rome, Italy"]},{"name":"Department of Psychology and Cognitive Science, University of Trento","place":["Trento, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Grecucci","sequence":"additional","affiliation":[{"name":"Department of Education, Psychology, and Communication Sciences, University of Bari Aldo Moro","place":["Bari, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Messina","sequence":"additional","affiliation":[{"name":"Faculty of Social and Communication Sciences, Mercatorum University","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref1","year":"2013"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1016\/j.cpr.2012.04.004","article-title":"Factors predicting the outcome of psychotherapy for borderline personality disorder: a systematic review","volume":"32","author":"Barnicot","year":"2012","journal-title":"Clin. Psychol. Rev."},{"key":"ref3","first-page":"293","article-title":"Validaci\u00f3n de la versi\u00f3n Espa\u00f1ola de la diagnostic interview for Bordelines-revised (DIB-R) [validation of a Spanish version of the diagnostic interview for Bordelines-revised (DIB-R)]","volume":"32","author":"Barrachina","year":"2004","journal-title":"Actas Esp. Psiquiatr."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1037\/cou0000844","article-title":"Patient experiences of long-term psychodynamic psychotherapy for mood and personality disorders: a systematic review and meta-aggregation of qualitative studies","volume":"73","author":"Barrett","year":"2025","journal-title":"J. Couns. Psychol."},{"key":"ref5","first-page":"185","volume-title":"The Handbook of Mentalization-based Treatment","author":"Bateman","year":"2006"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1528","DOI":"10.1016\/S0140-6736(21)00476-1","article-title":"Borderline personality disorder","volume":"398","author":"Bohus","year":"2021","journal-title":"Lancet"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1521\/pedi_2019_33_439","article-title":"Effect of psychotherapy for borderline personality disorder on quality of life: a systematic review and meta-analysis","volume":"35","author":"Chakhssi","year":"2021","journal-title":"J. Personal. Disord."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1521\/pedi.2018.32.2.175","article-title":"Theories and treatment of borderline personality disorder: commentary on Gunderson","volume":"32","author":"Clarkin","year":"2018","journal-title":"J. Personal. Disord."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1001\/jamapsychiatry.2016.4287","article-title":"Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis","volume":"74","author":"Cristea","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1097\/YCO.0000000000000380","article-title":"Schema therapy for emotional dysregulation in personality disorders: a review","volume":"31","author":"Dadomo","year":"2018","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1176\/appi.ajp.2018.17030367","article-title":"Sensitization of the neural salience network to repeated emotional stimuli following initial habituation in patients with borderline personality disorder","volume":"175","author":"Denny","year":"2018","journal-title":"Am. J. Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1016\/S0006-3223(03)00636-X","article-title":"Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation","volume":"54","author":"Donegan","year":"","journal-title":"Biol. Psychiatry"},{"key":"ref17","first-page":"134","volume-title":"Comprehensive Handbook of Psychological Assessment, Vol. 2. Personality Assessment","author":"First","year":"2004"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.3390\/brainsci13071001","article-title":"One year of outpatient dialectical behavioral therapy and its impact on neuronal correlates of attachment representation in patients with borderline personality disorder using a personalized fMRI task","volume":"13","author":"Flechsig","year":"2023","journal-title":"Brain Sci."},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.3389\/fnbeh.2022.938403","article-title":"Amygdala response predicts clinical symptom reduction in patients with borderline personality disorder: a pilot fMRI study","volume":"16","author":"Geurts","year":"2022","journal-title":"Front. Behav. Neurosci."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1521\/pedi.2022.36.4.431","article-title":"Dialectical behavior therapy for individuals with borderline personality disorder: a systematic review of outcomes after one year of follow-up","volume":"36","author":"Gillespie","year":"2022","journal-title":"J. Personal. Disord."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.jpsychires.2014.06.020","article-title":"Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder","volume":"57","author":"Goodman","year":"2014","journal-title":"J. Psychiatr. Res."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2862","DOI":"10.3390\/s23052862","article-title":"Abnormal brain circuits characterize borderline personality and mediate the relationship between childhood traumas and symptoms: a mCCA+ jICA and random forest approach","volume":"23","author":"Grecucci","year":"2023","journal-title":"Sensors"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1589440","DOI":"10.3389\/fnhum.2025.1589440","article-title":"Salience and default networks predict borderline personality traits and affective symptoms: a dynamic functional connectivity analysis","volume":"19","author":"Grecucci","year":"2025","journal-title":"Front. Hum. Neurosci."},{"key":"ref9001","doi-asserted-by":"publisher","first-page":"255","DOI":"10.31887\/DCNS.2014.16.2\/ghasler","article-title":"Patient-reported outcomes in borderline personality disorder","volume":"16","author":"Hasler","year":"2014","journal-title":"Dialogues in clinical neuroscience"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1037\/per0000453","article-title":"Dropout rates from psychotherapy trials for borderline personality disorder: a meta-analysis","volume":"12","author":"Iliakis","year":"2021","journal-title":"Personality Disorders"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1002\/jclp.20240","article-title":"Schema therapy for borderline personality disorder","volume":"62","author":"Kellogg","year":"2006","journal-title":"J. Clin. Psychol."},{"key":"ref26","volume-title":"Severe Personality Disorders: Psychotherapeutic Strategies","author":"Kernberg","year":"1984"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1111\/psyp.12518","article-title":"The NIMH research domain criteria initiative: background, issues, and pragmatics","volume":"53","author":"Kozak","year":"2016","journal-title":"Psychophysiology"},{"key":"ref28","volume-title":"Cognitive-Behavioral Treatment of Borderline Personality Disorder","author":"Linehan","year":"1993"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"121050","DOI":"10.1016\/j.jad.2025.121050","article-title":"Effectiveness of bipolar-balanced prefrontal tDCS in patients with borderline personality disorder: results from a randomized, double-blind, sham-controlled trial","volume":"398","author":"Lisoni","year":"2026","journal-title":"J. Affect. Disord."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1001\/archpsyc.1994.03950030051005","article-title":"The international personality disorder examination. The World Health Organization\/alcohol, drug abuse, and mental health administration international pilot study of personality disorders","volume":"51","author":"Loranger","year":"1994","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref9002","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40479-014-0022-5","article-title":"Consistency and coherence in treatment outcome measures for borderline personality disorder","volume":"2","author":"Madan","year":"2015","journal-title":"Borderline Personality Disorder and Emotion Dysregulation"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/YCO.0000000000000820","article-title":"Improving treatment outcomes for borderline personality disorder: what can we learn from biomarker studies of psychotherapy?","volume":"36","author":"Marceau","year":"2023","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e0171592","DOI":"10.1371\/journal.pone.0171592","article-title":"The value of psychological treatment for borderline personality disorder: systematic review and cost offset analysis of economic evaluations","volume":"12","author":"Meuldijk","year":"2017","journal-title":"PLoS One"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.jad.2024.08.041","article-title":"Prefrontal cortex engagement during an fMRI task of emotion regulation as a potential predictor of treatment response in borderline personality disorder","volume":"364","author":"Michel","year":"2024","journal-title":"J. Affect. Disord."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s00406-023-01597-8","article-title":"Emotion dysregulation, impulsivity and anger rumination in borderline personality disorder: the role of amygdala and insula","volume":"274","author":"Mitolo","year":"2024","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.jad.2020.05.007","article-title":"Repeated transcranial direct current stimulation of dorsolateral-prefrontal cortex improves executive functions, cognitive reappraisal emotion regulation, and control over emotional processing in borderline personality disorder: a randomized, sham-controlled, parallel-group study","volume":"274","author":"Molavi","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref36","volume-title":"Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease","year":"2011"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.1038\/sj.npp.1301283","article-title":"Amygdala\u2013prefrontal disconnection in borderline personality disorder","volume":"32","author":"New","year":"2007","journal-title":"Neuropsychopharmacology"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.tics.2004.01.004","article-title":"Cortical midline structures and the self","volume":"8","author":"Northoff","year":"2004","journal-title":"Trends Cogn. Sci."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1177\/0004867418791257","article-title":"Specialized psychotherapies for adults with borderline personality disorder: a systematic review and meta-analysis","volume":"52","author":"Oud","year":"2018","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1111\/pcn.12357","article-title":"Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder","volume":"70","author":"Perez","year":"2016","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2502","DOI":"10.1007\/s11682-021-00451-6","article-title":"Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response","volume":"15","author":"Sampedro","year":"2021","journal-title":"Brain Imaging Behav."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e01384","DOI":"10.1002\/brb3.1384","article-title":"Individualized treatment response prediction of dialectical behavior therapy for borderline personality disorder using multimodal magnetic resonance imaging","volume":"9","author":"Schmitgen","year":"2019","journal-title":"Brain Behav."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"3261","DOI":"10.1017\/S0033291723000685","article-title":"Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub) clinical borderline personality disorder? A systematic review and network meta-analysis","volume":"53","author":"Setkowski","year":"2023","journal-title":"Psychol. Med."},{"key":"ref45","first-page":"22","article-title":"The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J. Clin. Psychiatry"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s40479-019-0106-3","article-title":"European guidelines for personality disorders: past, present and future","volume":"6","author":"Simonsen","year":"2019","journal-title":"Borderline Personality Disorder Emotion Dysregulation"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1192\/bjp.2021.204","article-title":"Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis","volume":"221","author":"Stoffers-Winterling","year":"2022","journal-title":"Br. J. Psychiatry"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.tics.2007.01.001","article-title":"The self and social cognition: the role of cortical midline structures and mirror neurons","volume":"11","author":"Uddin","year":"2007","journal-title":"Trends Cogn. Sci."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1016\/j.eurpsy.2007.04.001","article-title":"The cost of borderline personality disorder: societal cost of illness in BPD-patients","volume":"22","author":"van Asselt","year":"2007","journal-title":"Eur. Psychiatry"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e0255055","DOI":"10.1371\/journal.pone.0255055","article-title":"Searching in the dark: shining a light on some predictors of non-response to psychotherapy for borderline personality disorder","volume":"16","author":"Woodbridge","year":"2021","journal-title":"PLoS One"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1177\/00048674211046893","article-title":"Non-response to psychotherapy for borderline personality disorder: a systematic review","volume":"56","author":"Woodbridge","year":"2022","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref52","article-title":"International Classification of Diseases, Eleventh Revision (ICD-11)","year":"2020"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1523\/ENEURO.0445-17.2018","article-title":"Amygdala adaptation and temporal dynamics of the salience network in conditioned fear: a single-trial fMRI study","volume":"5","author":"Yin","year":"2018","journal-title":"eNeuro"}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1787003\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T06:17:28Z","timestamp":1779344248000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1787003\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":50,"alternative-id":["10.3389\/fnhum.2026.1787003"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2026.1787003","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"article-number":"1787003"}}