{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T07:18:52Z","timestamp":1788247132558,"version":"build-2803163510"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"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. Psychiatry"],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Aggressive behavior is highly prevalent in patients with borderline personality disorder (BPD) and represents a major burden for patients and their environment. Previous studies have hypothesized threat hypersensitivity, among other mechanisms, as a biobehavioral mechanism underlying aggressive behavior in patients with BPD. The effects of a 6-week mechanism-based anti-aggression psychotherapy (MAAP) for the group setting were tested in comparison to the effects of a non-specific supportive psychotherapy (NSSP) on this hypothesized mechanism and their relation to the effects on aggressive behavior.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> To assess mechanisms of reactive aggression, 38 patients with BPD (20 in MAAP and 18 in NSSP) and 24 healthy controls participated in an emotion classification task before and after therapy or at a similar interval of 7 weeks for controls, respectively. In addition, current reactive aggressive behavior was assessed by the externally directed overt aggression score of the Overt Aggression Scale Modified (OAS-M) at both time points. Mixed linear models were used to test for group differences and differential treatment effects.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Consistent with previous findings, patients showed longer response latencies and misclassified faces as angry more often than healthy controls. Comparing pre- and post-treatment measurements, the MAAP group showed an increase in response latency in classifying angry faces, whereas the NSSP group showed a decrease in latency. Furthermore, the difference between pre- and post-treatment response latencies in classifying emotional faces correlated with the reductions in reactive aggression in the MAAP group, but not in the NSSP group or healthy controls.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The results suggest an impact of MAAP on threat sensitivity as well as cognitive control, which has also been previously hypothesized as a biobehavioral mechanism underlying reactive aggression in patients with BPD. In addition, our findings shed light on the importance of these two biobehavioral mechanisms underlying reactive aggression as mechanisms of change addressed by MAAP. Further studies are needed to determine whether the behavioral change is stable over time and to what extent this change is related to a stable reduction in reactive aggression in a larger group of patients with BPD.<\/jats:p>","DOI":"10.3389\/fpsyt.2021.689267","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T07:20:25Z","timestamp":1628148025000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of a Mechanism-Based Anti-Aggression Psychotherapy on Behavioral Mechanisms of Aggression in Patients With Borderline Personality Disorder"],"prefix":"10.3389","volume":"12","author":[{"given":"Hannah","family":"Honecker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Bertsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Spie\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Krauch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Kleindienst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine C.","family":"Herpertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Neukel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"key":"B1","first-page":"936","article-title":"The borderline diagnosis I: psychopathology, comorbidity, and personaltity structure","volume-title":"Biol Psychiatry.","author":"Skodol","year":"2002"},{"key":"B2","first-page":"541","article-title":"Violent behavior in borderline personality","volume-title":"J Pers Disord.","author":"Newhill","year":"2009"},{"key":"B3","first-page":"403","article-title":"Does maladaptive coping mediate the relationship between borderline personality traits and reactive and proactive aggression?","volume-title":"Aggress Behav.","author":"Gardner","year":"2012"},{"key":"B4","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1037\/per0000098","article-title":"Aggression in borderline personality disorder: a multidimensional model","volume":"6","author":"Mancke","year":"2015","journal-title":"Pers Disord."},{"key":"B5","first-page":"1","article-title":"Understanding brain mechanisms of reactive aggression","volume-title":"Curr Psychiatry Rep.","author":"Bertsch","year":"2020"},{"key":"B6","volume-title":"Skills Training Manual for Treating Borderline Personality Disorder.","author":"Linehan","year":"1993"},{"key":"B7","first-page":"36","article-title":"Mentalization-based treatment of BPD","volume-title":"J Pers Disord.","author":"Bateman","year":"2004"},{"key":"B8","doi-asserted-by":"publisher","first-page":"CD012955","DOI":"10.1002\/14651858.CD012955.pub2","article-title":"Psychological therapies for people with borderline personality disorder","volume":"5","author":"Storeb\u00f8","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.1192\/bjo.2020.131","article-title":"A mechanism-based group-psychotherapy approach to aggressive behaviour in borderline personality disorder: findings from a cluster-randomised controlled trial","volume":"7","author":"Herpertz","year":"2021","journal-title":"BJPsych Open."},{"key":"B10","first-page":"1","article-title":"Mediators and mechanisms of change in psychotherapy research","volume-title":"Annu Rev Clin Psychol.","author":"Kazdin","year":"2007"},{"key":"B11","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1037\/per0000228","article-title":"Identification of mental states and interpersonal functioning in borderline personality disorder","volume":"9","author":"Berenson","year":"2018","journal-title":"Pers Disord."},{"key":"B12","first-page":"135","article-title":"Recognition of facial affect in borderline personality disorder","volume-title":"J Pers Disord.","author":"Domes","year":"2008"},{"key":"B13","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1503\/jpn.140215","article-title":"Time course of facial emotion processing in women with borderline personality disorder: an ERP study","volume":"41","author":"Izurieta Hidalgo","year":"2016","journal-title":"J Psychiatry Neurosci."},{"key":"B14","first-page":"1","article-title":"Emotion recognition in borderline personality disorder: effects of emotional information on negative bias","volume-title":"Borderline Personal Disord Emot Dysregulation.","author":"Fenske","year":"2015"},{"key":"B15","first-page":"76","article-title":"Behavioral and neurobiological correlates of disturbed emotion processing in borderline personality disorder","volume-title":"Psychopathology.","author":"Bertsch","year":"2018"},{"key":"B16","first-page":"1953","article-title":"Facial emotion recognition in borderline personality disorder","volume-title":"Psychol Med.","author":"Daros","year":"2013"},{"key":"B17","first-page":"1635","article-title":"Orienting to threat: faster localization of fearful facial expressions and body postures revealed by saccadic eye movements","volume-title":"Proc R Soc B.","author":"Bannerman","year":"2009"},{"key":"B18","first-page":"257","article-title":"Brain mechanisms underlying reactive aggression in borderline personality disorder\u2014sex matters","volume-title":"Biol Psychiatry.","author":"Herpertz","year":"2017"},{"key":"B19","first-page":"647","article-title":"Interpersonal threat sensitivity in borderline personality disorder: an eye-tracking study","volume-title":"J Pers Disord.","author":"Bertsch","year":"2017"},{"key":"B20","first-page":"1169","article-title":"Oxytocin and reduction of social threat hypersensitivity in women with borderline personality disorder","volume-title":"Am J Psychiatry.","author":"Bertsch","year":"2013"},{"key":"B21","first-page":"687","article-title":"Enhanced sensitivity and response bias for male anger in women with borderline personality disorder","volume-title":"Psychiatry Res.","author":"Veague","year":"2014"},{"key":"B22","first-page":"234","article-title":"Emotional sensitivity in youth with borderline personality pathology","volume-title":"Psychiatry Res.","author":"Jovev","year":"2011"},{"key":"B23","first-page":"671","article-title":"Biased attention to facial expressions of ambiguous emotions in borderline personality disorder: an eye-tracking study","volume-title":"J Pers Disord.","author":"Kaiser","year":"2019"},{"key":"B24","first-page":"1","article-title":"An eye-tracking study of interpersonal threat sensitivity and adverse childhood experiences in borderline personality disorder","volume-title":"Borderline Personal Disord Emot Dysregulation.","author":"Seitz","year":"2021"},{"key":"B25","first-page":"215","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-title":"Arch Gen Psychiatry.","author":"Loranger","year":"1994"},{"key":"B26","article-title":"Structured clinical interview for DSM-IV Axis I Disorders (SCID)","volume-title":"Biometrics Research.","author":"First","year":"1995"},{"key":"B27","first-page":"S44","article-title":"Development of neuropharmacologically based behavioral assessments of impulsive aggressive behavior","volume-title":"J Neuropsychiatry Clin Neurosci.","author":"Coccaro","year":"1991"},{"key":"B28","first-page":"233","article-title":"Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology","volume-title":"J Pers Disord.","author":"Zanarini","year":"2003"},{"key":"B29","first-page":"584","article-title":"The inhibition of socially rejecting information among people with high versus low self-esteem: the role of attentional bias and the effects of bias reduction training","volume-title":"J Soc Clin Psychol.","author":"Dandeneau","year":"2004"},{"key":"B30","volume-title":"The Karolinska Directed Emotional Faces\u2014KDEF (CD ROM).","author":"Lundqvist","year":"1998"},{"key":"B31","volume-title":"Pictures of Facial Affect.","author":"Ekman","year":"1976"},{"key":"B32","first-page":"351","article-title":"FACES\u2014A database of facial expressions in young, middle-aged, and older women and men: Development and validation","volume-title":"Behav Res Methods.","author":"Ebner","year":"2010"},{"key":"B33","unstructured":"R: A language and environment for statistical computingViennaR Foundation for Statistical Computing,2020"},{"key":"B34","first-page":"1","article-title":"lmerTest package: tests in linear mixed effects models","volume-title":"J Stat Softw.","author":"Kuznetsova","year":"2017"},{"key":"B35","first-page":"7","article-title":"Borderline personality disorder and bias in the recognition of facial expressions of emotion: a pathway to understand the psychopathology","volume-title":"Arch Clin Psychiatry.","author":"Ferreira","year":"2018"},{"key":"B36","first-page":"1","article-title":"A negative bias in decoding positive social cues characterizes emotion processing in patients with symptom-remitted borderline personality disorder","volume-title":"Borderline Personal Disord Emot Dysregul.","author":"Kleindienst","year":"2019"},{"key":"B37","first-page":"217","article-title":"Enhanced detection of emotional facial expressions in borderline personality disorder","volume-title":"Psychopathology.","author":"Schulze","year":"2013"},{"key":"B38","first-page":"1","article-title":"Emotion regulation: current status and future prospects","volume-title":"Psychol Inq.","author":"Gross","year":"2015"},{"key":"B39","first-page":"150","article-title":"Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder","volume-title":"Behav Res Ther.","author":"Soler","year":"2012"},{"key":"B40","first-page":"58","article-title":"Experimental investigation of cognitive and affective empathy in borderline personality disorder: effects of ambiguity in multimodal social information processing","volume-title":"Psychiatry Res.","author":"Niedtfeld","year":"2017"},{"key":"B41","doi-asserted-by":"publisher","first-page":"9","DOI":"10.5334\/joc.10","article-title":"Power analysis and effect size in mixed effects models: a tutorial","volume":"1","author":"Brysbaert","year":"2018","journal-title":"J Cogn."},{"key":"B42","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1037\/1528-3542.6.4.647","article-title":"Heightened sensitivity to facial expressions of emotion in borderline personality disorder","volume":"6","author":"Lynch","year":"2006","journal-title":"Emotion."},{"key":"B43","first-page":"150","article-title":"Accuracy for subtle facial emotional expressions among individuals with borderline personality disorder symptoms and diagnoses","volume-title":"Pers Disord.","author":"Herr","year":"2020"},{"key":"B44","first-page":"1","article-title":"Identifying mechanisms of change in psychotherapy: mediators of treatment outcome","volume-title":"Clin Psychol Psychother.","author":"Johansson","year":"2007"},{"key":"B45","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1521\/pedi_2018_32_379","article-title":"Dialectical behavior therapy for men with borderline personality disorder and antisocial behavior: a clinical trial","volume":"34","author":"Wetterborg","year":"2020","journal-title":"J Pers Disord."},{"key":"B46","first-page":"87","article-title":"Oxytocin specifically enhances valence-dependent parasympathetic responses","volume-title":"Psychoneuroendocrinology.","author":"Gamer","year":"2012"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2051-6673-1-12","article-title":"Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of knowledge and research agenda of the German Clinical Research Unit","volume":"1","author":"Schmahl","year":"2014","journal-title":"Borderline Personal Disord Emot Dysregulation."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.689267\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T07:21:10Z","timestamp":1628148070000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.689267\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,5]]},"references-count":47,"alternative-id":["10.3389\/fpsyt.2021.689267"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.689267","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,5]]},"article-number":"689267"}}