Borderline Personality Disorder (BPD) is characterized by affective instability, 
but self-injurious behavior appears to have an emotion-regulating effect. We 
investigated whether pain-mediated affect regulation can be altered at the 
neural level by residential Dialectical Behavior Therapy (DBT), providing 
adaptive emotion regulation techniques. Likewise, we investigated whether pain 
thresholds or the appraisal of pain change after psychotherapy. We investigated 
28 patients with BPD undergoing DBT (self-referral), 15 patients with treatment 
as usual and 23 healthy control subjects at two time points 12 weeks apart. We 
conducted an fMRI experiment eliciting negative emotions with picture stimuli 
and induced heat pain to investigate the role of pain in emotion regulation. 
Additionally, we assessed heat and cold pain thresholds.At first measurement, 
patients with BPD showed amygdala deactivation in response to painful 
stimulation, as well as altered connectivity between left amygdala and dorsal 
anterior cingulate cortex. These effects were reduced after DBT, as compared 
with patients with treatment as usual. Pain thresholds did not differ between 
the patient groups. We replicated the role of pain as a means of affect 
regulation in BPD, indicated by increased amygdala coupling. For the first time, 
we could demonstrate that pain-mediated affect regulation can be changed by DBT.