Neural underpinnings of emotion dysregulation in borderline personality disorder 
(BPD) are characterized by limbic hyperactivity and disturbed prefrontal 
activity. It is unknown whether neural correlates of emotion regulation change 
after a psychotherapy which has the goal to improve emotion dysregulation in 
BPD, such as dialectical behavioral therapy (DBT). We investigated distraction 
as a main emotion regulation strategy before and after DBT in female patients 
with BPD. Thirty-one BPD patients were instructed to either passively view or 
memorize letters before being confronted with negative or neutral pictures in a 
distraction task during functional magnetic resonance imaging. This paradigm was 
applied before and after a 12-week residential DBT-based treatment program. We 
compared the DBT group to 15 BPD control patients, who continued their usual, 
non-DBT-based treatment or did not have any treatment, and 22 healthy 
participants. Behaviorally, BPD groups and healthy participants did not differ 
significantly with respect to alterations over time. On the neural level, BPD 
patients who received DBT-based treatment showed an activity decrease in the 
right inferior parietal lobe/supramarginal gyrus during distraction from 
negative rather than neutral stimuli when compared to both control groups. This 
decrease was correlated with improvement in self-reported borderline symptom 
severity. DBT responders exhibited decreased right perigenual anterior cingulate 
activity when viewing negative (rather than neutral) pictures. In conclusion, 
our findings reveal changes in neural activity associated with distraction 
during emotion processing after DBT in patients with BPD. These changes point to 
lower emotional susceptibility during distraction after BPD symptom improvement.