New research published in Psychiatry Research suggests that a nasal spray of the hormone oxytocin may help individuals with borderline personality disorder get more out of compassion-based meditation. The study provides evidence that oxytocin specifically improves a person’s ability to create and hold onto comforting mental images during these exercises. These early findings suggest a potential new way to support people who often find self-compassion practices difficult or uncomfortable.
Borderline personality disorder, commonly known as BPD, is a mental health condition characterized by intense emotional instability. People with BPD often experience severe difficulties in their relationships, deep struggles with their self-image, and sudden impulsive behaviors. These features make it exceptionally hard for individuals to regulate their emotions on a daily basis.
A major feature of this disorder involves high levels of self-criticism and shame. This tends to result in a habit of self-invalidation, where individuals constantly dismiss, minimize, or punish their own emotional experiences. This pattern of self-invalidation often stems from childhood experiences in environments where a person’s private emotions were ignored or rejected.
“Some individuals have difficulty feeling valued and exhibit a self-critical attitude, which constitutes a transdiagnostic variable that is both a source of vulnerability and a factor contributing to the persistence of mental disorders,” said study author Joaquim Soler. Soler is a clinical psychologist at the Borderline Personality Disorder Unit of the Psychiatric Department at Hospital de la Santa Creu i Sant Pau in Barcelona, Spain. He is also an associate professor in the Department of Psychiatry and Legal Medicine at the Autonomous University of Barcelona.
“One of the disorders more often experiencing high levels of shame, self-criticism, and self-invalidation are individuals with borderline personality disorder, which can make self-compassion practices difficult or even aversive,” Soler explained. Because of these intense negative self-evaluations, compassion-based therapies can be highly beneficial for this population. These therapeutic practices teach people how to direct kindness and understanding toward themselves rather than harsh judgment.
Over time, practicing self-compassion can help reduce emotional vulnerability and lower overall symptom severity. However, individuals with BPD frequently encounter intense mental roadblocks when trying to engage in self-compassion. They might feel deep discomfort, fierce resistance, or even find the experience to be emotionally painful.
Psychologists sometimes refer to this as “backdraft,” a phenomenon where attempting to offer oneself love and kindness accidentally triggers a rush of past emotional pain and severe self-criticism. To address this specific challenge, scientists looked to oxytocin, a chemical messenger naturally produced in the brain. Oxytocin is well-known for its role in social bonding, emotional regulation, and processing social information.
Prior research suggests that oxytocin can influence how people process social and emotional information in a clinical setting. “Although intranasal oxytocin has been studied as a potential modulator of social and emotional processes, its effects in borderline personality disorder remain mixed, and few studies have examined whether it can facilitate specific processes during psychotherapy,” Soler told PsyPost. “We therefore investigated whether administering oxytocin before a guided compassion-based meditation could improve the subjective quality of the practice.”
To explore this idea, the scientists set up a small clinical trial known as a pilot double-blind, randomized, placebo-controlled study. They recruited 18 individuals who had been formally diagnosed with borderline personality disorder. The diagnosis was confirmed by mental health professionals using a specific clinical interview tool called the Diagnostic Interview for Borderlines, Revised.
Soler expressed deep gratitude for the people who volunteered for the research. “I would like to acknowledge the participants who took part in this study and were willing to engage in compassion practices that can be particularly challenging for people with borderline personality disorder,” Soler said. “Their participation made it possible for us to explore this research question.”
The researchers randomly divided the participants into two equal groups of nine. One group received a nasal spray containing a standard dose of oxytocin, measuring exactly 24 international units. The other group received a placebo, which was a nasal spray containing inactive ingredients. The study was strictly double-blind, meaning neither the participants nor the therapist guiding the meditation knew who received the actual hormone or the placebo.
Participants attended five weekly sessions at the hospital clinic in Barcelona. During each session, they were given their assigned nasal spray and then waited for one hour for the substance to take effect. Following the waiting period, they participated in a 15-minute guided meditation focused on compassion.
The meditation program is part of a system called Contextual Compassion Training. The exercises started with generating feelings of loving-kindness toward a loved one or a benefactor, and eventually transitioned to directing that same kindness toward themselves. As the five weeks progressed, the guided practices included more advanced mental exercises.
These included visualizing a safe place, imagining a compassionate color, and performing a compassionate body scan. Participants also received instructions to practice these meditation exercises at home every day between their weekly appointments. To measure the effects of the intervention, the authors used a tool called the Compassion Practice Quality Scale.
This self-report survey asks participants to rate their experience during the meditation on a scale from zero to 100. Higher scores indicate that a person experienced fewer difficulties during the mental exercises. However, the scientists stressed exactly what this survey evaluates.
“The main caveat concerns what we measured,” Soler explained. “The Compassion Practice Quality Scale assesses participants’ experience while performing a compassion meditation; it does not measure borderline personality disorder symptoms, general or trait self-compassion, or treatment efficacy.”
This scale specifically measures two different aspects of the meditation experience. The first is the mental imagery dimension, which captures how well a person can create, inspect, and sustain a vivid compassionate mental picture without being distracted by self-criticism. The second aspect is the somatic dimension, which relates to physical and bodily sensations experienced during the practice, such as feelings of bodily warmth and comfort.
Participants completed this survey at the very beginning of the study and again at the end of the five-week period. The scientists then compared the final scores between the two groups using a statistical model that adjusted for the participants’ initial starting scores at baseline. At the start of the study, the two groups had similar scores across all measures.
The data showed that the group receiving oxytocin scored significantly higher on the mental imagery dimension at the end of the study compared to the placebo group. “In this small pilot study, participants who received intranasal oxytocin before the compassion meditation reported fewer difficulties with compassionate mental imagery than those who received placebo, after accounting for baseline scores,” Soler said. “This dimension reflects the ability to create, sustain, examine, and transform a vivid compassionate image during meditation, while managing interference from self-critical thoughts.”
“Rather than surprising me, what struck me most was that the clearest difference appeared specifically in the imagery dimension,” Soler noted. “As we said, this dimension reflects the ability to create and sustain a compassionate mental image despite interference from self-critical thoughts. We expected oxytocin might help participants overcome this barrier and remain connected to the meditation, so it was encouraging to observe a preliminary effect precisely in that process.”
The oxytocin group reached an average imagery score of nearly 77 out of 100, compared to an average of about 67 in the placebo group. The somatic scores and the overall total scores on the survey were roughly similar whether the participants received oxytocin or the placebo. Soler noted that the lack of change in the placebo group requires specific context.
“The absence of improvement in the placebo group should not be interpreted as evidence that compassion meditation is ineffective, because both groups received the same meditation intervention and the study was designed to examine the additional effect of oxytocin,” he explained. To analyze the strength of the oxytocin findings, the authors looked at the statistical effect size. “The adjusted difference between groups on the imagery dimension was 23.98 points on a 0 to 100 scale, with a 95% confidence interval ranging from 5.28 to 42.68 and a partial eta-squared of .57,” Soler detailed.
“Although this represents a large statistical effect within this sample, the pilot study included only 18 participants, which limits the precision and generalizability of the estimate,” Soler cautioned. “We also do not yet know whether improved compassionate imagery translates into meaningful changes in symptoms, self-compassion, self-criticism, interpersonal functioning, or treatment response. More studies would be needed to confirm this.”
The small group size prevented the scientists from analyzing how individual characteristics might change a person’s reaction to the hormone. Additionally, the vast majority of the participants were female. This imbalance means the results might not accurately reflect how oxytocin and meditation affect men with borderline personality disorder. The researchers also did not formally evaluate whether the participants had other overlapping personality disorders, which adds another layer of unknown variables.
The authors also noted that the oxytocin spray was well-tolerated by the participants. No one reported any adverse side effects from the medication during the five-week trial, and all participants completed the final assessments. The psychological effects of oxytocin are known to vary greatly from person to person. A person’s past history of trauma, their specific attachment style, and their sensitivity to social rejection can all change how they react to the hormone in a clinical setting.
Future research with much larger groups of people is underway to see if these initial findings hold up over time and across different types of patients. “We have recently completed a larger randomized, double-blind clinical trial that expands on this pilot study by including a broader range of outcome measures,” Soler revealed. “We are preparing to report the results, which indicate that oxytocin may have beneficial effects across several relevant dimensions in borderline personality disorder, including quality of life.”
“We would like to continue exploring oxytocin as an adjunct to psychotherapy, determine which therapeutic processes it may facilitate, and identify for whom these effects may be most helpful and whether they are sustained over time,” he concluded.
The study, “Promoting self-compassion meditation with intranasal oxytocin in borderline personality disorder: a pilot study,” was authored by Maria Arqueros, Joaquim Soler, David Almenta, Anna Soria-Madrid, Carlos Schmidt, and Juan C. Pascual.